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Patient-Specific Bicuspid Aortic Valve Biomechanics: A Magnetic Resonance Imaging Integrated Fluid–Structure Interaction Approach

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Abstract

Congenital bicuspid aortic valve (BAV) consists of two fused cusps and represents a major risk factor for calcific valvular stenosis. Herein, a fully coupled fluid–structure interaction (FSI) BAV model was developed from patient-specific magnetic resonance imaging (MRI) and compared against in vivo 4-dimensional flow MRI (4D Flow). FSI simulation compared well with 4D Flow, confirming direction and magnitude of the flow jet impinging onto the aortic wall as well as location and extension of secondary flows and vortices developing at systole: the systolic flow jet originating from an elliptical 1.6 cm2 orifice reached a peak velocity of 252.2 cm/s, 0.6% lower than 4D Flow, progressively impinging on the ascending aorta convexity. The FSI model predicted a peak flow rate of 22.4 L/min, 6.7% higher than 4D Flow, and provided BAV leaflets mechanical and flow-induced shear stresses, not directly attainable from MRI. At systole, the ventricular side of the non-fused leaflet revealed the highest wall shear stress (WSS) average magnitude, up to 14.6 Pa along the free margin, with WSS progressively decreasing towards the belly. During diastole, the aortic side of the fused leaflet exhibited the highest diastolic maximum principal stress, up to 322 kPa within the attachment region. Systematic comparison with ground-truth non-invasive MRI can improve the computational model ability to reproduce native BAV hemodynamics and biomechanical response more realistically, and shed light on their role in BAV patients’ risk for developing complications; this approach may further contribute to the validation of advanced FSI simulations designed to assess BAV biomechanics.

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Acknowledgments

Simulia and Capvidia are in an academic partnership with Dr. Bluestein. This project was supported by NIH-NIBIB-BRPU01EB026414 (DB). IRCCS Policlinico San Donato is a clinical research hospital partially funded by the Italian Ministry of Health.

Conflict of interest

Dr. Bluestein have stock ownership in PolyNova Cardiovascular Inc. All other authors declare that they have no conflict of interest.

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Author notes

  1. Monica Emendi and Francesco Sturla have equally contributed to first authorship.

Authors and Affiliations

  1. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy

    Monica Emendi, Francesca R. Pluchinotta & Alberto Redaelli

  2. Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA

    Monica Emendi, Ram P. Ghosh, Matteo Bianchi & Danny Bluestein

  3. 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy

    Francesco Sturla & Filippo Piatti

  4. Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Francesca R. Pluchinotta & Massimo Lombardi

  5. Department of Pediatric and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy

    Francesca R. Pluchinotta

  6. Siemens Healthcare GmbH, Erlangen, Germany

    Daniel Giese

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  1. Monica Emendi
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Emendi, M., Sturla, F., Ghosh, R.P. et al. Patient-Specific Bicuspid Aortic Valve Biomechanics: A Magnetic Resonance Imaging Integrated Fluid–Structure Interaction Approach. Ann Biomed Eng 49, 627–641 (2021). https://doi.org/10.1007/s10439-020-02571-4

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