Skip to main content
SpringerLink
Log in

3D Characterization of the Aortic Valve and Aortic Arch in Bicuspid Aortic Valve Patients

  • Original Article
  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

Patients with bicuspid aortic valve (BAV) commonly have associated aortic stenosis and aortopathy. The geometry of the aortic arch and BAV is not well defined quantitatively, which makes clinical classifications subjective or reliant on limited 2D measurements. The goal of this study was to characterize the 3D geometry of the aortic arch and BAV using objective and quantitative techniques. Pre-TAVR computed tomography angiogram (CTA) in patients with BAV and aortic stenosis (AS) were analyzed (n = 59) by assessing valve commissural angle, presence of a fused region, percent of fusion, and calcium volume. The ascending aorta and aortic arch were reconstructed from patient-specific imaging segmentation to generate a centerline and calculate maximum curvature and maximum area change for the ascending aorta and the descending aorta. Aortic valve commissural angle signified a bimodal distribution suggesting tricuspid-like (≤ 150°, 52.5% of patients) and bicuspid-like (> 150°, 47.5%) morphologies. Tricuspid like was further classified by partial (10.2%) or full (42.4%) fusion, and bicuspid like was further classified into valves with fused region (27.1%) or no fused region (20.3%). Qualitatively, the aortic arch was found to have complex patient-specific variations in its 3D shape with some showing extreme diameter changes and kinks. Quantitatively, subgroups were established using maximum curvature threshold of 0.04 and maximum area change of 30% independently for the ascending and descending aorta. These findings provide insight into the geometric structure of the aortic valve and aortic arch in patients presenting with BAV and AS where 3D characterization allows for quantitative classification of these complex anatomic structures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

Abbreviations

AS:

Aortic stenosis

AV:

Aortic valve

BAV:

Bicuspid aortic valve

CTA:

Computed tomography angiogram

MRI:

Magnetic resonance imaging

STJ:

Sinotubular junction

TAVR:

Transcatheter aortic valve replacement

References

  1. Siu, S. C., and C. K. Silversides. Bicuspid aortic valve disease. Journal of the American College of Cardiology. 55(25):2789–2800, 2010.

    Article  PubMed  Google Scholar 

  2. Verma, S., and S. C. Siu. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med. 370:1920–1929, 2014.

    Article  CAS  PubMed  Google Scholar 

  3. Carabello, B. A., and W. J. Paulus. Aortic stenosis. The Lancet. 373(9667):956–966, 2009.

    Article  Google Scholar 

  4. Lindman, B. R., et al. Calcific aortic stenosis. Nature reviews Disease primers. 2(1):1–28, 2016.

    Article  Google Scholar 

  5. Yang, L.-T., et al., Aortic Stenosis Progression, Cardiac Damage, and Survival: Comparison Between Bicuspid and Tricuspid Aortic Valves. JACC: Cardiovascular Imaging %@ 1936-878X, 2021.

  6. Blanke, P., et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR) an expert consensus document of the Society of Cardiovascular Computed Tomography. JACC: Cardiovascular Imaging. 12(1):1–24, 2019.

    PubMed  Google Scholar 

  7. Bax, J. J., et al. Transcatheter aortic valve replacement: role of multimodality imaging in common and complex clinical scenarios. Cardiovascular Imaging. 13(1_Part):124–139, 2020.

    PubMed  Google Scholar 

  8. Burzotta, F., et al. Clinical and procedural impact of aortic arch anatomic variants in carotid stenting procedures. Catheterization and Cardiovascular Interventions. 86(3):480–489, 2015.

    Article  PubMed  Google Scholar 

  9. Shen, S., et al. Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting. Journal of International Medical Research. 47(2):682–688, 2019.

    Article  PubMed  Google Scholar 

  10. Frydrychowicz, A., et al. Interdependencies of aortic arch secondary flow patterns, geometry, and age analysed by 4-dimensional phase contrast magnetic resonance imaging at 3 Tesla. European Radiology. 22(5):1122–1130, 2012.

    Article  PubMed  Google Scholar 

  11. Grabenwöger, M., et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal. 33(13):1558–1563, 2012.

    Article  PubMed  Google Scholar 

  12. Abramowitz, Y., et al. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC: Cardiovascular Imaging. 9(8):964–972, 2016.

    PubMed  Google Scholar 

  13. O’Flynn, P. M., G. O’Sullivan, and A. S. Pandit. Methods for three-dimensional geometric characterization of the arterial vasculature. Annals of Biomedical Engineering. 35(8):1368–1381, 2007.

    Article  PubMed  Google Scholar 

  14. Müller-Eschner, M., et al. Accuracy and variability of semiautomatic centerline analysis versus manual aortic measurement techniques for TEVAR. European Journal of Vascular and Endovascular Surgery. 45(3):241–247, 2013.

