Results:
Patient 1 demonstrated restoration of cohesive flow and resolution of the large systolic vortex previously present in the aneurysmal portion of her AAo (Figure 1). Patient 2 also showed a cohesive flow pattern in the AAo with some complex flow in the arch. Compared to the control, there was qualitatively less helical flow in patients with HAART ring. Flow at the level of the HAART ring was uniform in both patients. In patient 1, peak velocities were increased in the aortic root and all levels of the arch, but slightly decreased in the proximal and mid AAo following surgery (Figure 2). The highest velocities occurred just distal to the HAART ring in patient 1 (1.59 m/s) and in patient 2 (2.82 m/s). Peak velocities in the control patient increased along her entire aorta post-operatively except for at the proximal AAo, where it decreased from 1.53 to 1.24 m/s. The peak velocity gradient across the HAART ring, captured at planes just above in the root and below in the LVOT, was negligible in patient 1 (-0.02 m/s), while in patient 2 there was a 0.34 m/s increase in velocity. In the control patient there was a 0.3 m/s increase.
Compared to levels before surgery, there was marginally lower WSS in the AAo and arch in patient 1 after HAART as determined by the mean value of aortic surface with the highest 5% of WSS levels (0.902 and 0.894 Pa), but higher overall mean WSS in the AAo and arch (0.298 and 0.403 Pa). The matched control had a marked increase in WSS after surgery and greater post-surgery levels of WSS overall than patient 1 (0.629 and 1.163 Pa). Post-surgery WSS in patient 2 was elevated in comparison to both patient 1 and the control (1.995 Pa), with peak WSS occurring in the native aortic root (Figure 3).
Patient 1 demonstrated higher levels of VEL in the AAo and arch after surgery (23.3 and 3.3 W/m3 vs 56.6 and 13.1 W/m3); however, the post-surgery energy loss in patient 1 was both lower overall and increased to a lesser extent than in the control after surgery (23.4 and 5.0 W/m3 vs 73.2 and 30.2 W/m3). Patient 2 showed modestly greater energy loss in the AAo but less in the arch compared to the control (109.0 and 25.3 W/m3). All patients presented in this report had no aorta related complications and trace to no AI or AS on echocardiogram following surgery.