Introduction:
In patients with aortic insufficiency (AI), preserving the native aortic valve (AV) through valve repair has been shown to reduce valve-related complications and improve survival compared to surgical AV replacement1. Valve-sparing aortic root replacement (VSARR) also carries similar to improved morbidity and mortality compared to valve-replacing root replacement; therefore, improving valve repair techniques is of significant interest2. AV repair typically includes annuloplasty to reduce annular diameter and prevent later annular dilatation and reintervention3. The hemispherical aortic annuloplasty reconstructive technology (HAART) is an internal geometric annuloplasty ring designed to restore a natural elliptical shape to the aortic annulus, unlike other annuloplasty methods (Biostable Science and Engineering, Inc.). Noninvasive 4-dimensional (4D) flow magnetic resonance imaging (MRI) is a useful diagnostic tool to characterize the complex hemodynamics present in AV disease4. We present the first 4D MR hemodynamic analysis of aortic flow before and after placement of the HAART internal annuloplasty ring.