Ascending thoracic aorta aneurysm repair induces positive hemodynamic outcomes in a patient with unchanged bicuspid aortic valve

Francesca Condemi (1) , Salvatore Campisi (2) , Magalie Viallon (3) , Pierre Croisille (3) , Jean-François Fuzelier (2) , Stéphane Avril (1)

1 SAINBIOSE - Santé Ingénierie Biologie Saint-Etienne
2 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
3 RMN et optique : De la mesure au biomarqueur

We report a patient-specific case of bicuspid aortic valve with fusion of right and left coronary leaflets (RL type I BAV), moderate aortic valve deficiency and ascending thoracic aortic aneurysms (ATAA) who was treated by only ascending aorta replacement preserving the BAV. The flow eccentricity, the helicity intensity (h2), the circumferential time averaged wall shear stress (TAWSScircumferential), the cumulative viscous energy loss at the systolic peak (E0L) and the pulse wave velocity (PWV) were calculated by combining 4D flow MRI and CFD analysis before (Stage I) and after (Stage II) the surgical procedure. CFD analyses assumed rigid walls, a non-Newtonian behavior for the blood and MRI measured patient-specific blood flow profiles as inlet boundary conditions. Stage II results showed suppression of recirculation in the ascending aorta, loss of jet flow impingement onto the aortic wall, maximum TAWSScircumferential decrease (from 6.69 Pa in Stage I to 6 Pa in Stage II), reduction of flow helicity (from 10.97 in Stage I to 8.47 in Stage II) and E0L (from 15.8 mW in Stage I to 11.2mW in Stage II). However, Floweccentricity and PWV were found higher in Stage II due to the diameter reduction (Floweccentricity = 0.60 in Stage I and Floweccentricity = 0.91 in Stage II; PWV = 3.80 m/s in Stage I and PWV = 9.37 m/s in Stage II). Our work has permitted to compute for the first time the hemodynamic alterations obtained after restoration of normal ascending aorta and sinotubular junction geometry even preserving an R-L type I BAV with still acceptable function.

Mots clés: Ascending Thoracic Aortic Aneurysms; Bicuspid Aortic Valve; 4D MRI

Domaines: Biomécanique [physics.med-ph]

Francesca Condemi, Salvatore Campisi, Magalie Viallon, Pierre Croisille, Jean-François Fuzelier, et al.. Ascending thoracic aorta aneurysm repair induces positive hemodynamic outcomes in a patient with unchanged bicuspid aortic valve. Journal of Biomechanics, 2018, 81, pp.145-148. ⟨hal-02004894⟩