Abstract
(1) The study’s objective is to assess sinus hemodynamics differences between stenotic native bicuspid aortic valve (BAV) and native tricuspid aortic valve (TrAV) sinuses in order to assess sinus flow shear and vorticity dynamics in these common pathological states of the aortic valve. (2) Representative patient-specific aortic roots with BAV and TrAV were selected, segmented, and 3D printed. The flow dynamics within the sinus were assessed in-vitro using particle image velocimetry in a left heart simulator at physiological pressure and flow conditions. Hemodynamic data calculations, vortex tracking, shear stress probability density functions and sinus washout calculations based on Lagrangian particle tracking were performed. (3) (a) At peak systole, velocity and vorticity in BAV reach 0.67 ± 0.02 m/s and 374 ± 5 s−1 versus 0.49 ± 0.03 m/s and 293 ± 3 s−1 in TrAV; (b) Aortic sinus vortex is slower to form but conserved in BAV sinus; (c) BAV shear stresses exceed those of TrAV (1.05 Pa versus 0.8 Pa); (d) Complete TrAV washout was achieved after 1.5 cycles while it was not for BAV. (4) In conclusion, sinus hemodynamics dependence on the different native aortic valve types and sinus morphologies was clearly highlighted in this study.
Highlights
A bicuspid aortic valve (BAV) typically comprises two leaflets of unequal size, while tricuspid aortic valves (TrAV) are comprised of three leaflets [1]
While the durability of BAV compared to TrAV is of critical concern, calcification and thrombus formation have been common between these populations [5]—both related to hemodynamic factors [6,7,8,9]
Patients with severe degenerative aortic stenosis being evaluated for transcatheter aortic valve replacement at the Ohio State University Wexner Medical Center were selected as part of an institutional review board (IRB)-approved study
Summary
A bicuspid aortic valve (BAV) typically comprises two leaflets of unequal size, while tricuspid aortic valves (TrAV) are comprised of three leaflets [1]. There is little knowledge regarding sinus flow hemodynamics in a BAV root, or for that matter, an anatomical TrAV root, and little knowledge around what makes sinus flow different between a bicuspid valve sinus and a tricuspid valve sinus. Evaluating these may shed the light on the differences between valve function and valve disease progression from one side, and may put into context how patient-specific parameters can dictate different fluid mechanics
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