Restricted cusp motion in right-left type of bicuspid aortic valves: A new risk marker for aortopathy Alessandro Della Corte, MD, PhD, Ciro Bancone,

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Date of download: 6/29/2016 Copyright © The American College of Cardiology. All rights reserved. From: Multimodality Imaging in Transcatheter Aortic Valve.

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Presentation transcript:

Restricted cusp motion in right-left type of bicuspid aortic valves: A new risk marker for aortopathy Alessandro Della Corte, MD, PhD, Ciro Bancone, MD, Carlo A. Conti, PhD, Emiliano Votta, PhD, Alberto Redaelli, PhD, Luca Del Viscovo, MD, Maurizio Cotrufo, MD The Journal of Thoracic and Cardiovascular Surgery Volume 144, Issue 2, Pages 360-369.e1 (August 2012) DOI: 10.1016/j.jtcvs.2011.10.014 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 MRI measurements. A, Cross-sectional diastolic view of the TAV and BAV root (top) with prescription of 3 long-axis views (bottom), each passing through 1 commissure (or raphe) and the midpoint of the opposite sinus wall, for which the view is named. B, Diagram of sinus width measurement (ICD). C, Diagram of diameter and height measurements. h, Height; D, diameter; ICD, Intercommissural distance; BAV, bicuspid aortic valve; TAV, tricuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 360-369.e1DOI: (10.1016/j.jtcvs.2011.10.014) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Examples of COA measurement in the “left coronary” view (A, D). The transversal plane passing through the proximal end of the root depicted the aortoventricular junction, or “annular plane” (whereas the orthogonal line represents the outflow axis; B, E). The angle between the cusp (dotted line passing in the body of the leaflet section) and the annular plane was measured (C, F). Ao-V, Aortoventricular; LVOT, left ventricular outflow tract; COA, cusp opening angle; BAV, bicuspid aortic valve; TAV, tricuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 360-369.e1DOI: (10.1016/j.jtcvs.2011.10.014) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Compared with TAV, the nonstenotic BAV showed a misshaped orifice in systole, although planimetric orifice areas and peak velocities were not significantly different (A, B). Long-axis “noncoronary” views (peak systolic frames from true-FISP cine-sequences) showed a skewed jet stream, directed toward the right-lateral wall of the ascending tract (C and D, left). BAV, Bicuspid aortic valve; TAV, tricuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 360-369.e1DOI: (10.1016/j.jtcvs.2011.10.014) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Phase-contrast MRI sequences with in-plane velocity encoding. The noncoronary scan-plane profiled the jet direction toward the right anterolateral wall. The dark area (white arrowhead) indicates systolic retrograde flow. B, Peak systolic flow velocity comparison between BAV and TAV computational models showing markedly less homogeneous velocities in the BAV aorta. C, Streamlines evidencing a vertical vortex above the conjoint cusp (black arrowhead). D, Computed flow velocity patterns in cross-sections of the models were qualitatively consistent with phase-contrast images (through-plane velocity encoding) from the same levels (STJ and ascending tract). BAV, Bicuspid aortic valve; TAV, tricuspid aortic valve; STJ, sinotubular junction; Asc Ao, ascending aorta. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 360-369.e1DOI: (10.1016/j.jtcvs.2011.10.014) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Scatter-plots showing COAleft correlation with ascending aorta diameter indexed to body surface area (A) and with growth rate of the BAV aorta at the tubular tract level (B). BAV, Bicuspid aortic valve; BSA, body surface area; TAV, tricuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 360-369.e1DOI: (10.1016/j.jtcvs.2011.10.014) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Ascending diameter measurements for WS calculation (noncoronary view) in systole (A) and diastole (B). Comparability of h2 values ensured consistency of measurement levels among the 3 views and between BAV and TAV groups (all P = NS). AoDs, Systolic diameter; AoDd, diastolic diameter; h2, distance from the annular plane. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 360-369.e1DOI: (10.1016/j.jtcvs.2011.10.014) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions