Skip to main content
SpringerLink
Log in

In Vitro Characterization of Bicuspid Aortic Valve Hemodynamics Using Particle Image Velocimetry

  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

An Erratum to this article was published on 08 May 2012

Abstract

The congenital bicuspid aortic valve (BAV) is associated with increased leaflet calcification, ascending aortic dilatation, aortic stenosis (AS) and regurgitation (AR). Although underlying genetic factors have been primarily implicated for these complications, the altered mechanical environment of BAVs could potentially accelerate these pathologies. The objective of the current study is to characterize BAV hemodynamics in an in vitro system. Two BAV models of varying stenosis and jet eccentricity and a trileaflet AV (TAV) were constructed from excised porcine AVs. Particle Image Velocimetry (PIV) experiments were conducted at physiological flow and pressure conditions to characterize fluid velocity fields in the aorta and sinus regions, and ensemble averaged Reynolds shear stress and 2D turbulent kinetic energy were calculated for all models. The dynamics of the BAV and TAV models matched the characteristics of these valves which are observed clinically. The eccentric and stenotic BAV showed the strongest systolic jet (V = 4.2 m/s), which impinged on the aortic wall on the non-fused leaflet side, causing a strong vortex in the non-fused leaflet sinus. The magnitudes of TKE and Reynolds stresses in both BAV models were almost twice as large as comparable values for TAV, and these maximum values were primarily concentrated around the central jet through the valve orifice. The in vitro model described here enables detailed characterization of BAV flow characteristics, which is currently challenging in clinical practice. This model can prove to be useful in studying the effects of altered BAV geometry on fluid dynamics in the valve and ascending aorta. These altered flows can be potentially linked to increased calcific responses from the valve endothelium in stenotic and eccentric BAVs, independent of concomitant genetic factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11

Similar content being viewed by others

References

  1. Aicher, D., et al. Endothelial nitric oxide synthase in bicuspid aortic valve disease. Ann. Thorac. Surg. 83(4):1290–1294, 2007.

    Article  PubMed  Google Scholar 

  2. Balachandran, K., et al. Elevated cyclic stretch alters matrix remodeling in aortic valve cusps: implications for degenerative aortic valve disease. Am. J. Physiol. Heart Circ. Physiol. 296(3):H756–H764, 2009.

    Article  PubMed  CAS  Google Scholar 

  3. Batchelor, G. K. An Introduction to Fluid Dynamics. Cambridge Mathematical Library: Cambridge, UK, 1967, p. 660.

    Google Scholar 

  4. Bauer, M., et al. Configuration of the ascending aorta in patients with bicuspid and tricuspid aortic valve disease undergoing aortic valve replacement with or without reduction aortoplasty. J. Heart Valve Dis. 15(5):594–600, 2006.

    PubMed  Google Scholar 

  5. Bauer, M., et al. Different hemodynamic stress of the ascending aorta wall in patients with bicuspid and tricuspid aortic valve. J. Card. Surg. 21(3):218–220, 2006.

    Article  PubMed  Google Scholar 

  6. Bellhouse, B. J., and T. Talbot. The fluid mechanics of the aortic valve. J. Fluid Mech. 35(4):721–735, 1969.

    Article  Google Scholar 

  7. Beppu, S., et al. Rapidity of progression of aortic stenosis in patients with congenital bicuspid aortic valves. Am. J. Cardiol. 71(4):322–327, 1993.

    Article  PubMed  CAS  Google Scholar 

  8. Bonow, R. O., et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114(5):e84–e231, 2006.

    Article  PubMed  Google Scholar 

  9. Braverman, A. C., et al. The bicuspid aortic valve. Curr. Probl. Cardiol. 30(9):470–522, 2005.

    Article  PubMed  Google Scholar 

  10. Cotrufo, M., et al. Different patterns of extracellular matrix protein expression in the convexity and the concavity of the dilated aorta with bicuspid aortic valve: preliminary results. J. Thorac. Cardiovasc. Surg. 130(2):504–511, 2005.

