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Assessment of prosthetic aortic valve performance by magnetic resonance velocity imaging

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Abstract

Objectives

Magnetic resonance (MRI) velocity mapping was used to evaluate non-invasively the flow profiles of the ascending aorta in normal volunteers and in patients with an aortic (mechanical) valve prosthesis.

Background

In patients with artificial aortic valves the flow profile in the ascending aorta is severely altered. These changes have been associated with an increased risk of thrombus formation and mechanical hemolysis.

Methods

Velocity profiles were determined 30 mm distal to the aortic valve in six healthy volunteers and seven patients with aortic valve replacement (replacement within the last 2 years) using ECG triggered phase contrast MRI. Peak flow, mean flow and mean reverse flow were measured in intervals of 25 ms during the entire heart cycle. Systolic reverse flow, end-systolic closing and diastolic leakage volume were calculated for all subjects.

Results

Peak flow velocity during mid-systole was significantly higher in patients with valvular prosthesis than in normals (mean±SD, 1.9±0.4 m/s vs. 1.2±0.03 m/s,P<0.001) with a double peak and a zone of reversed flow close to the inner (left lateral) wall of the ascending aorta of the patients. Closing volume was significantly larger in patients than in controls (−3.3±1.2 ml/beat vs. −0.9±0.5 ml/beat;P<0.001). There was reverse flow during systole in valvular patients amounting to 15.7±6.7% of total cardiac output compared to 2.3±1.2% in controls (P<0.001). Diastolic mean flow was negative in patients after valve replacement but not in controls (−11.0±15.2 ml/beat vs. 6.8±3.2 ml/beat;P<0.01).

Conclusions

The following three major quantitative observations have been made in the present study: (1) Mechanical valve prostheses have an increased peak flow velocity with a systolic reverse flow at the inner (left lateral) wall of the ascending aorta. (2) A double peak flow velocity pattern can be observed in patients with bileaflet (mechanical) prosthesis. (3) The blood volume required for leaflet closure and the diastolic leakage blood volume are significantly higher for the examined bileaflet valve than for native heart valves.

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Author notes

  1. René Botnar

    Present address: Beth Israel Deaconess Medical Center, Cardiovascular Division, Cardiac MR Center, 330 Brookline Avenue, 02215, Boston, MA, USA

Authors and Affiliations

  1. Institute of Biomedical Engineering, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland

    René Botnar, Markus Beat Scheidegger & Peter Boesiger

  2. Department of Internal Medicine, Cardiology, University Hospital Zurich, Zurich, Switzerland

    Eike Nagel & Otto Hess

  3. Department of Cardiothoracic and Vascular Surgery and Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark

    Erik Morre Pedersen

Authors
  1. René Botnar
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  2. Eike Nagel
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  3. Markus Beat Scheidegger
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  4. Erik Morre Pedersen
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  5. Otto Hess
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  6. Peter Boesiger
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Correspondence to René Botnar.

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Botnar, R., Nagel, E., Scheidegger, M.B. et al. Assessment of prosthetic aortic valve performance by magnetic resonance velocity imaging. MAGMA 10, 18–26 (2000). https://doi.org/10.1007/BF02613108

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  • DOI: https://doi.org/10.1007/BF02613108

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