Blood Speckle Imaging as an emerging approach for perioperative evaluation in aortic valve-remodeling procedures

P0070 

Abstract Submission 

Justin Tretter (1), Elias Sundstrom (2), Lama Dakik (1), Debkalpa Goswami (1), Hani Najm (1)

(1) Cleveland Clinic, Cleveland, OH, (2) KTH Royal Institute of Technology, Stockholm, NA

Justin Tretter    -  Contact Me
Cleveland Clinic

Elias Sundstrom    -  Contact Me
KTH Royal Institute of Technology

Lama Dakik    -  Contact Me
Cleveland Clinic

Debkalpa Goswami    -  Contact Me
Cleveland Clinic

*Hani Najm    -  Contact Me
Cleveland Clinic

Justin Tretter    -  Contact Me
Cleveland Clinic

Objective: We aimed to explore the utility of blood speckle imaging in assessing changes in systolic antegrade flow characteristics in a patient undergoing aortic valve-remodeling procedure.
Methods: A 20-year old patient with history of partial atrioventricular septal defect and subaortic membrane stenosis status post atrioventricular septal defect repair and subaortic membrane resection in infancy presented with progression to severe aortic root and ascending aortic dilation with moderate aortic valve regurgitation. The aortic valve was trileaflet, however, with subcommissural nodular fusion of both commissures related to the left coronary leaflet and mild leaflet thickening causing leaflet restriction. This restriction in combination with annular and sinutubular junction dilation resulted in moderate regurgitation related to the free edge of the left coronary leaflet. The patient underwent a valve-remodeling aortic root and ascending aortic replacement with 28-mm Dacron graft, including resection of subcommissural nodular fusion and leaflet thinning. Pre- and post-operative transesophageal echocardiography, including blood speckle imaging, was obtained. Hemodynamic parameters, time-averaged wall shear stress, and oscillatory shear index were derived from blood speckle imaging and compared between pre- and post-operative conditions.
Results: Pre-operative blood speckle imaging evaluation depicted an uneven jet pattern during systole across the aortic valve directed anteriorly toward the right coronary sinus wall. Postoperative blood speckle imaging evaluation demonstrated aligned laminar blood flow during systole in the left ventricular outflow tract and through the aortic valve (Figure 1). In addition, there was reduced oscillatory shear index, indicating diminished endothelial alterations in the aortic wall structure. Color Doppler evaluation demonstrated improvement from moderate to trivial regurgitation.
Conclusions: This case study highlights the additive value of blood speckle imaging in illuminating detailed flow characteristics in those undergoing aortic valve-remodeling procedures. Blood speckle imaging provides additional insights into the spatiotemporally varying flow in the left ventricular outflow tract and aorta. This may offer valuable insight into the short and long-term durability of repair beyond traditional echocardiographic parameters. Larger studies are necessary to validate these findings and determine their insight into predicting long-term durable repair.

Aortic Root