Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 153, Issue 1, Pages 8-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2016.09.040
Keywords
bicuspid aortic valve; aorta; wall shear stress; MRI
Funding
- European Research Council under European Union's Seventh Framework Programme FP/European Research Council [307532]
- British Heart Foundation New Horizons program [NH/11/5/29058]
- Royal College of Surgeons of England Research Fellowship
- United Kingdom Department of Health via National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award
- King's College London
- King's College Hospital NHS Foundation Trust
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Objectives: The complexity of aortic disease is not fully exposed by aortic dimensions alone, andmorbidity or mortality can occur before intervention thresholds aremet. Patient-specific computational fluid dynamics (CFD) were used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress (WSS), and oscillatory shear index (OSI) in the thoracic aorta. Methods: A total of 45 subjects were divided into 5 groups: volunteers, aortic regurgitation-tricuspid aortic valve (AR-TAV), aortic stenosis-tricuspid aortic valve (AS-TAV), aortic stenosis-bicuspid aortic valve right-left cusp fusion (BAV[RL]), and aortic stenosis-right-non cusp fusion (AS-BAV[RN]). Subjects underwent magnetic resonance angiography, with phase-contrast magnetic resonance imaging at the sino-tubular junction to define patient-specific inflow velocity profiles. Hemodynamic recordings were used alongside magnetic resonance imaging angiographic data to run patient-specific CFD. Results: The BAV groups had larger mid-ascending aorta diameters (P < .05). Ascending aorta flow was more eccentric in BAV (flow asymmetry = 78.9% +/- 6.5% for AS-BAV(RN), compared with 4.7% +/- 2.1% for volunteers, P < .05). Helicity was greater in AS-BAV(RL) (P < .05). Mean WSS was elevated in AS groups, greatest in AS-BAV(RN) (37.1 +/- 4.0 dyn/cm(2), compared with 9.8 +/- 5.4 for volunteers, P < .05). The greater curvature of the ascending aorta experienced highest WSS and lowest OSI in AS patients, most significant in AS-BAV(RN) (P < .05). Conclusions: BAV displays eccentric flow with high helicity. The presence of AS, particularly in BAV-RN, led to greater WSS and lower OSI in the greater curvature of the ascending aorta. Patient-specific CFD provides noninvasive functional assessment of the thoracic aorta, and may enable development of a personalized approach to diagnosis and management of aortic disease beyond traditional guidelines.
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