Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system

AbstractThe characteristics of aortic valvular outflow jet affect aortopathy in the bicuspid aortic valve (BAV). This study aimed to elucidate the effects of BAV morphology on the aortic valvular outflow jets. Morphotype-specific valve-devising apparatuses were developed to create aortic valve models. A magnetic resonance imaging-compatible pulsatile flow circulation system was developed to quantify the outflow jet. The eccentricity and circulation values of the peak systolic jet were compared among tricuspid aortic valve (TAV), three asymmetric BAVs, and two symmetric BAVs. The results showed mean aortic flow and leakage did not differ among the five BAVs (six samples, each). Asymmetric BAVs demonstrated the eccentric outflow jets directed to the aortic wall facing the smaller leaflets. In the asymmetric BAV with the smaller leaflet facing the right-anterior, left-posterior, and left-anterior quadrants of the aorta, the outflow jets exclusively impinged on the outer curvature of the ascending aorta, proximal arch, and the supra-valvular aortic wall, respectively. Symmetric BAVs demonstrated mildly eccentric outflow jets that did not impinge on the aortic wall. The circulation values at peak systole increased in asymmetric BAVs. The bicuspid symmetry and the position of smaller leaflet were determinant factors of the characteristics of aortic valvular outflow jet.

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Abstract 14618: Bicuspid Aortic Valve Morphology and Risk Factors of Abnormal Hemodynamics: An Experimental Investigation of Velocity, Vorticity and Eccentricity of Systolic Jet Stream, Using a Magnetic Resonance Imaging Compatible Pulsatile Flow Circulation System

Circulation ◽

10.1161/circ.142.suppl_3.14618 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kaoru Hattori ◽

Natsuki Nakama ◽

Jumpei Takada ◽

Gohki Nishimura ◽

Ryo Moriwaki ◽

...

Keyword(s):

Risk Factor ◽

Aortic Valve ◽

Aortic Arch ◽

Bicuspid Aortic Valve ◽

Pulsatile Flow ◽

Aortic Wall ◽

Circulation System ◽

Arch Model ◽

Flow Vorticity ◽

Flow Circulation

Introduction: Abnormal hemodynamics with bicuspid aortic valve (BAV) is influenced by the BAV morphology. However, due to the morphological variety, the relationship between BAV morphology and hemodynamics has not been well clarified. We experimentally investigated influences of BAV morphology on hemodynamics. Methods: An MRI compatible pulsatile flow circulation system incorporating an aortic valve model and morphologically relevant aortic arch model was developed. Two types of BAV models with cusp angles of 240-120 (asymmetric BAV) and 180-180 (symmetric BAV) were prepared using bovine aorta and pericardium. The vorticity and eccentricity of jet in the aortic arch model in systolic phase were assessed using 4D-flow MRI. Streamlines at peak systole were compared among 5 BAV morphologies defined based on the symmetry and the position of leaflets (Fig). Results: Eccentric supra-valvular jets directed to the aortic wall faced to the smaller leaflet were present in the 3 asymmetric BAVs. In the ABAV-1, a markedly eccentric jet impinging on the aortic outer curvature was present. In the ABAV-2, a left-posterior directed jet shifting to the outer curvature of proximal arch was present. The asymmetric BAVs induced larger flow vorticity in the ascending aorta than the symmetric BAVs (ABAV-1 vs -2 vs -3 vs SBAV-1 vs -2, 0.018 vs 0.019 vs 0.014 vs 0.010 vs 0.011 m 2 /s). The ABAV-2 had a larger vortex in the middle arch than the ABAV-1 (ABAV-2 vs -1, 0.010 vs 0.005 m 2 /s). Conclusion: Our study indicated that the angles and orientations of the BAV impacted on the locations of jets impinging on the aortic wall and magnitudes of vorticities in systole. In the asymmetric BAVs, the direction of jet was influenced by the position of smaller leaflet. Our data suggests that the ABAV-1 morphology may be a risk factor inducing asymmetric aneurysm bulged toward the aortic outer curvature, while the ABAV-2 morphology may be a risk factor of an aortic aneurysm involving the transvers arch.

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Anomalous origin of the right coronary artery from the ascending aorta high above the left posterior sinus of Valsalva of a bicuspid aortic valve

American Heart Journal ◽

10.1016/0002-8703(85)90657-x ◽

1985 ◽

Vol 109 (4) ◽

pp. 902-904 ◽

Cited By ~ 29

Author(s):

Andres R. Palomo ◽

Bernard R. Schrager ◽

Robert A. Chahine

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Right Coronary Artery ◽

Ascending Aorta ◽

Anomalous Origin ◽

Sinus Of Valsalva ◽

Left Posterior ◽

The Right

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Ascending aorta dilation in association with bicuspid aortic valve: A maturation defect of the aortic wall

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.01.027 ◽

2014 ◽

Vol 148 (4) ◽

pp. 1583-1590 ◽

Cited By ~ 47

Author(s):

Nimrat Grewal ◽

Adriana C. Gittenberger-de Groot ◽

Robert E. Poelmann ◽

Robert J.M. Klautz ◽

Johannes H.N. Lindeman ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Wall ◽