    Article  PubMed  CAS  Google Scholar 

  11. Dasi, L. P., et al. Vorticity dynamics of a bileaflet mechanical heart valve in an axisymmetric aorta. Phys. Fluids 19(6):067105(1)–067109(17), 2007.

    Article  Google Scholar 

  12. den Reijer, P. M., et al. Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance. J. Cardiovasc. Magn. Reson. 12:4, 2010.

    Article  Google Scholar 

  13. Garg, V., et al. Mutations in NOTCH1 cause aortic valve disease. Nature 437(7056):270–274, 2005.

    Article  PubMed  CAS  Google Scholar 

  14. Giersiepen, M., et al. Estimation of shear stress-related blood damage in heart valve prostheses—in vitro comparison of 25 aortic valves. Int. J. Artif. Organs 13(5):300–306, 1990.

    PubMed  CAS  Google Scholar 

  15. Girdauskas, E., et al. Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument. Eur. J. Cardiothorac. Surg. 39(6):809–814, 2011.

    Article  PubMed  Google Scholar 

  16. Goland, S., et al. Assessment of aortic stenosis by three-dimensional echocardiography: an accurate and novel approach. Heart 93(7):801–807, 2007.

    Article  PubMed  Google Scholar 

  17. Hope, T. A., et al. Comparison of flow patterns in ascending aortic aneurysms and volunteers using four-dimensional magnetic resonance velocity mapping. J. Magn. Reson. Imaging 26:1471–1479, 2007.

    Article  PubMed  Google Scholar 

  18. Hope, M. D., et al. Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology 255(1):53–61, 2010.

    Article  PubMed  Google Scholar 

  19. Keane, R. D., and R. J. Adrian. Optimization of particle image velocimeters. I. Double pulsed systems. Meas. Sci. Technol. 1(11):1202–1215, 1990.

    Article  Google Scholar 

  20. Keane, M. G., et al. Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation 102(19 Suppl 3):III35–III39, 2000.

    PubMed  CAS  Google Scholar 

  21. Kline, S. J., and F. A. McClintock. Describing uncertainties in single-sample experiments. Mech. Eng. 75:3–8, 1953.

    Google Scholar 

  22. Leo, H. L., et al. Fluid dynamic assessment of three polymeric heart valves using particle image velocimetry. Ann. Biomed. Eng. 34(6):936–952, 2006.

    Article  PubMed  Google Scholar 

  23. Nistri, S., et al. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 82(1):19–22, 1999.

    PubMed  CAS  Google Scholar 

  24. Pachulski, R. T., A. L. Weinberg, and K. L. Chan. Aortic aneurysm in patients with functionally normal or minimally stenotic bicuspid aortic valve. Am. J. Cardiol. 67(8):781–782, 1991.

    Article  PubMed  CAS  Google Scholar 

  25. Peskin, C. S. Numerical analysis of blood flow in the heart. J. Comput. Phys. 25(3):220–252, 1977.

    Article  Google Scholar 

  26. Pouleur, A. C., et al. Planimetric and continuity equation assessment of aortic valve area: Head to head comparison between cardiac magnetic resonance and echocardiography. J. Magn. Reson. Imaging 26(6):1436–1443, 2007.

    Article  PubMed  Google Scholar 

  27. Pouleur, A. C., et al. Aortic valve area assessment: multidetector CT compared with cine MR imaging and transthoracic and transesophageal echocardiography. Radiology 244(3):745–754, 2007.

    Article  PubMed  Google Scholar 

  28. Prasad, A. K., et al. Effect of resolution on the speed and accuracy of particle image velocimetry interrogation. Exp. Fluids 13(2–3):105–116, 1992.

    Article  CAS  Google Scholar 

  29. Querzoli, G., S. Fortini, and A. Cenedese. Effect of the prosthetic mitral valve on vortex dynamics and turbulence of the left ventricular flow. Phys. Fluids 22:041901, 2010.

