Abstract
Bicuspid aortic valve (BAV) disease presents a unique management challenge both pre- and post-operatively. 4D flow MRI offers multiple tools for the assessment of the thoracic aorta in aortic valve disease. In particular, its assessment of flow patterns and wall shear stress have led to new understandings around the mechanisms of aneurysm development in BAV disease. Novel parameters have now been developed that have the potential to predict pathological aortic dilatation and may help to risk stratify BAV patients in future. This systematic review analyses the current 4D flow MRI literature after aortic valve and/or ascending aortic replacement in bicuspid aortic valve disease. 4D flow MRI has also identified distinct challenges posed by this cohort at the time of valve replacement compared to standard management of tri-leaflet disorders, and may help tailor the type and timing of replacement. Eccentric pathological flow patterns seen after bioprosthetic valve implantation, but not with mechanical prostheses, might be an important future consideration in intervention planning. 4D flow MRI also has promising potential in supporting the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.
Highlights
Bicuspid aortic valve (BAV) is the commonest congenital cardiac condition, affecting ∼0.5–1% of the general population [1]
Studies which examined the use of 4D flow magnetic resonance imaging (MRI) for assessment of hemodynamic changes after Aortic Valve Replacement in Bicuspid Aortic Valve disease were included
The remaining 14 studies were included for review of methodology and key results, with particular focus on Bicuspid Aortic Valve disease
Summary
Bicuspid aortic valve (BAV) is the commonest congenital cardiac condition, affecting ∼0.5–1% of the general population [1]. More than 20% of asymptomatic individuals will require surgical intervention in their young adult life [2] and at least 50% patients with BAV will undergo aortic valve replacement at some point in their lifetime [3]. Aortopathy, another common comorbidity, occurs in association with BAV in 40–50% of adults [2]. Cardiovascular magnetic resonance imaging (MRI) is the preferred choice to cardiovascular computed tomography as repeated surveillance does not accumulate radiation exposure [5, 6]
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