Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: <i>A Proof of Concept Study</i>

Lewis Holmes; George Black; Richmond Jeremy; Rachael Cordina; David Celermajer; Srinivas Karkenahalli; Rajesh Puranik

doi:doi:10.11648/j.ccr.20210504.13

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Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study

Lewis Holmes, George Black, Richmond Jeremy, Rachael Cordina, David Celermajer, Srinivas Karkenahalli, Rajesh Puranik

Published in Cardiology and Cardiovascular Research (Volume 5, Issue 4)

Received: 18 September 2021 Accepted: 1 November 2021 Published: 17 November 2021

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Abstract

Background: Bicuspid aortic valve (BAV) is a common congenital heart disease which is associated with aortic dilatation. There is controversy in the literature regarding the various measures of the biomechanical properties of the aorta in these patients and their relationship to aortic dilatation. The present study aimed to assess both conventional 2D Cardiac Magnetic Resonance Imaging (CMRI) measurements of aortic biomechanics (compliance and distensibility) and a computational fluid dynamics (CFD) approach in patients with BAV and either normal or dilated ascending aorta. Methods: 2D CMRI was performed in 18 patients (6 controls, 6 BAV with dilated ascending aorta and 6 BAV with normal ascending aorta i.e. <36mm diameter) and ascending aortic compliance and distensibility was calculated. CFD was performed with ANSYS Fluent software using 2D CMRI derived parameters to simulate the hemodynamic relationships between blood and the aortic wall. Results: The groups were similar in terms of demographics (mean age 38±13 years, 56% male, pulse pressure 56±15mmHg). There was a numerically lower but not significant difference in aortic compliance between dilated BAV and the other groups. Aortic distensibility was no different between groups. Using CFD, at the mid-ascending aorta pressure was significantly higher in patients with dilated BAV (147.6 ± 24.1 mmHg) than non-dilated BAV (118.6 ± 16.2 mmHg) and controls (124.5 ± 14.4 mmHg), p=0.04. Conclusions: We demonstrate that is possible to estimate regional aortic pressure from 2D CMRI derived parameters using a CFD approach. These novel parameters may add value to surveillance strategies in aortic disease.

Published in	Cardiology and Cardiovascular Research (Volume 5, Issue 4)
DOI	10.11648/j.ccr.20210504.13
Page(s)	172-175
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Cardiac Magnetic Resonance Imaging, Bicuspid Aortic Valve, Aortic Disease, Aortic Compliance

