From Unicuspid to Quadricuspid: Influence of Aortic Valve Morphology on Aortic Three-Dimensional Hemodynamics

PurposeTo assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology. Materials and MethodsAortic three-dimensional (3D) blood flow was evaluated by 4D flow MRI in 14 healthy volunteers with normal trileaflet valves and 14 patients with unicuspid (n=3), bicuspid (n=9, 3 true bicuspid, 3 right-left (RL), 3 right-noncoronary (RN) leaflet fusion, and quadricuspid aortic valves (n=2). Data analysis included the co-registered visualization of aortic valve morphology with systolic 3D blood flow. The influence of valve morphology on aortic hemodynamics was quantified by valve flow angle. ResultsAll RL-bicuspid aortic valve (BAV) were associated with flow jets directed toward the right anterior aortic wall while RN-fusion and unicuspid valves resulted in flow jet patterns toward the right-posterior or posterior wall. Flow angles were clearly influenced by valve morphology (47 degrees 10, 28 degrees +/- 2, 29 degrees +/- 18, 18 degrees +/- 12, 15 degrees +/- 2 for unicuspid, true BAV, RN-BAV, RL-BAV, quadricuspid valves) and increased compared with controls (7.2 degrees +/- 1.1, P=0.001). ConclusionAltered 3D aortic hemodynamics are impacted by the morphology of congenitally malformed aortic valves.J. Magn. Reson. Imaging 2014;40:1342-1346. (c) 2013 Wiley Periodicals, Inc.