title: From unicuspid to quadricuspid: influence of aortic valve morphology on aortic three-dimensional hemodynamics.
abstract: OBJECTIVE
  To assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology.
  
  
  METHODS
  Aortic three-dimensional (3D) blood flow was evaluated by 4D flow MRI in 14 healthy volunteers with normal trileaflet valves and 14 patients with unicuspid (n = 3), bicuspid (n = 9, 3 "true" bicuspid, 3 right-left (RL), 3 right-noncoronary (RN) leaflet fusion, and quadricuspid aortic valves (n = 2). Data analysis included the co-registered visualization of aortic valve morphology with systolic 3D blood flow. The influence of valve morphology on aortic hemodynamics was quantified by valve flow angle.
  
  
  RESULTS
  All RL-bicuspid aortic valve (BAV) were associated with flow jets directed toward the right anterior aortic wall while RN-fusion and unicuspid valves resulted in flow jet patterns toward the right-posterior or posterior wall. Flow angles were clearly influenced by valve morphology (47° ± 10, 28° ± 2, 29° ± 18, 18° ± 12, 15° ± 2 for unicuspid, true BAV, RN-BAV, RL-BAV, quadricuspid valves) and increased compared with controls (7.2° ± 1.1, P = 0.001).
  
  
  CONCLUSIONS
  Altered 3D aortic hemodynamics are impacted by the morphology of congenitally malformed aortic valves.
authors.affiliation: Departments of Radiology and Biomedical Engineering, Northwestern University, Chicago, Illinois, USA.
authors.forename: Pegah
authors.initials: P
authors.lastname: Entezari
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnell
authors.forename: Riti
authors.initials: R
authors.lastname: Mahadevia
authors.forename: Chris
authors.initials: C
authors.lastname: Malaisrie
authors.forename: Patrick
authors.initials: P
authors.lastname: McCarthy
authors.forename: Marla
authors.initials: M
authors.lastname: Mendelson
authors.forename: Jeremy
authors.initials: J
authors.lastname: Collins
authors.forename: James C
authors.initials: JC
authors.lastname: Carr
authors.forename: Michael
authors.initials: M
authors.lastname: Markl
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Barker
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology* / Q000503:physiopathology*; D000082882:Bicuspid Aortic Valve Disease; D001783:Blood Flow Velocity; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D055414:Myocardial Perfusion Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D055815:Young Adult
keywords: 4D flow MRI; aortic valve; bicuspid valve; hemodynamics; quadricuspid valve; unicuspid valve