References

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[2]	Erbel R, Aboyans V, Boileau C et al. 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases: Document Covering Acute and Chronic Aortic Diseases of the Thoracic and Abdominal Aorta of the Adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35 (41): 2873–2926.
[3]	Evangelista A, Isselbacher EM, Bossone E et al. Insights From the International Registry of Acute Aortic Dissection: A 20-year Experience of Collaborative Clinical Research. Circulation 2018; 137 (17): 1846–1860.
[4]	Hiratzka L, Creager M, Isselbacher E et al. Surgery for Aortic Dilatation in Patients with Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 67 (6): 724-31.
[5]	Nistri S, Grande-Allen J, Noale M et al. Aortic Elasticity and Size in Bicuspid Aortic Valve Syndrome. Eur Heart J 2008; 29: 472-479.
[6]	Yap S, Nemes A, Meijboom F et al. Abnormal Aortic Elastic Properties in Adults with Congenital Valvular Aortic Stenosis. Int J Cardiol 2008; 128: 336-341.
[7]	Grotenhuis H, Ottenkamp J, Westenberg J et al. Reduced Aortic Elasticity and Dilatation are Associated with Aortic Regurgitation and Left Ventricular Hypertrophy in Nonstenotic Bicuspid Aortic Valve Patients. J Am Coll Cardiol 2007; 49 (15): 1660-1665.
[8]	Rooprai J, Boodhwani M, Beauchesne L et al. Thoracic Aortic Aneurysm Growth in Bicuspid Aortic Valve Patients: Role of Aortic Stiffness and Pulsatile Haemodynamics. J Am Heart Assoc 2019; 8 (8): e010885.
[9]	Guala A, Rodriguez-Palomares J, Dux-Santoy L et al. Influence of Aortic Dilatation on the Regional Aortic Stiffness of Bicuspid Aortic Valve Assessed by 4-Dimensional Flow Cardiac Magnetic Resonance. JACC Cardiovasc Imaging 2018; 12 (6).
[10]	Cavalcante J, Lima J, Redheuil A, Al-Mallah M. Aortic Stiffness: Current Understanding and Future Directions. J Am Coll Cardiol 2011; 57 (14): 1511-22.
[11]	Goubergrits L, Riesenkampff E, Yevtushenko P et al. MRI‐Based Computational Fluid Dynamics for Diagnosis and Treatment Prediction: Clinical Validation Study in Patients with Coarctation of Aorta. J Magn Reson Imaging 2015; 41 (4): 909-916.
[12]	Pasta S, Rinaudo A, Luca A et al. Difference in Hemodynamic and Wall Stress of Ascending Thoracic Aortic Aneurysms with Bicuspid and Tricuspid Aortic Valve. J Biomech 2013; 46 (10): 1729-38.
[13]	Rojczyk M, Ostrowski Z, Adamczyk W et al. CFD Analysis of Blood Flow Within Aorta of Patient with Coarctation of Aorta Studia Informatica 2016; 37 (3A(125)): 43-55.
[14]	Van Ooij P, Potters W, Collins J et al. Characterisation of Abnormal Wall Shear Stress Using 4D Flow MRI in Human Bicuspid Aortopathy. Ann Biomed Eng 2015: 43 (6): 1385-97.
[15]	Barker A, Markl M, Burk J et al. Bicuspid Aortic Valve is Associated with Altered Wall Shear Stress in the Ascending Aorta. Circ Cardiovasc Imaging 2012; 5 (4):457-66.
[16]	Rodriguez-Palomares JF, Dux-Santoy L, Guala A et al. Aortic Flow Patterns and Wall Shear Stress Maps by 4D-Flow Cardiovascular Magnetic Resonance in the Assessment of Aortic Dilatation in Bicuspid Aortic Valve Disease. J of Cardiovasc Magn Reason 2018; 20: 28.

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APA Style

Lewis Holmes, George Black, Richmond Jeremy, Rachael Cordina, David Celermajer, et al. (2021). Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Cardiology and Cardiovascular Research, 5(4), 172-175. https://doi.org/10.11648/j.ccr.20210504.13

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ACS Style

Lewis Holmes; George Black; Richmond Jeremy; Rachael Cordina; David Celermajer, et al. Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Cardiol. Cardiovasc. Res. 2021, 5(4), 172-175. doi: 10.11648/j.ccr.20210504.13

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AMA Style

Lewis Holmes, George Black, Richmond Jeremy, Rachael Cordina, David Celermajer, et al. Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Cardiol Cardiovasc Res. 2021;5(4):172-175. doi: 10.11648/j.ccr.20210504.13

