title: Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency.
abstract: Bicuspid aortic valve, characterized by valve malformation and risk for aortopathy, displays profound alteration in systolic aortic outflow and wall shear stress distribution. The present study performed 4-dimensional flow magnetic resonance imaging in patients with bicuspid aortic valve with right-left cusp fusion, focusing on the impact of valve function on hemodynamic status within the ascending aorta.
  
  
  
  Four-dimensional flow magnetic resonance imaging was performed in 50 subjects with right-left bicuspid aortic valve and 15 age- and aortic size-matched controls with tricuspid aortic valve. Patients with bicuspid aortic valve were categorized into 3 groups according to their aortic valve function as follows: bicuspid aortic valve with no more than mild aortic valve dysfunction (bicuspid aortic valve control, n = 20), bicuspid aortic valve with severe aortic insufficiency (n = 15), and bicuspid aortic valve with severe aortic stenosis (n = 15).
  
  
  
  All patients with right-left bicuspid aortic valve exhibited peak wall shear stress at the right-anterior position of the ascending aorta (bicuspid aortic valve vs trileaflet aortic valve at the right-anterior position: 0.91 ± 0.23 N/m2vs 0.43 ± 0.12 N/m2, P < .001) with no distinct alteration between bicuspid aortic valve with severe aortic insufficiency and bicuspid aortic valve with severe aortic stenosis. The predominance of dilatation involving the tubular ascending aorta (82%, type 2 aortopathy) persisted, with or without valve dysfunction. Compared with bicuspid aortic valve control subjects, the bicuspid aortic valve with severe aortic insufficiency group displayed universally elevated wall shear stress (0.75 ± 0.12 N/m2vs 0.57 ± 0.09 N/m2, P < .01) in the ascending aorta, which was associated with elevated cardiac stroke volume (P < .05). The bicuspid aortic valve with severe aortic stenosis group showed elevated flow eccentricity in the form of significantly increased standard deviation of circumferential wall shear stress, which correlated with markedly increased peak aortic valve velocity (P < .01).
  
  
  
  The location of peak aortic wall shear stress and type of aortopathy remained homogeneous among patients with right-left bicuspid aortic valve irrespective of valve dysfunction. Severe aortic insufficiency or stenosis resulted in further elevated aortic wall shear stress and exaggerated flow eccentricity.
authors.affiliation: Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Shan
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China. Electronic address: wang.yongshi@zs-hospital.sh.cn.
authors.forename: Yongshi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Transfusion, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Boting
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Barker
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill.
authors.forename: Michael
authors.initials: M
authors.lastname: Markl
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
authors.affiliation: Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Shu
mesh_terms: D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D000082882:Bicuspid Aortic Valve Disease; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D012039:Regional Blood Flow; D012307:Risk Factors; D012720:Severity of Illness Index; D013314:Stress, Mechanical
keywords: bicuspid aortic valve; magnetic resonance imaging; wall shear stress