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Comparative finite element model analysis of ascending aortic flow in bicuspid and tricuspid aortic valve.

机译：二尖瓣和三尖瓣主动脉瓣升主动脉血流的比较有限元模型分析。

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In bicuspid aortic valve (BAV) disease, the role of genetic and hemodynamic factors influencing ascending aortic pathology is controversial. To test the effect of BAV geometry on ascending aortic flow, a finite element analysis was undertaken. A surface model of aortic root and ascending aorta was obtained from magnetic resonance images of patients with BAV and tricuspid aortic valve using segmentation facilities of the image processing code Vascular Modeling Toolkit (developed at the Mario Negri Institute). Analytical models of bicuspid (antero-posterior [AP], type 1 and latero-lateral, type 2 commissures) and tricuspid orifices were mathematically defined and turned into a volumetric mesh of linear tetrahedra for computational fluid dynamics simulations. Numerical simulations were performed with the finite element code LifeV. Flow velocity fields were assessed for four levels: aortic annulus, sinus of Valsalva, sinotubular junction, and ascending aorta. Comparison of finite element analysis of bicuspid and tricuspid aortic valve showed different blood flow velocity pattern. Flow in bicuspid configurations showed asymmetrical distribution of velocity field toward the convexity of mid-ascending aorta returning symmetrical in distal ascending aorta. On the contrary, tricuspid flow was symmetrical in each aortic segment. Comparing type 1 BAV with type 2 BAV, more pronounced recirculation zones were noticed in the latter. Finally, we found that in both BAV configurations, maximum wall shear stress is highly localized at the convex portion of the mid-ascending aorta level. Comparison between models showed asymmetrical and higher flow velocity in bicuspid models, in particular in the AP configuration. Asymmetry was more pronounced at the aortic level known to be more exposed to aneurysm formation in bicuspid patients. This supports the hypothesis that hemodynamic factors may contribute to ascending aortic pathology in this subset of patients.
机译：在二尖瓣主动脉瓣（BAV）疾病中，影响升主动脉病理的遗传和血液动力学因素的作用是有争议的。为了测试BAV几何形状对升主动脉血流的影响，进行了有限元分析。使用图像处理代码Vascular Modeling Toolkit（由Mario Negri Institute开发）的分割工具，从BAV和三尖瓣主动脉瓣的患者的磁共振图像中获得主动脉根和升主动脉的表面模型。数学上定义了二尖瓣（前后型[AP]，1型和后外侧，2型连合）和三尖瓣孔口的分析模型，并将其转换为线性四面体的体积网格，以进行计算流体动力学模拟。使用有限元代码LifeV进行了数值模拟。评估了流速场的四个水平：主动脉瓣环，瓦尔瓦尔窦，窦管交界和升主动脉。二尖瓣和三尖瓣主动脉瓣的有限元分析的比较显示了不同的血流速度模式。双尖牙形态的血流显示速度场朝中升主动脉凸面的速度场不对称分布，并在远端升主动脉中对称返回。相反，三尖瓣血流在每个主动脉段均对称。将1型BAV与2型BAV进行比较，在后者中发现了更明显的回流区。最后，我们发现在两种BAV配置中，最大壁切应力高度集中在中升主动脉水平的凸部。模型之间的比较表明，在二尖瓣模型中，尤其是在AP配置中，流速不对称且流速较高。在二尖瓣患者中，不对称性在主动脉水平上更为明显，这更容易暴露于动脉瘤的形成。这支持了以下假设：血液动力学因素可能有助于该患者亚组中升主动脉病变。

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