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@article{10.11648/j.ccr.20210504.13,
  author = {Lewis Holmes and George Black and Richmond Jeremy and Rachael Cordina and David Celermajer and Srinivas Karkenahalli and Rajesh Puranik},
  title = {Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {4},
  pages = {172-175},
  doi = {10.11648/j.ccr.20210504.13},
  url = {https://doi.org/10.11648/j.ccr.20210504.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210504.13},
  abstract = {Background: Bicuspid aortic valve (BAV) is a common congenital heart disease which is associated with aortic dilatation. There is controversy in the literature regarding the various measures of the biomechanical properties of the aorta in these patients and their relationship to aortic dilatation. The present study aimed to assess both conventional 2D Cardiac Magnetic Resonance Imaging (CMRI) measurements of aortic biomechanics (compliance and distensibility) and a computational fluid dynamics (CFD) approach in patients with BAV and either normal or dilated ascending aorta. Methods: 2D CMRI was performed in 18 patients (6 controls, 6 BAV with dilated ascending aorta and 6 BAV with normal ascending aorta i.e. ANSYS Fluent software using 2D CMRI derived parameters to simulate the hemodynamic relationships between blood and the aortic wall. Results: The groups were similar in terms of demographics (mean age 38±13 years, 56% male, pulse pressure 56±15mmHg). There was a numerically lower but not significant difference in aortic compliance between dilated BAV and the other groups. Aortic distensibility was no different between groups. Using CFD, at the mid-ascending aorta pressure was significantly higher in patients with dilated BAV (147.6 ± 24.1 mmHg) than non-dilated BAV (118.6 ± 16.2 mmHg) and controls (124.5 ± 14.4 mmHg), p=0.04. Conclusions: We demonstrate that is possible to estimate regional aortic pressure from 2D CMRI derived parameters using a CFD approach. These novel parameters may add value to surveillance strategies in aortic disease.},
 year = {2021}
}

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TY  - JOUR
T1  - Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study
AU  - Lewis Holmes
AU  - George Black
AU  - Richmond Jeremy
AU  - Rachael Cordina
AU  - David Celermajer
AU  - Srinivas Karkenahalli
AU  - Rajesh Puranik
Y1  - 2021/11/17
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210504.13
DO  - 10.11648/j.ccr.20210504.13
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 172
EP  - 175
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210504.13
AB  - Background: Bicuspid aortic valve (BAV) is a common congenital heart disease which is associated with aortic dilatation. There is controversy in the literature regarding the various measures of the biomechanical properties of the aorta in these patients and their relationship to aortic dilatation. The present study aimed to assess both conventional 2D Cardiac Magnetic Resonance Imaging (CMRI) measurements of aortic biomechanics (compliance and distensibility) and a computational fluid dynamics (CFD) approach in patients with BAV and either normal or dilated ascending aorta. Methods: 2D CMRI was performed in 18 patients (6 controls, 6 BAV with dilated ascending aorta and 6 BAV with normal ascending aorta i.e. ANSYS Fluent software using 2D CMRI derived parameters to simulate the hemodynamic relationships between blood and the aortic wall. Results: The groups were similar in terms of demographics (mean age 38±13 years, 56% male, pulse pressure 56±15mmHg). There was a numerically lower but not significant difference in aortic compliance between dilated BAV and the other groups. Aortic distensibility was no different between groups. Using CFD, at the mid-ascending aorta pressure was significantly higher in patients with dilated BAV (147.6 ± 24.1 mmHg) than non-dilated BAV (118.6 ± 16.2 mmHg) and controls (124.5 ± 14.4 mmHg), p=0.04. Conclusions: We demonstrate that is possible to estimate regional aortic pressure from 2D CMRI derived parameters using a CFD approach. These novel parameters may add value to surveillance strategies in aortic disease.
VL  - 5
IS  - 4
ER  -

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Author Information

Lewis Holmes

Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia
George Black

School of Medicine, The University of Sydney, Sydney, Australia
Richmond Jeremy

Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia
Rachael Cordina

Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia
David Celermajer

Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia
Srinivas Karkenahalli

School of Medicine, The University of Sydney, Sydney, Australia
Rajesh Puranik

Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia

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APA Style

Lewis Holmes, George Black, Richmond Jeremy, Rachael Cordina, David Celermajer, et al. (2021). Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Cardiology and Cardiovascular Research, 5(4), 172-175. https://doi.org/10.11648/j.ccr.20210504.13

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ACS Style

Lewis Holmes; George Black; Richmond Jeremy; Rachael Cordina; David Celermajer, et al. Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Cardiol. Cardiovasc. Res. 2021, 5(4), 172-175. doi: 10.11648/j.ccr.20210504.13

