Confirmation and initial documentation of thoracic and abdominal aortic helical flow. An ultrasound study.

Abstract

Aortic helical flow may play an important role in plaque deposition, dissection formation, and organ perfusion. The authors have previously demonstrated, using in vitro flow models and transesophageal echocardiography, that helical flow begins in the mammalian aortic arch and continues into the descending thoracic aorta. The purpose of this study was to confirm thoracic aortic helical flow and document its extent into the abdominal aorta using direct measurements. Twelve mongrel dogs underwent surgery with exposure of the abdominal aorta up to the diaphragm. Six of the 12 underwent further thoracotomy with thoracic aorta exposure. Color Doppler ultrasound images were obtained using a 5 megaHz esophageal transducer, hand held, directly applied, and visually aligned for transverse aortic imaging. Helical flow was considered present with the appearance of red/blue hemicircles during a systolic wave when the aorta was imaged transversely. All six dogs that had thoracotomy showed clockwise thoracic aortic helical flow (along the direction of blood flow) at the retro left ventricular region. In all dogs, clockwise helical flow was demonstrated to and immediately beyond the renal arteries. In 11 of 12 dogs, clockwise helical flow was demonstrated 7 cm below the renal arteries. The study confirms the presence of helical flow in the thoracic aorta and documents its extent into the abdominal aorta below the level of the renal arteries. The teleologic flow pattern of mammals may extend to other classes of vertebrates and must be accounted for in studies of endothelial shear and flow separation. In addition, tangential velocities imparted by helical flow may affect organ perfusion.