Abstract
The bicuspid aortic valve (BAV) is a congenital malformation of the aortic valve with a variety of structural features. The current research on BAV mainly focuses on the systolic phase, while ignoring the diastolic hemodynamic characteristics and valve mechanics. The purpose of this study is to compare the differences in hemodynamics and mechanical properties of BAV with different phenotypes throughout the cardiac cycle by means of numerical simulation. Based on physiological anatomy, we established an idealized tricuspid aortic valve (TAV) model and six phenotypes of BAV models (including Type 0 a–p, Type 0 lat, Type 1 L–R, Type 1 N-L, Type 1 R-N, and Type 2), and simulated the dynamic changes of the aortic valve during the cardiac cycle using the fluid–structure interaction method. The morphology of the leaflets, hemodynamic parameters, flow patterns, and strain were analyzed. Compared with TAV, the cardiac output and effective orifice area of different BAV phenotypes decreased certain degree, along with the peak velocity and mean pressure difference increased both. Among all BAV models, Type 2 exhibited the worst hemodynamic performance. During the systole, obvious asymmetric flow field was observed in BAV aorta, which was related to the orientation of BAV. Higher strain was generated in diastole for BAV models. The findings of this study suggests specific differences in the hemodynamic characteristics and valve mechanics of different BAV phenotypes, including different severity of stenosis, flow patterns, and leaflet strain, which may be critical for prediction of other subsequent aortic diseases and differential treatment strategy for certain BAV phenotype.
Highlights
Bicuspid aortic valve (BAV) malformation is a relatively common congenital heart valve disease, which is mainly manifested by abnormal changes in the number of valves
The results showed that Type 0 produced the best hemodynamics and mechanical properties, and the raphe of Type 1 changed the position of abnormal hemodynamic characteristics, while Type 2 inhibited the development of blood flow, and the leaflet stress and hemodynamic parameters were the worst
This study demonstrates the importance of BAV classification for the clinical prediction, diagnosis, and treatment of BAVassociated diseases because of the different hemodynamic characteristics and valve mechanical properties of BAV phenotypes
Summary
Bicuspid aortic valve (BAV) malformation is a relatively common congenital heart valve disease, which is mainly manifested by abnormal changes in the number of valves. Studies have shown that the development of the. BAV causes the two leaflets of the aortic valve to fail to separate from each other and fuse together. According to the Sievers and Schmidtke (2007) classification method, BAV can be categorized as Type 0, Type 1, and Type 2 based on the spatial position and number of raphes. Type 1 can be classified into three subtypes, left–right fusion (Type 1 L–R), non-coronary-left fusion (Type 1 N-L), non-coronary-right fusion (Type 1 R-N), depending on the leaflet fusion.
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