Key result
Maximal flow-induced stress on the proximal aortic wall was associated with higher histological change scores compared to the opposite wall.
Why the study?
Does eccentric transvalvular flow jet increase histological aortic wall changes in patients with bicuspid aortic valve stenosis?
Observational (n=48)
Does eccentric transvalvular flow jet increase histological aortic wall changes in patients with bicuspid aortic valve stenosis?
Answers are grounded in this paper and cite their sources.
In patients with bicuspid aortic valve stenosis, eccentric transvalvular flow jets identified by MRI correlate strongly with asymmetric histological changes in the proximal aortic wall.
OBJECTIVES: The purpose of this study was to analyse the correlation between preoperative systolic transvalvular flow patterns and proximal aortic wall lesions in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis. METHODS: A total of 48 consecutive patients with BAV stenosis (mean age 58 ± 9 years, 65% male) underwent aortic valve replacement (AVR) ± proximal aortic surgery from January 2012 through February 2013. Preoperative cardiac phase-contrast cine magnetic resonance imaging (MRI) assessment was performed in all patients in order to detect the area of maximal flow-induced stress in the proximal aorta. Based on these MRI data, two aortic wall samples (i.e. area of the maximal stress (jet sample) and the opposite aortic wall (control sample)) were collected during AVR surgery. Aortic wall changes were graded based on a summation of seven histological criteria (each scored from 0 to 3). Histological sum score (0-21) was separately calculated and compared between the two aortic samples (i.e. jet sample vs control sample). RESULTS: An eccentric transvalvular flow jet hitting the proximal aortic wall could be identified in all 48 (100%) patients. The mean histological sum score was significantly higher in the jet sample vs control sample areas of the aorta (i.e. 4.1 ± 1.8 vs 2.2 ± 1.5, respectively) (P = 0.02). None of the patients had a higher sum score value in the control sample. CONCLUSIONS: Our study demonstrates a strong correlation between the systolic pattern of the transvalvular flow jet and asymmetric proximal aortic wall changes in patients undergoing AVR for BAV stenosis.
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Girdauskas et al. (2014) conducted an observational in Bicuspid aortic valve (BAV) stenosis (n=48). Maximal flow-induced stress (jet sample) vs. Opposite aortic wall (control sample) was evaluated on Histological sum score (0-21) of aortic wall changes (p=0.02). Maximal flow-induced stress on the proximal aortic wall was associated with higher histological change scores compared to the opposite wall.
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