Abstract
Bicuspid aortic valve (BAV) is associated with aortic dilatation and aneurysm. Several studies evidenced an eccentric systolic flow in ascending aorta associated with increased wall shear stresses (WSS) and the occurrence of an helical systolic flow. This study seeks to elucidate the connections between jet asymmetry and helical flow in patients with normally functioning BAV and dilated ascending aorta. We performed a computational parametric study by varying, for a patient-specific geometry, the valve area and the flow rate entering the aorta and drawing also a tricuspid valve (TAV). We considered also phase-contrast magnetic resonance imaging of four BAV and TAV patients. Measurement of normalized flow asymmetry index, systolic WSS and of a new index (positive helix fraction, PHF) quantifying the presence of a single a single helical flow were performed. In our computation, BAV cases featured higher values of all indices with respect to TAV in both numerical and imaged-based results. Moreover, all indices increased with decreasing valve area and/or with increasing flow rate. This allowed to separate the BAV and TAV cases with respect to the jet asymmetry, WSS localization and helical flow. Interestingly, these results were obtained without modeling the leaflets.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Antiga L, Piccinelli M, Botti L, Ene-Iordache B, Remuzzi A, Steinman D (2008) An image-based modeling framework for patient-specific computational hemodynamics. Med Biol Eng Comput 46: 1097–1112
Baltes C, Hansen M, Tsao J, Kozerke S, Rezavi R, Pedersen E, Boesiger P (2008) Determination of peak velocity in stenotic areas: echocardiography versus kt sense accelerated mr fourier velocity encoding1. Radiology 246(1): 249–257
Barker A, Markl M (2011) Editorial: the role of hemodynamics in bicuspid aortic valve disease. Eur J Cardio-thorac Surg 39(6): 805–806. doi:10.1016/j.ejcts.2011.01.006
Barker A, Lanning C, Shandas R (2010) Quantification of hemodynamic wall shear stress in patients with bicuspid aortic valve using phase-contrast mri. Ann Biomed Eng 38(3): 788–800. doi:10.1007/s10439-009-9854-3
Barker AJ, Markl M, Bürk J, Lorenz R, Bock J, Bauer S, Schulz-Menger J, von Knobelsdorff-Brenkenhoff F (2012) Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Clinical perspective. Circ Cardiovasc Imaging 5(4): 457–466
Bauer M, Siniawski H, Pasic M, Schaumann B, Hetzer R (2006) Different hemodynamic stress of the ascending aorta wall in patients with bicuspid and tricuspid aortic valve. J Cardiac Surg 21(3): 218–220
Beroukhim RS, Kruzick TL, Taylor AL, Gao D, Yetman AT (2006) Progression of aortic dilation in children with a functionally normal bicuspid aortic valve. Am J Cardiol 98(6): 828–830
Chandra S, Rajamannan N, Sucosky P (2012) Computational assessment of bicuspid aortic valve wall-shear stress: implications for calcific aortic valve disease. Biomech Modeling Mechanobiol. doi:10.1007/s10237-012-0375-x
Celik IB, Ghia U, Roache PJ, Freitas CJ, Coleman H, Raad PE (2008) Procedure for estimation and reporting of uncertainty due to discretization in CFD applications. J Fluids Eng Trans ASME 130: 078001-1–078001-4. doi:10.1115/1.2960953
Della Corte A, Quarto C, Bancone C, Castaldo C, Di Meglio F, Nurzynska D, De Santo L, De Feo M, Scardone M, Montagnani S et al (2008) Spatiotemporal patterns of smooth muscle cell changes in ascending aortic dilatation with bicuspid and tricuspid aortic valve stenosis: focus on cell-matrix signaling. J Thorac Cardiovasc Surg 135(1): 8–18. doi:10.1016/j.jtcvs.2007.09.009
Della Corte A, Bancone C, Conti C, Votta E, Redaelli A, Del Viscovo L, Cotrufo M (2011) Restricted cusp motion in right-left type of bicuspid aortic valves: a new risk marker for aortopathy. J Thorac Cardiovasc Surg. doi:10.1016/j.bbr.2011.03.031
