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Comparative Study
. 2011 Oct;92(4):1384-9.
doi: 10.1016/j.athoracsur.2011.04.118. Epub 2011 Aug 25.

Increased ascending aortic wall stress in patients with bicuspid aortic valves

Derek P Nathan  1 , Chun Xu, Ted Plappert, Benoit Desjardins, Joseph H Gorman 3rd, Joseph E Bavaria, Robert C Gorman, Krishnan B Chandran, Benjamin M Jackson
Affiliations
Comparative Study

Increased ascending aortic wall stress in patients with bicuspid aortic valves

Derek P Nathan et al. Ann Thorac Surg. 2011 Oct.

Abstract

Background: Patients with bicuspid aortic valves (BAV) are at increased risk of ascending aortic dilatation, dissection, and rupture. We hypothesized that ascending aortic wall stress may be increased in patients with BAV compared with patients with tricuspid aortic valves (TAV).

Methods: Twenty patients with BAV and 20 patients with TAV underwent electrocardiogram-gated computed tomographic angiography. Patients were matched for diameter. The thoracic aorta was segmented, reconstructed, and triangulated to create a mesh. Utilizing a uniform pressure load of 120 mm Hg, and isotropic, incompressible, and linear elastic shell elements, finite element analysis was performed to predict 99th percentile wall stress.

Results: For patients with BAV and TAV, aortic root diameter was 4.0 ± 0.6 cm and 4.0 ± 0.6 cm (p = 0.724), sinotubular junction diameter was 3.6 ± 0.8 cm and 3.6 ± 0.7 cm (p = 0.736), and maximum ascending aortic diameter was 4.0 ± 0.8 cm and 4.1 ± 0.9 cm (p = 0.849), respectively. The mean 99 th percentile wall stress in the BAV group was greater than in the TAV group (0.54 ± 0.06 MPa vs 0.50 ± 0.09 MPa), though this did not reach statistical significance (p = 0.090). When normalized by radius, the 99 th percentile wall stress was greater in the BAV group (0.31 ± 0.06 MPa/cm vs 0.27 ± 0.03 MPa/cm, p = 0.013).

Conclusions: Patients with BAV, regardless of aortic diameter, have increased 99 th percentile wall stress in the ascending aorta. Ascending aortic three-dimensional geometry may account in part for the increased propensity to aortic dilatation, rupture, and dissection in patients with BAV.

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Figures

Figure 1
Figure 1
Wall stress in the ascending aorta of A) a patient with a tricuspid aortic valve, and aortic root, sinotubular, and maximum ascending aortic diameter of 4.0, 3.4 and 5.4 cm, respectively, and B) a patient with a bicuspid aortic valve, and aortic root, sinotubular junction, and maximum ascending aortic diameter of 3.8, 3.5 and 5.1 cm, respectively. Note the increased stress in the latter patient.
Figure 2
Figure 2
Location of 99-percentile wall stress in the ascending aorta in patients with A) tricuspid and B) bicuspid aortic valves. This differing distribution of peak wall stress approached but did not reach statistical significance (P=0.075).
See this image and copyright information in PMC

Comment in

  • Invited commentary.
    Davies RR. Davies RR. Ann Thorac Surg. 2011 Oct;92(4):1389-90. doi: 10.1016/j.athoracsur.2011.07.046. Ann Thorac Surg. 2011. PMID: 21958785 No abstract available.

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