Figure - available from: The International Journal of Cardiovascular Imaging
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Scheme of the of the bicuspid aortic valves with different type of cusp fusion. In right to left cusp fusion (see left) blood flow in aorta is directed more anteriorly and to the right impinging proximal ascending aortic wall (dilatation of mainly aortic sinuses), while in R–N fusion (see right) blood travels posteriorly and to the left, thus increasing hemodynamic load on the aortic wall more distally (dilatation of mid-ascending aorta and even aortic arch). Such hemodynamic characteristics are directly observed by MRI and are also reflected by the results of our study
Source publication
The ascending aorta dilatation in the bicuspid aortic valve (BAV) patients is often attributed to congenital abnormalities of the aortic wall, but it may be related to hemodynamic disturbances in the course of BAV disease. At present, ascending aortic diameter is used as almost sole but weak predictor of aortic dissection and rupture in BAV. We exa...
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Objective
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Objective
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Citations
... Hence, according to the consensus guidelines on BAVrelated aortopathy of the American Association for Thoracic Surgery, predominant AI or root dilatation (the so-called root phenotype) should prompt elective repair of ATAA at a lower diameter (> _50 mm) [19]. On the other hand, Kalinowski et al. [20] demonstrated that the severity of BAV stenosis and insufficiency was associated with ascending tubular aorta and aortic root dilatation, respectively, implying that both valve lesions induce haemodynamic impact on the aortic wall. ...
OBJECTIVES
Ascending thoracic aortic aneurysms (ATAAs) often coexist with dysfunctional tricuspid aortic valves (TAVs). How valvular pathology relates to the aortic wall mechanical properties requires detailed examination.
METHODS
Intact-wall and layer-specific mechanical properties from 40 and 21 patients with TAV-ATAAs, respectively, were studied using uniaxial tensile testing, longitudinally and circumferentially. Failure stress (tensile strength), failure stretch (extensibility) and peak elastic modulus (stiffness) measurements, along with histological assays of thickness and elastin/collagen contents, were compared among patients with no valvular pathology (NVP), aortic stenosis (AS) or aortic insufficiency (AI).
RESULTS
Intact-wall stiffness longitudinally and medial strength and stiffness, in either direction, were significantly lower in AI patients than in AS and NVP patients. Intact-wall/medial thickness and extensibility in either direction were significantly lower in AS patients than in AI and NVP patients. In contrast, intact-wall/medial stiffness circumferentially was significantly higher in AS patients than in NVP patients, consistent with the significantly increased medial collagen in AS patients. Failure properties and medial thickness and elastin/collagen contents were significantly lower (more impaired) in females. The left lateral was the thickest quadrant in NVP patients, but the 4 quadrants were equally thick in AS and AI patients. There were significant differences in strength and stiffness among quadrants, which varied however in the 3 patient groups.
CONCLUSIONS
The aortic wall load-bearing capacity was impaired in patients with ATAA in the presence of TAV stenosis or insufficiency. These findings lend biomechanical support to the current guidelines suggesting lower thresholds for elective ascending aorta replacement in cases of aortic valve surgery.
The impact of the distribution in space of the inlet velocity in the numerical simulations of the hemodynamics in the thoracic aorta is systematically investigated. A real healthy aorta geometry, for which in-vivo measurements are available, is considered. The distribution is modeled through a truncated cone shape, which is a suitable approximation of the real one downstream of a trileaflet aortic valve during the systolic part of the cardiac cycle. The ratio between the upper and the lower base of the truncated cone and the position of the center of the upper base are selected as uncertain parameters. A stochastic approach is chosen, based on the generalized Polynomial Chaos expansion, to obtain accurate response surfaces of the quantities of interest in the parameter space. The selected parameters influence the velocity distribution in the ascending aorta. Consequently, effects on the wall shear stress are observed, confirming the need to use patient-specific inlet conditions if interested in the hemodynamics of this region. The surface base ratio is globally the most important parameter. Conversely, the impact on the velocity and wall shear stress in the aortic arch and descending aorta is almost negligible.
Background:
The influence of different bicuspid aortic valve (BAV) morphology in the clinical course of infective endocarditis (IE) has not yet been investigated. This study aimed to describe the clinical and echocardiographic features of IE in patients with BAV (BAVIE) according to valve morphology.
Methods:
Patients with definite BAVIE prospectively enrolled in 4 high-volume referral centers from 2000 to 2019, were evaluated and divided into two groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right-non-coronary or left-non-coronary (non-RL type) cusp fusion. All patients were followed up for 1 year.
Results:
138 patients with BAVIE were included [male 77.7%; median age 52 (36.83-61.00 years)]: 112 patients with RL type (81%) and 26 patients with non-RL type BAV (19%), with no significant differences in age, sex and comorbidities between groups. Although 43% of the cohort had known BAV, the referral was late after symptom onset, particularly for the RL phenotype; time from symptom onset to hospitalization >30 days (31.3% vs 11.5%; p=0.032) and NYHA class ≥II (64.3% vs 42.3%; p=0.039) were more frequent in patients with RL type BAV than in patients with non-RL type BAV. Conversely, patients with non-RL type BAV had a higher incidence of hemorrhagic stroke (19.2% vs 5.4%; p=0.034) and high-grade atrio-ventricular block (11.5% vs 0.9%; p=0.021). Streptococcus viridans was more frequently isolated in patients with non-RL type BAV than in patients with RL type BAV (44% vs 24.1%; p=0.045). No difference in short- and intermediate-term mortality was observed between groups.
Conclusions:
Clinical profile and echocardiographic features in BAVIE patients may differ according to valve morphology and patients with BAVIE appear to be referred late, even when BAV disease is previously known.