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AMA Style

Lewis Holmes, George Black, Richmond Jeremy, Rachael Cordina, David Celermajer, et al. Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Cardiol Cardiovasc Res. 2021;5(4):172-175. doi: 10.11648/j.ccr.20210504.13

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@article{10.11648/j.ccr.20210504.13,
  author = {Lewis Holmes and George Black and Richmond Jeremy and Rachael Cordina and David Celermajer and Srinivas Karkenahalli and Rajesh Puranik},
  title = {Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {4},
  pages = {172-175},
  doi = {10.11648/j.ccr.20210504.13},
  url = {https://doi.org/10.11648/j.ccr.20210504.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210504.13},
  abstract = {Background: Bicuspid aortic valve (BAV) is a common congenital heart disease which is associated with aortic dilatation. There is controversy in the literature regarding the various measures of the biomechanical properties of the aorta in these patients and their relationship to aortic dilatation. The present study aimed to assess both conventional 2D Cardiac Magnetic Resonance Imaging (CMRI) measurements of aortic biomechanics (compliance and distensibility) and a computational fluid dynamics (CFD) approach in patients with BAV and either normal or dilated ascending aorta. Methods: 2D CMRI was performed in 18 patients (6 controls, 6 BAV with dilated ascending aorta and 6 BAV with normal ascending aorta i.e. ANSYS Fluent software using 2D CMRI derived parameters to simulate the hemodynamic relationships between blood and the aortic wall. Results: The groups were similar in terms of demographics (mean age 38±13 years, 56% male, pulse pressure 56±15mmHg). There was a numerically lower but not significant difference in aortic compliance between dilated BAV and the other groups. Aortic distensibility was no different between groups. Using CFD, at the mid-ascending aorta pressure was significantly higher in patients with dilated BAV (147.6 ± 24.1 mmHg) than non-dilated BAV (118.6 ± 16.2 mmHg) and controls (124.5 ± 14.4 mmHg), p=0.04. Conclusions: We demonstrate that is possible to estimate regional aortic pressure from 2D CMRI derived parameters using a CFD approach. These novel parameters may add value to surveillance strategies in aortic disease.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study
AU  - Lewis Holmes
AU  - George Black
AU  - Richmond Jeremy
AU  - Rachael Cordina
AU  - David Celermajer
AU  - Srinivas Karkenahalli
AU  - Rajesh Puranik
Y1  - 2021/11/17
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210504.13
DO  - 10.11648/j.ccr.20210504.13
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 172
EP  - 175
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210504.13
AB  - Background: Bicuspid aortic valve (BAV) is a common congenital heart disease which is associated with aortic dilatation. There is controversy in the literature regarding the various measures of the biomechanical properties of the aorta in these patients and their relationship to aortic dilatation. The present study aimed to assess both conventional 2D Cardiac Magnetic Resonance Imaging (CMRI) measurements of aortic biomechanics (compliance and distensibility) and a computational fluid dynamics (CFD) approach in patients with BAV and either normal or dilated ascending aorta. Methods: 2D CMRI was performed in 18 patients (6 controls, 6 BAV with dilated ascending aorta and 6 BAV with normal ascending aorta i.e. ANSYS Fluent software using 2D CMRI derived parameters to simulate the hemodynamic relationships between blood and the aortic wall. Results: The groups were similar in terms of demographics (mean age 38±13 years, 56% male, pulse pressure 56±15mmHg). There was a numerically lower but not significant difference in aortic compliance between dilated BAV and the other groups. Aortic distensibility was no different between groups. Using CFD, at the mid-ascending aorta pressure was significantly higher in patients with dilated BAV (147.6 ± 24.1 mmHg) than non-dilated BAV (118.6 ± 16.2 mmHg) and controls (124.5 ± 14.4 mmHg), p=0.04. Conclusions: We demonstrate that is possible to estimate regional aortic pressure from 2D CMRI derived parameters using a CFD approach. These novel parameters may add value to surveillance strategies in aortic disease.
VL  - 5
IS  - 4
ER  -

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