Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

Abstract

Background: Bicuspid aortic valve (BAV) disease leads to deviant helical flow patterns especially in the mid-ascending aorta (AAo), potentially causing wall alterations such as aortic dilation and dissection. Among others, wall shear stress (WSS) could contribute to the prediction of long-term outcome of patients with BAV. 4D flow in cardiovascular magnetic resonance (CMR) has been established as a valid method for flow visualization and WSS estimation. The aim of this study is to reevaluate flow patterns and WSS in patients with BAV 10 years after the initial evaluation. Methods: Fifteen patients (median age 34.0 years) with BAV were re-evaluated 10 years after the initial study from 2008/2009 using 4D flow by CMR. Our particular patient cohort met the same inclusion criteria as in 2008/2009, all without enlargement of the aorta or valvular impairment at that time. Flow patterns, aortic diameters, WSS and distensibility were calculated in different aortic regions of interest (ROI) with dedicated software tools.Results: Indexed aortic diameters in the descending aorta (DAo), but especially in the AAo did not change in the 10-year period. Median difference 0.05 cm/m 2 (95% CI: 0.01 to 0.22; P=0.06) for AAo and median difference −0.08 cm/m 2 (95% CI: −0.12 to 0.01; P=0.07) for DAo. WSS values were lower in 2018/2019 at all measured levels. Aortic distensibility decreased by median 25.6% in the AAo, while stiffness increased concordantly (median +23.6%).Conclusions: After a ten years' follow-up of patients with isolated BAV disease, indexed aortic diameters did not change in this patient cohort. WSS was lower compared to values generated 10 years earlier. Possibly a drop of WSS in BAV could serve as a marker for a benign long-term course and implementation of more conservative treatment strategies.

Unlocking insights in bicuspid aortic valve management in adult patients: the vital role of cardiac imaging

“…Consistent follow-up holds immense importance in the management of BAV patients due to potential complications and the dynamic nature of the condition [7,12,22]. Regular medical evaluations, echocardiograms, and subsequent scans during follow-up enable the early detection of any alterations in valve structure, function, or aortic measurements [14,[23][24][25][26]. This early identification of complications allows for timely intervention, thwarting the progression of conditions like aortic stenosis or aneurysms.…”

Blood flow dynamics in the ascending aorta of patients with bicuspid aortic valve before and after transcatheter aortic valve replacement -A computational fluid dynamics study

“…Recent developments in imaging have suggested that the blood ow dynamics in the ascending aorta may be a major contributor to the BAV aortopathy [4,5] . Computational uid dynamics (CFD) is a useful tool that allows for the visualization of blood ow patterns [6,7] .…”