Den Reijer P, Sallee D III, Van Der Velden P, Zaaijer E, Parks W, Ramamurthy S, Robbie T, Donati G, Lamphier C, Beekman R et al (2010) Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson 12(4). doi:10.1186/1532-429X-12-4
Formaggia, L, Quarteroni, A, Veneziani, A (eds) (2009) Cardiovascular mathematics: modeling and simulation of the circulatory system, modeling, simulation and applications, vol 1. Springer, Milan
Fowles R, Martin R, Abrams J, Schapira J, French J, Popp R (1979) Two-dimensional echocardiographic features of bicuspid aortic valve. Chest 75(4): 434–440
Girdauskas E, Borger M, Secknus M, Girdauskas G, Kuntze T (2011) Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument. Eur J Cardio-thorac Surg 39(6): 809–814
Hahn R, Roman M, Mogtadek A, Devereux R (1992) Association of aortic dilation with regurgitant, stenotic and functionally normal bicuspid aortic valves. J Am Coll Cardiol 19(2): 283–288
Haycock G, Schwartz G, Wisotsky D (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 93(1): 62–66
Hope T, Markl M, Wigström L, Alley M, Miller D, Herfkens R (2007) Comparison of flow patterns in ascending aortic aneurysms and volunteers using four-dimensional magnetic resonance velocity mapping. J Magn Reson Imaging 26(6): 1471–1479. doi:10.1002/jmri.21082
Hope M, Hope T, Meadows A, Ordovas K, Urbania T, Alley M, Higgins C (2010) Bicuspid aortic valve: four-dimensional mr evaluation of ascending aortic systolic flow patterns1. Radiology 255(1): 53–61. doi:10.1148/radiol.09091437
Hope M, Hope T, Crook S, Ordovas K, Urbania T, Alley M, Higgins C (2011) 4d flow cmr in assessment of valve-related ascending aortic disease. JACC Cardiovasc Imaging 4(7): 781–787
Moireau P, Xiao N, Astorino M, Figueroa CA, Chapelle D, Taylor CA, Gerbeau JF (2012) External tissue support and fluidstructure simulation in blood flows. Biomech Modeling Mechanobiol 11(1–2): 1–18
Morbiducci U, Gallo D, Ponzini R, Massai D, Antiga L, Montevecchi FM, Redaelli A (2010) Quantitative analysis of bulk flow in image-based hemodynamic models of the carotid bifurcation: the influence of outflow conditions as test case. Ann Biomed Eng 38(12): 3688–3705
Nichols W, O’Rourke M (1998) Mcdonalds blood flow in arteries: theoretical, experimental and clinical principles. Edward Arnold, London
Nkomo V, Enriquez-Sarano M, Ammash N, Melton L, Bailey K, Desjardins V, Horn R, Tajik A (2003) Bicuspid aortic valve associated with aortic dilatation. Arteriosclerosis Thromb Vasc Biol 23(2): 351–356
Roman M, Devereux R, Kramer-Fox R, O’Loughlin J (1989) Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 64(8): 507–512
Sievers HH, Sievers HL (2011) Aortopathy in bicuspid aortic valve diseasegenes or hemodynamics? or Scylla and Charybdis?. Eur J Cardio-thorac Surg 39(6): 803–804
Sigovan M, Hope M, Dyverfeldt P, Saloner D (2011) Comparison of four-dimensional flow parameters for quantification of flow eccentricity in the ascending aorta. J Magn Reson Imaging 34: 1226–1230
Vergara C, Viscardi F, Antiga L, Luciani GB (2011) Influence of bicuspid valve geometry on ascending aortic fluid dynamics: a parametric study. Artif Organs 36(4): 368–378
Viscardi F, Vergara C, Antiga L, Merelli S, Veneziani A, Puppini G, Faggian G, Mazzucco A, Luciani GB (2010) Comparative finite element model analysis of ascending aortic flow in bicuspid and tricuspid aortic valve. Artif Organs 34(12): 1114–1120
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Faggiano, E., Antiga, L., Puppini, G. et al. Helical flows and asymmetry of blood jet in dilated ascending aorta with normally functioning bicuspid valve. Biomech Model Mechanobiol 12, 801–813 (2013). https://doi.org/10.1007/s10237-012-0444-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10237-012-0444-1