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Updated: Oct 20, 2025
In vitro Assessment of Aortic Regurgitation Using Four-Dimensional Flow Magnetic Resonance Imaging
Published on: February 25, 2022
4D flow MRI of type B dissection with later retrograde progression to type A dissection in Marfan: a case report
Max J P van Hout1, Joe F Juffermans2, Arthur J Scholte1
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Background:
Due to the malfunction of connective tissue, Marfan patients are at increased risk of aortic dissection. Uncomplicated acute type B dissection is usually managed with medical therapy. Retrograde progression or new type A dissection is a relatively rare but often fatal complication that occur most frequently in the first 6 months after acute type B dissection.
Case Summary:
We present a 31-year-old male with Marfan syndrome and a recent uncomplicated type B dissection from the left subclavian to the right common iliac artery who underwent 4D flow magnetic resonance imaging (MRI). The dissection had a large proximal intimal tear just distal to the left subclavian artery (15 mm) and large false lumen (35 mm). Aortic blood flow just distal to the left subclavian artery (3.6 L/min) was split disproportionately into the true (0.8 L/min, 22%) and false lumen (2.8 L/min, 78%). 4D flow streamlines revealed vortical flow in the proximal false lumen. Increased wall shear stress was observed at the sinotubular junction (STJ), inner wall of the ascending aorta and around the subclavian artery. Two weeks after MRI, the patient presented with jaw pain. Computed tomography showed a type A dissection with an entry tear at the STJ for which an acute valve-sparing root, ascending and arch replacement was performed.
Discussion:
Better risk assessment of life-threatening complications in uncomplicated type B dissections could improve treatment strategies in these patients. Our case demonstrates that besides clinical and morphological parameters, flow derived parameters could aid in improved risk assessment for retrograde progression from uncomplicated type B dissection to acute type A dissection.
Insights
Patients with Marfan syndrome and type B aortic dissection face risks of type A dissection. Advanced 4D flow MRI can help assess these risks by analyzing blood flow dynamics.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Aortic Diseases
Background:
- Marfan syndrome predisposes individuals to aortic dissection due to connective tissue abnormalities.
- Uncomplicated acute type B aortic dissection typically requires medical management.
- Retrograde progression to type A dissection is a rare but critical complication within six months of type B dissection.
Observation:
- A 31-year-old male with Marfan syndrome and type B dissection underwent 4D flow MRI.
- The dissection involved a large intimal tear and false lumen, with 78% of blood flow in the false lumen.
- Vortical flow and increased wall shear stress were noted in specific aortic regions.
Findings:
- 4D flow MRI revealed abnormal flow patterns and elevated wall shear stress in a patient with Marfan syndrome and type B aortic dissection.
- These hemodynamic parameters may indicate an increased risk for retrograde progression.
- The patient subsequently developed a type A dissection, necessitating surgical intervention.
Implications:
- Integrating hemodynamic data from 4D flow MRI could enhance risk stratification for type B aortic dissection patients.
- Improved risk assessment may lead to more personalized and effective treatment strategies.
- This case highlights the potential of advanced imaging in predicting life-threatening aortic complications.
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