Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy.
Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy.
复制标题
双刺主动脉尖融合形态改变主动脉三维流出模式，壁剪应力和主动脉病的表达。
DOI：
10.1161/circulationaha.113.003026
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发表时间：
2014-02-11
期刊：
影响因子：
37.8
通讯作者：
Markl M
中科院分区：
文献类型：
--
作者：
Mahadevia R;Barker AJ;Schnell S;Entezari P;Kansal P;Fedak PW;Malaisrie SC;McCarthy P;Collins J;Carr J;Markl M
分析主动脉3D血流，以研究二叶式主动脉瓣（BAV）患者升主动脉（AAo）血流动力学改变及其与瓣尖融合模式（右-左，RL vs右-非冠状，RN）差异和血管病表达的相关性。4D flow MRI测量了75例受试者主动脉中的体内3D血流：根据瓣叶融合模式分层的主动脉扩张的BAV患者（n=15 RL-BAV，中AAO直径=39.9± 4.4 mm; n=15 RN-BAV，39.6± 7.2 mm）;带三尖瓣主动脉瓣的主动脉尺寸对照（n=30，41.1± 4.4 mm）;健康志愿者（n=15，24.9± 3.0 mm）。测定所有受试者的主动脉病变类型（0-3）、收缩期血流角、血流位移和局部壁切应力（WSS）。与主动脉尺寸对照组相比，BAV患者的偏心流出射流模式导致RL-BAV右前壁和RN-BAV右后壁的局部WSS升高（p<0.0125）。在大多数RN-BAV患者（87%）中发现了仅主动脉根扩张（1型）或累及整个AAO和弓（3型），但在RL-BAV患者中大多不存在（87% 2型）。RL-BAV和RN-BAV之间的动脉病变类型差异与1型近端和中部AAO（与2型相比减少42-81%）和3型远端AAO（与2型相比增加33-39%）的血流位移改变相关。BAV融合的存在和类型与局部WSS分布、收缩期血流偏心率和BAV异位表达的变化相关。血液动力学标志物提示瓣膜形态表型可影响BAV瓣膜病表型的生理机制。
Aortic 3D blood flow was analyzed to investigate altered ascending aorta (AAo) hemodynamics in bicuspid aortic valve (BAV) patients and its association with differences in cusp fusion patterns (right-left, RL versus right-noncoronary, RN) and expression of aortopathy. 4D flow MRI measured in vivo 3D blood flow in the aorta of 75 subjects: BAV patients with aortic dilatation stratified by leaflet fusion pattern (n=15 RL-BAV, mid AAo diameter=39.9±4.4mm; n=15 RN-BAV, 39.6±7.2mm); aorta size controls with tricuspid aortic valves (n=30, 41.1±4.4mm); healthy volunteers (n=15, 24.9±3.0mm). Aortopathy type (0-3), systolic flow angle, flow displacement, and regional wall shear stress (WSS) were determined for all subjects. Eccentric outflow jet patterns in BAV patients resulted in elevated regional WSS (p<0.0125) at the right-anterior walls for RL-BAV and right-posterior walls for RN-BAV compared to aorta size controls. Dilatation of the aortic root only (type 1) or involving the entire AAo and arch (type 3) was found in the majority of RN-BAV patients (87%) but was mostly absent for RL-BAV (87% type 2). Differences in aortopathy type between RL-BAV and RN-BAV were associated with altered flow displacement in the proximal and mid AAo for type 1 (42-81% decrease versus type 2) and distal AAo for type 3 (33-39% increase versus type 2). The presence and type of BAV fusion was associated with changes in regional WSS distribution, systolic flow eccentricity, and expression of BAV aortopathy. Hemodynamic markers suggest a physiologic mechanism by which valve morphology phenotype can influence phenotypes of BAV aortopathy.