Ascending Aorta ◽

Maturation Defect

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Rupture of Aneurysm of Valsalva Sinus and Aortopathy in Bicuspid Aortic Valve: A Case Report and Review of Literature

International Cardiovascular Forum Journal ◽

10.17987/icfj.v8i0.289 ◽

2016 ◽

Vol 8 ◽

Author(s):

Patrizia Carità ◽

Massimo Verdecchia ◽

Elisabetta Mancini ◽

Giovanni Ferro ◽

Marco Guglielmo ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Left Subclavian Artery ◽

Ascending Aorta ◽

Review Of Literature ◽

Font Size ◽

Common Site ◽

Disease Spectrum ◽

Kommerell’S Diverticulum ◽

The Right

The bicuspid aortic valve is one of the most common forms of congenital heart defect. It is a complex entity, in which involvement of the thoracic aorta forms part of the disease spectrum. The ascending aorta is the most common site involved in this process. We report the extremely rare case of a patient with true BAV associated with a diffuse aortopathy, involving the aneurysm of the non coronary sinus, that suddenly rupted into the right atrium and required urgent cardiac surgery, and the aneurismal dilation of a (non aberrant) left subclavian artery, resembling a Kommerell’s diverticulum.

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Elastic Properties of Aortic Wall in Patients With Bicuspid Aortic Valve by Magnetic Resonance Imaging

The American Journal of Cardiology ◽

10.1016/j.amjcard.2011.03.005 ◽

2011 ◽

Vol 108 (1) ◽

pp. 81-87 ◽

Cited By ~ 22

Author(s):

Giovanni Donato Aquaro ◽

Lamia Ait-Ali ◽

Maira Levorato Basso ◽

Massimo Lombardi ◽

Alessandro Pingitore ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Aortic Valve ◽

Elastic Properties ◽

Bicuspid Aortic Valve ◽

Aortic Wall ◽

Resonance Imaging

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Dilatation of the ascending aorta in bicuspid aortic valve disease: a magnetic resonance imaging study

Clinical Research in Cardiology ◽

10.1007/s00392-008-0731-0 ◽

2008 ◽

Vol 98 (2) ◽

pp. 114-120 ◽

Cited By ~ 17

Author(s):

Kurt Debl ◽

Behrus Djavidani ◽

Stefan Buchner ◽

Florian Poschenrieder ◽

Franz-Xaver Schmid ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valve Disease ◽

Imaging Study ◽

Ascending Aorta ◽

Valve Disease ◽

Magnetic Resonance Imaging Study ◽

Resonance Imaging

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Aortic stenosis exacerbates flow aberrations related to the bicuspid aortic valve fusion pattern and the aortopathy phenotype

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy308 ◽

2018 ◽

Vol 55 (3) ◽

pp. 534-542 ◽

Cited By ~ 6

Author(s):

Yan Shan ◽

Jun Li ◽

Yongshi Wang ◽

Boting Wu ◽

Alex J Barker ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Vortical Flow ◽

Aortic Dilatation ◽

Valve Dysfunction ◽

Transverse Arch ◽

The Right ◽

The Impact

Abstract OBJECTIVES A bicuspid aortic valve (BAV) is characterized by variable phenotypic manifestations, as well as longitudinal evolution of valve dysfunction and ascending aorta dilatation. The present study investigated the impact of severe aortic stenosis (AS) on the flow patterns and wall shear stress (WSS) distribution in BAV patients with right–left (RL) and right-non-coronary (RN) cusp fusion types, and the study aimed to reveal whether aortic dysfunction could further alter intrinsic aortic haemodynamic aberrations generated by abnormal BAV cusp fusion patterns. METHODS Four-dimensional flow magnetic resonance imaging was performed in 120 BAV subjects and 20 tricuspid aortic valve controls. BAV patients were evenly categorized into 4 cohorts, including RL and RN BAV with no more than mild aortic dysfunction as well as RL and RN BAV-AS with isolated severe AS. RESULTS BAV subjects exhibited eccentric outflow jets resulting in regional WSS elevation at the right-anterior position of the ascending aorta in the RL group and the right-posterior location in the RN group (P < 0.005). The presence of severe AS resulted in accelerated outflow jets and more prominent flow and WSS eccentricity (P < 0.005) by marked helical (P = 0.014) and vortical flow formation (P < 0.005), as well as increased prevalence of tubular and transverse arch dilatation. The changes to the flow jet in BAV-AS subjects blurred the differences in peak flow velocity and WSS distribution between RL and RN BAV. Differences in the phenotypes of aortopathy were associated with changes in functional haemodynamic parameters such as flow displacement and WSS eccentricity. CONCLUSIONS Severe AS markedly exacerbated aortic flow aberrations in BAV patients and masked the existing distinct flow features deriving from RL and RN fusion types. Longitudinal studies are needed to investigate the evolution of ascending aortic dilatation relative to the interaction between intrinsic cusp fusion types and acquired severe valve dysfunction.

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