    Article  Google Scholar 

  30. Roberts, W. C. The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am. J. Cardiol. 26(1):72–83, 1970.

    Article  PubMed  CAS  Google Scholar 

  31. Roberts, W. C., and J. M. Ko. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation 111(7):920–925, 2005.

    Article  PubMed  Google Scholar 

  32. Robicsek, F., et al. The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann. Thorac. Surg. 77(1):177–185, 2004.

    Article  PubMed  Google Scholar 

  33. Saikrishnan, N. Studies in wall turbulence using dual plane particle image velocimetry and direct numerical simulation data. In: Aerospace Engineering & Mechanics. Minneapolis, MN: University of Minnesota, 2010, p. 224.

  34. Sievers, H. H., and C. Schmidtke. A classification system for the bicuspid aortic valve from 304 surgical specimens. J. Thorac. Cardiovasc. Surg. 133(5):1226–1233, 2007.

    Article  PubMed  Google Scholar 

  35. Sucosky, P., et al. Altered shear stress stimulates upregulation of endothelial VCAM-1 and ICAM-1 in a BMP-4- and TGF-beta1-dependent pathway. Arterioscler. Thromb. Vasc. Biol. 29(2):254–260, 2009.

    Article  PubMed  CAS  Google Scholar 

  36. Ward, C. Clinical significance of the bicuspid aortic valve. Heart 83(1):81–85, 2000.

    Article  PubMed  CAS  Google Scholar 

  37. Warnes, C. A., et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J. Am. Coll. Cardiol. 52(23):e1–e121, 2008.

    Article  Google Scholar 

  38. Weinberg, E. J., and M. R. Kaazempur Mofrad. A multiscale computational comparison of the bicuspid and tricuspid aortic valves in relation to calcific aortic stenosis. J. Biomech. 41(16):3482–3487, 2008.

    Article  PubMed  Google Scholar 

  39. Xing, Y., et al. Cyclic pressure affects the biological properties of porcine aortic valve leaflets in a magnitude and frequency dependent manner. Ann. Biomed. Eng. 32(11):1461–1470, 2004.

    Article  PubMed  Google Scholar 

  40. Yap, C. H., et al. Experimental measurement of dynamic fluid shear stress on the aortic surface of the aortic valve leaflet. Biomech. Model. Mechanobiol. 11:171–182, 2011.

    Article  PubMed  Google Scholar 

  41. Yap, C. H., et al. Experimental technique of measuring dynamic fluid shear stress on the aortic surface of the aortic valve leaflet. J. Biomech. Eng. 133(6):15, 2011.

    Article  Google Scholar 

  42. Yap, C. H., et al. Experimental measurement of dynamic fluid shear stress on the ventricular surface of the aortic valve leaflet. Biomech. Model. Mechanobiol. 11:231–244, 2011.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Holifield Farms, Covington, GA and Town & Country Packing Company, Thomson, GA for providing porcine hearts. This study was funded by the American Heart Association Postdoctoral Fellowship Number 10POST3050054 and the Petit Undergraduate Research Scholars Program.

Author information

Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA

    Neelakantan Saikrishnan, Choon-Hwai Yap, Nicole C. Milligan & Ajit P. Yoganathan

  2. Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA

    Nikolay V. Vasilyev

Authors
  1. Neelakantan Saikrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Choon-Hwai Yap
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicole C. Milligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nikolay V. Vasilyev
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ajit P. Yoganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ajit P. Yoganathan.

Additional information

Associate Editor Jane Grande-Allen oversaw the review of this article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saikrishnan, N., Yap, CH., Milligan, N.C. et al. In Vitro Characterization of Bicuspid Aortic Valve Hemodynamics Using Particle Image Velocimetry. Ann Biomed Eng 40, 1760–1775 (2012). https://doi.org/10.1007/s10439-012-0527-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-012-0527-2

Keywords

Search

Navigation