    Article  PubMed  Google Scholar 

  15. Suh, G.-Y., et al. Aortic arch vessel geometries and deformations in patients with thoracic aortic aneurysms and dissections. Journal of Vascular and Interventional Radiology. 25(12):1903–1911, 2014.

    Article  PubMed  Google Scholar 

  16. Chiu, P., et al. Anatomical characteristics of the thoracic aortic arch in an Asian population. Asian Cardiovascular and Thoracic Annals. 21(2):151–159, 2013.

    Article  PubMed  Google Scholar 

  17. Alhafez, B. A., et al. Aortic arch tortuosity, a novel biomarker for thoracic aortic disease, is increased in adults with bicuspid aortic valve. International Journal of Cardiology. 284:84–89, 2019.

    Article  PubMed  Google Scholar 

  18. Kilner, P. J., et al. Helical and retrograde secondary flow patterns in the aortic arch studied by three-directional magnetic resonance velocity mapping. Circulation. 88(5):2235–2247, 1993.

    Article  CAS  PubMed  Google Scholar 

  19. Hatoum, H., B. L. Moore, and L. P. Dasi. On the significance of systolic flow waveform on aortic valve energy loss. Annals of Biomedical Engineering. 46(12):2102–2111, 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Michelena, H. I., et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. European Journal of Cardio-Thoracic Surgery. 60(3):448–476, 2021.

    Article  PubMed  Google Scholar 

  21. Sievers, H.-H., and C. Schmidtke. A classification system for the bicuspid aortic valve from 304 surgical specimens. Journal of Thoracic and Cardiovascular Surgery. 133(5):1226–1233, 2007.

    Article  PubMed  Google Scholar 

  22. Jackson, P. R., G. T. Tucker, and H. F. Woods. Testing for bimodality in frequency distributions of data suggesting polymorphisms of drug metabolism-histograms and probit plots. British Journal of Clinical Pharmacology. 28(6):647–653, 1989.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Jilaihawi, H., et al. A bicuspid aortic valve imaging classification for the TAVR era. JACC: Cardiovascular Imaging. 9(10):1145–1158, 2016.

    PubMed  Google Scholar 

  24. Yoon, S.-H., et al. Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement. Journal of the American College of Cardiology. 76(9):1018–1030, 2020.

    Article  CAS  PubMed  Google Scholar 

  25. Fukui, M., et al. Deformation of transcatheter aortic valve prostheses: implications for hypoattenuating leaflet thickening and clinical outcomes. Circulation. 146(6):480–493, 2022.

    Article  CAS  PubMed  Google Scholar 

  26. Gunning, P. S., et al. An in vitro evaluation of the impact of eccentric deployment on transcatheter aortic valve hemodynamics. Annals of Biomedical Engineering. 42(6):1195–1206, 2014.

    Article  PubMed  Google Scholar 

  27. Bettinger, N., et al. Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: elucidating optimal threshold cutoffs. Journal of Cardiovascular Computed Tomography. 11(4):302–308, 2017.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA

    Breandan B. Yeats, Dahlia Galvez, Sri Krishna Sivakumar, Ajit Yoganathan & Lakshmi P. Dasi

  2. Department of Cardiovascular Surgery, Piedmont Heart Institute, Marcus Valve Center, Atlanta, GA, USA

    Kimberly Holst & Vinod H. Thourani

  3. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Kimberly Holst

  4. Department of Cardiology, Piedmont Heart Institute, Marcus Valve Center, Atlanta, GA, USA

    Venkateshwar Polsani & Pradeep K. Yadav

Authors
  1. Breandan B. Yeats
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dahlia Galvez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sri Krishna Sivakumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimberly Holst
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Venkateshwar Polsani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pradeep K. Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vinod H. Thourani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ajit Yoganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lakshmi P. Dasi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lakshmi P. Dasi.

Ethics declarations

Conflict of interest

Breandan B. Yeats has a patent pending as co-inventor of patents related to computational predictive modeling of heart valves and is a stakeholder in DASI Simulations. Sri Krishna Sivakumar has a patent pending as co-inventor of patents related to computational predictive modeling of heart valves. Pradeep K. Yadav is a consultant for Edwards Lifesciences, Medtronic Inc., Abbott Vascular, and Shockwave Medical. Vinod H. Thourani is a consultant or research with Abbott Vascular, Boston Scientific, Cryolife, Edwards Lifesciences, Medtronic Corp, and Shockwave Medical and stakeholder in Dasi Simulations. Lakshmi P. Dasi is a stakeholder in DASI Simulations and has a patent pending as co-inventor of patents related to computational predictive modeling of heart valves. Other authors report no conflicts of interest.

Additional information

Associate Editor Stefan M. Duma oversaw the review of this article.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 351 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yeats, B.B., Galvez, D., Sivakumar, S.K. et al. 3D Characterization of the Aortic Valve and Aortic Arch in Bicuspid Aortic Valve Patients. Ann Biomed Eng (2024). https://doi.org/10.1007/s10439-024-03527-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10439-024-03527-8

Keywords

Search

Navigation