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Corresponding authors. P Martijn den Reijer: p.m.reijer@hotmail.com; Denver Sallee, III: SalleeD@kidsheart.com; Petra van der Velden: p.j.van.der.velden.2@umail.leidenuniv.nl; Eline R Zaaijer: e.r.zaaijer@umail.leidenuniv.nl; W James Parks: parksj@kidsheart.com; Senthil Ramamurthy: sramam@cellbio.emory.edu; Trevor Q Robbie: trobbie@emory.edu; Giorgina Donati: giorgina8@hotmail.com; Carey Lamphier: Carey.Lamphier@choa.org; Rudolf P Beekman: rpbeekman@gmail.com; Marijn E Brummer: mbrumme@emory.edu

PMdR performed much of the final data analysis, the MMP analyses, and drafted the manuscript; DSIII performed/supervised and read most CMR scans, was responsible for clinical direction and project design, and participated in scan and analysis protocol design, and contributed in manuscript writing and review; PvdV participated in design of image analysis protocols, performed early image and statistical analysis work; ERZ participated in scan protocol and project design, and early image analysis efforts; WJP performed/supervised/read CMR scans, and participated in scan protocol design; SR performed all off-line image reconstructions, image transfer and management, and 4-D flow acquisition; TQR contributed software/methods development for flow visualization and analysis and HIPAA compliance; GD performed all final image analysis work; CL was responsible for patient recruitment and IRB matters; RPB contributed as research advisor for PMdR, PvdV, and ERZ; MEB served as project director, finalized manuscript preparation, designed scan and image analysis software and methods, and performed the final statistical analyses.

The authors thank Ms. Jeryl Huckaby and Ms. Christine Spainhour for initial research coordination efforts, and Drs Ronald Joyner and Robert Campbell for their leadership and continued support of this project.

We also thank Mr. Floyd Knight and the CMR staff at Egleston Hospital for committing late and weekend hours, Ms. Diana Worthington-White for help with blood work, Dr. Sopio Chochua for initial assistance with statistics, and Mr. Barry Imhoff for help with the ELISA tests. Finally, we wish to thank both reviewers of the manuscript for their input and suggestions which helped improve the manuscript.

The authors declare that they have no competing interests.

Subjects:

Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance

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Journal Title:

Journal of Cardiovascular Magnetic Resonance

Volume:

Volume 12, Number 4

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Type of Work:

Article | Final Publisher PDF

Abstract:

Background Congenital Bicuspid Aortic Valve (BAV) is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available. Methods This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease. Results The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees) than controls (10.01 ± 1.29) (p = 0.01). Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048), AAO: r = 0.536 (N = 18, p = 0.022), and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033), STJ: r = 0.562 (N = 28, p = 0.002), and AAO r = 0.645 (N = 28, p < 0.001). Dilatation and the flow jet angle were also found to correlate with plasma levels of matrix metallo-proteinase 2. Conclusions The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.

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© 2010 den Reijer et al; licensee BioMed Central Ltd.

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