Hemodynamic Assessment of Severe Aortic Stenosis

Weininger, Markus; Sagmeister, Florian; Herrmann, Sebastian; Lange, Volkmar; Schoepf, U. Joseph; Beissert, Matthias; Voelker, Wolfram; Koestler, Herbert; Hahn, Dietbert; Weidemann, Frank; Beer, Meinrad

doi:10.1097/rli.0b013e3181f79ca2

Cited by 10 publications

(6 citation statements)

References 38 publications

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“…5a) indicates that all the fundamental phases and features that typically mark aortic valve/jet dynamics (opening, maximum opening and concurrent fluttering, closing) are effectively reproduced. Indeed, EOA (t) exhibits a behaviour remarkably similar to what obtained in in-vivo, in-vitro and (sophisticated) in-silico investigations for either the geometrical, the projected, and the effective orifice area [25,38,40,47,48]. Notice that although these areas pertain to different cross sections along the downstream jet and their values may hence noticeably differ for the same valve [41,49], they all show similar evolution in time, that can be compared.…”

Section: Discussionsupporting

confidence: 74%

“…Notice that V, p and H are all time-dependent. The total head at any time varies with the distance along the flow direction, x according to the following equation [37] (2)…”

Section: Analytical Model Of δP Netmentioning

confidence: 99%

“…It then expands and reattaches to the wall at some distance downstream in the aortic tube (location 2). Turbulent recirculation with a complicated eddying behaviour occurs adjacent to the jet in the expansion region and produces energy losses [37], implying a pressure drop between location 1 and location 2.…”

Section: Introductionmentioning

confidence: 99%

“…1b). In particular, EOA dynamics typically exhibits opening, fairly constant, and closing phases with rate of change that is basically driven by stenosis level [29,38]. In addition, a wavy behaviour can be usually recognized in proximity of the maximum area, EOA max due to leaflets fluttering [39,40].…”

Section: Introductionmentioning

confidence: 99%

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Complete Unsteady One-Dimensional Model of the Net Aortic Pressure Drop

Susin¹

2019

TOBEJ

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Background: A large amount of engineering and medical research has been devoted to the assessment of aortic valve stenosis severity in the past decades. The net transvalvular pressure drop has been recognized as one of the parameters that better reflect stenosis effects on left ventricle overload, and its adoption in clinical assessment of stenosis has been proposed. Flow unsteadiness has been shown to have a non-negligible impact on the net drop; however, a simple formulation for net drop calculation that includes not only flow pulsatility but also the effects of valve dynamics is still lacking. Objective: The present contribution is hence aimed at developing a complete unsteady one-dimensional model of the net aortic transvalvular pressure drop that just requires non-invasive data to be implemented. Methods: Transvalvular flow is described as a jet of incompressible viscous fluid through a circular orifice placed in a concentric rigid circular tube. The classical one-dimensional mass and total head conservation equations are applied. The effective orifice area and transvalvular flow rate are assumed to vary with time throughout the ejection period. Results: The model is found to capture pressure drop oscillations occurring when the valve opens/closes and/or leaflets flutter, thanks to the inclusion of valve dynamics effects. The model is also proposed as a numerical tool for the calculation of the instantaneous effective orifice area once net pressure drop and flow rate are known. Conclusion: The model may contribute to the improvement of non-invasive aortic stenosis assessment.

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Section: Discussionsupporting

confidence: 74%

“…Notice that V, p and H are all time-dependent. The total head at any time varies with the distance along the flow direction, x according to the following equation [37] (2)…”

Section: Analytical Model Of δP Netmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complete Unsteady One-Dimensional Model of the Net Aortic Pressure Drop

Susin¹

2019

TOBEJ

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“…CMR emerged as an alternative and non-invasive method which avoids many of the pitfalls of other imaging techniques: sedation/anesthesia for TEE and contrast exposure of CT [43]. Moreover, CMR can offer a detailed identification and quantification of myocardial fibrosis, which has been implicated in prognosis post-SAVR or TAVI [44,45] and often predates a reduction in LVEF [46,47]. Late gadolinium enhancement (LGE) correlates with the degree of interstitial fibrosis on an endomyocardial biopsy [48].…”

Section: Cardiovascular Magnetic Resonancementioning

confidence: 99%

Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

Santangelo

Rossi

Toriello

et al. 2021

JCM

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Aortic stenosis is the most common heart valve disease necessitating surgical or percutaneous intervention. Imaging has a central role for the initial diagnostic work-up, the follow-up and the selection of the optimal timing and type of intervention. Referral for aortic valve replacement is currently driven by the severity and by the presence of aortic stenosis-related symptoms or signs of left ventricular systolic dysfunction. This review aims to provide an update of the imaging techniques and seeks to highlight a practical approach to help clinical decision making.

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Magnetic resonance imaging in valvular heart disease: Clinical application and current role for patient management

Sommer

Bremerich

Lund

2012

Magnetic Resonance Imaging

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Noninvasive imaging provides important information on cardiac anatomy and function and is a key element in clinical management of valvular heart disease (VHD). Beside echocardiography, which is still considered the first‐line modality for assessment of valvular anatomy and longitudinal evaluation of VHD, cardiovascular magnetic resonance (CMR) has evolved during the last two decades as an essential tool for evaluation of cardiac diseases. Today, CMR not only represents the reference standard for measuring cardiac volumes, function, and mass, but also enables accurate assessment of morphology and function of cardiac valves. It can play an important role in clinical decision‐making for patients with VHD. This review addresses current applications and limitations of CMR imaging techniques that are used in VHD including cine‐balanced steady‐state free precession (b‐SSFP), phase contrast MR (pcMR), gradient‐recalled echo (GRE), and turbo‐spin echo (TSE) sequences. Moreover, it describes their application for evaluation of valvular pathologies and gives an overview on the current role of valvular CMR in patient management. J. Magn. Reson. Imaging 2012;35:1241–1252. © 2012 Wiley Periodicals, Inc.

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Hemodynamic Assessment of Severe Aortic Stenosis

Abstract: MRI can measure systolic variations of the aortic valve area. Quantitative parameters of the hemodynamic relevance of valve dynamics obtained by this method correlate with established parameters of aortic stenosis severity and LVMR.

Cited by 10 publications

References 38 publications

Complete Unsteady One-Dimensional Model of the Net Aortic Pressure Drop

Complete Unsteady One-Dimensional Model of the Net Aortic Pressure Drop

Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

Magnetic resonance imaging in valvular heart disease: Clinical application and current role for patient management

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