Bicuspid Aortic Valve Is Associated With Altered Wall Shear Stress in the Ascending Aorta
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Open Access
- 1 July 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Imaging
- Vol. 5 (4), 457-466
- https://doi.org/10.1161/circimaging.112.973370
Abstract
Hemodynamics may play a role contributing to the progression of bicuspid aortic valve (BAV) aortopathy. This study measured the impact of BAV on the distribution of regional aortic wall shear stress (WSS) compared with control cohorts. Local WSS distribution was measured in the thoracic aorta of 60 subjects using 4-dimensional (4D) flow-sensitive magnetic resonance imaging. WSS analysis included 15 BAV patients: 12 with fusion of the right-left coronary cusp (6 stenotic) and 3 with fusion of the right and noncoronary cusp. The right-left BAV cohort was compared with healthy subjects (n=15), age-appropriate subjects (n=15), and age-/aorta size–controlled subjects (n=15). Compared with the age-appropriate and age-/aorta size–matched controls, WSS patterns in the right-left BAV ascending aorta were significantly elevated, independent of stenosis severity (peak WSS=0.9±0.3 N/m 2 compared with 0.4±0.3 N/m 2 in age-/aorta size–controlled subjects; P <0.001). Time-resolved (cine) 2D images of the bicuspid valves were coregistered with 4D flow data, directly linking cusp fusion pattern to a distinct ascending aortic flow jet pattern. The observation of right-anterior ascending aorta wall/jet impingement in right-left BAV patients corresponded to regions with statistically elevated WSS. Alternative jetting patterns were observed in the right and noncoronary cusp fusion patients. The results of this study demonstrate that bicuspid valves induced significantly altered ascending aorta hemodynamics compared with age- and size-matched controls with tricuspid valves. Specifically, the expression of increased and asymmetric WSS at the aorta wall was related to ascending aortic flow jet patterns, which were influenced by the BAV fusion pattern.Keywords
This publication has 38 references indexed in Scilit:
- Incidence of Aortic Complications in Patients With Bicuspid Aortic ValvesJAMA, 2011
- Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argumentEuropean Journal of Cardio-Thoracic Surgery, 2011
- Aortopathy in bicuspid aortic valve disease — genes or hemodynamics? or Scylla and Charybdis?European Journal of Cardio-Thoracic Surgery, 2011
- Aortic involvement in patients with a bicuspid aortic valveHeart, 2011
- Heart Disease and Stroke Statistics—2011 UpdateCirculation, 2011
- Bicuspid Aortic Valve DiseaseJournal of the American College of Cardiology, 2010
- Ascending Aortic Dilatation Associated With Bicuspid Aortic ValveCirculation, 2009
- Natural History of Ascending Aortic Aneurysms in the Setting of an Unreplaced Bicuspid Aortic ValveThe Annals of Thoracic Surgery, 2007
- Bicuspid aortic valve is heritableJournal of the American College of Cardiology, 2004
- Clinical and Pathophysiological Implications of a Bicuspid Aortic ValveCirculation, 2002