The influence of bicuspid aortic valves on the dynamic pressure distribution in the ascending aorta – a Porcine Ex-vivo Model

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Juraszek, A, Dziodzio, T, Stoiber, M, Fechtig, D, Gschlad, V, Aigner, P, Czerny, M, Schima, H
• Format: Conference Proceeding
• Language: English
• Published: 23.01.2013
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-0032-1332378

Aim: To simulate the effect of different bicuspid aortic valve configurations on dynamic pressure distribution in the ascending aorta. Methods: Aortic specimens were harvested from adult domestic pigs. In group 1, bicuspidalization was created by a running suture between the left and the right coronary leaflet (n = 6) and in group 2 by a running suture between the left and the non-coronary leaflet (n = 6). Eleven tricuspid specimen served as controls. Two intraluminal pressure catheters were positioned at the concavity and the convexity of the ascending aorta. The specimens were connected to a mock circulation (heart rate 60 bpm, target pressure 95 mmHg). A comparison of the different conditions was also assessed in a numerical simulation. Results: At a distal mean aortic pressure of 94 ± 10 mmHg a mean flow rate of 5.2 ± 0.3 L/min was achieved. The difference of maximal dynamic pressure values (which occured in systole) between locations at the convexity and the concavity was 7.8 ± 2.9 mmHg for the bicuspid and 1.0 ± 0.9 mmHg for the tricuspid specimens (p < 0.001). The numerical simulation revealed an even higher pressure difference between convexity and concavity for the bicuspid case. Conclusions: In this hydrodynamic mock circulation model, we were able to demonstrate that bicuspid aortic valves are associated with significant pressure differences in different locations within the ascending aorta as compared with tricuspid aortic valves. These altered pressure distributions and consecutively- flow patterns may further add to the understanding of aneurismal development in patients with bicuspid aortic valves and might serve to anticipate adverse aortic events due to a better knowledge of the underlying mechanisms.