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Impact of turbulent flow in aorta wall and valve leaflets in bicuspid aortic valve – a multimodality approach
Session:
CO 16 - Congénitos
Speaker:
Silvia Aguiar
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sílvia Aguiar Rosa; Diana Oliveira; Ana Galrinho; Luisa Moura Branco; Jorge Tiago; Ana Figueiredo Agapito; Lidia De Sousa; José Alberto Oliveira; André Viveiros Monteiro; Ana Teresa Timóteo; Adélia Sequeira; Luísa Figueiredo; Maria De Fátima Pinto; Rui Cruz Ferreira
Abstract
<p><strong>Introduction: </strong>Bicuspid aortic valve (BAV) is associated with aortic dilatation (AD). Using a multimodality approach, the aims were: to study the flow in aorta; to assess the relationship between aortic wall shear stress and dilatation; to study the aortic valve shear stress.</p> <p> </p> <p><strong>Methods: </strong>A computed model of BAV, aortic valve shear stress, aorta flow, aortic wall shear stress was built. The shape and BAV orifice was built using transthoracic echocardiographic images from parasternal long and short axis views. The BAV leaflets were built using SOLIDWORKS®.</p> <p>Peak radial strain was evaluated at annulus level in a transthoracic parasternal short axis view. Transvavular flow velocity was measured by continuous Doppler echocardiography in 5 chambers apical view</p> <p>The aortic lumen was reconstructed from thoracic computed tomographic images and the aortic wall was created using computational algorithms.</p> <p> </p> <p><strong>Results: </strong>In a BAV with two cusps without a raphe the flow in proximal aorta was turbulent and directed to the aortic wall immediately after sinotubular junction. The flow presented an elevated velocity in the aortic root and proximal aorta, reaching the aorta wall (fig A). The flow’s impact in aorta generated an area of higher wall displacement and wall shear stress, resulting in consequent AD (fig B-C). Maximum kinetic energy (1.06 J) was achieved immediately after the valve and in the flow that impacted in aortic wall (fig D). </p> <p>The reconstruction of BAV and the determination of valve shear stress showed a higher stress in valve leaflets tip. The area of greatest wall shear stress corresponded to the area of the lowest peak radial strain in echocardiography (fig E-F)</p> <p> </p> <p>In the patient with right and left cusps fusion the AD was more distal in ascending aorta. The flow velocity was higher in transvalvular zone and in area of impact on the aortic wall (fig G), generated AD and higher wall displacement (fig H), wall shear stress (fig I), kinetic energy (fig J), maximum viscous dissipation and maximum energy loss. The shear stress was uniform in valve leaflets tip, in line with similar peak radial strain around the valve (fig K-L).</p> <p>In the patient with right and non coronary cusps fusion the AD was more homogeneous along all ascending aorta, with the area of higher flow velocity, wall displacement, wall shear stress and kinetic energy correspondent with the area of bigger diameter, immediately after sinotubular junction (fig M-P). Shear stress in valve leaflets tip and peak radial strain were concordant around the valve (fig Q-R).</p> <p> </p> <p><strong>Conclusion:</strong> The turbulence and high velocity of blood flow in BAV generated a higher displacement and wall shear stress leading to AD. The highest hemodynamic stress areas in BAV corresponded to areas with the worst peak radial strain. This multimodality and non-invasive approach can be relevant in clinical practise to study the impact of the transvalvular flow in the aortic wall and valve leaflets in BAV patients.</p>
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