Restoration of 3-dimensional aortic hemodynamics after the Ross procedure for unicuspid aortic valve disease using 4-dimensional flow magnetic resonance imaging

Figures

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  Depiction of aortic wall shear stress on heat maps of patients and healthy controls.

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  Figure 1. Systolic peak velocity (PV) measurement. Depiction of systolic PV (m/s) on heat maps throughout the thoracic aorta in an example unicuspid aortic valve patient (pre- and post-Ross) and a corresponding healthy control.

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  Figure 2. Wall shear stress (WSS) measurement. Depiction of WSS (Pa) on heat maps throughout the thoracic aorta in an example unicuspid aortic valve patient (pre- and post-Ross) and a corresponding healthy control. A region immediately distal to the distal anastomosis of the aortic graft was selected manually (shown in a trapezoidal outline) in postoperative images and mirrored in corresponding preoperative and healthy control images. ROI, Region of interest.

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  Figure 3. Viscous energy loss measurement. Depiction of viscous energy loss (μJ) on heat maps throughout the thoracic aorta in an example patient with unicuspid aortic valve (pre- and post-Ross) and a corresponding healthy control.

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  Figure 4. Systolic peak velocity (PV) comparison. Boxplot of systolic PV (m/s) in unicuspid aortic valve patients pre-Ross and post-Ross and in healthy controls. Individual patients are represented by dots along the vertical axis of their corresponding boxplot and are connected before and after their surgery. Statistically significant differences were seen when comparing pre-Ross patients to post-Ross patients (P < .0001) and to healthy controls (P < 1 × 10−10).

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  Figure 5. Wall shear stress (WSS) comparison. Boxplot of mean (left) and 98th percentile (right) WSS (Pa) in unicuspid aortic valve patients pre-Ross and post-Ross and in healthy controls. Individual patients are represented by dots along the vertical axis of their corresponding boxplot and are connected before and after their surgery. Statistically significant differences in mean WSS were observed when comparing pre-Ross (P < .01) and post-Ross (P < .05) patients to healthy controls. Similar differences were observed in 98th percentile WSS values when comparing pre-Ross (P < .01) and post-Ross (P < .01) patients with healthy controls.

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  Figure 6. Viscous energy loss comparison. Boxplot of viscous energy loss (J) in unicuspid aortic valve patients pre-Ross and post-Ross and in healthy controls. Individual patients are represented by dots along vertical axis of their corresponding boxplot and are connected before and after their surgery. Statistically significant differences were seen when comparing pre-Ross patients to post-Ross patients (P < .01) and to healthy controls (P < 1 × 10−6).

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  Figure 7. Restoration of aortic hemodynamic flow after the Ross procedure for unicuspid aortic valve disease. Four-dimensional flow magnetic resonance imaging (MRI) offers a dynamic and multidimensional approach to assessing hemodynamics, providing new insights into blood flow, shear stress, and kinetic energetics. UAV, Unicuspid aortic valve.