Biomechanical implications of the congenital bicuspid aortic valve: A finite element study of aortic root function from in vivo data Carlo A. Conti,

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Biomechanical implications of the congenital bicuspid aortic valve: A finite element study of aortic root function from in vivo data Carlo A. Conti, MD, Alessandro Della Corte, MD, PhD, Emiliano Votta, PhD, Luca Del Viscovo, MD, Ciro Bancone, MD, Luca S. De Santo, MD, Alberto Redaelli, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 140, Issue 4, Pages 890-896.e2 (October 2010) DOI: 10.1016/j.jtcvs.2010.01.016 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Comparison between BAV and TAV kinematics. A, Radial displacements of the noduli of Arantius of TAV leaflets (averaged value), BAV conjoint cusp, and BAV noncoronary leaflet plotted with the transvalvular pressure. B, Aortic view of the BAV model at maximal systolic opening. C, Short-axis view MRI scan at the maximal systolic opening frame. BAV, Bicuspid aortic valve; TAV, tricuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 890-896.e2DOI: (10.1016/j.jtcvs.2010.01.016) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Maximum principal stress distributions on the aortic root throughout the cardiac cycle for the BAV (top) and TAV (bottom) models. BAV, Bicuspid aortic valve; TAV, tricuspid aortic valve; R, right coronary sinus; L, left coronary sinus; NC, noncoronary sinus. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 890-896.e2DOI: (10.1016/j.jtcvs.2010.01.016) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Maximum principal stress distribution on the aortic root at peak aortic pressure: circumferential stresses on BAV (A) and TAV (C); longitudinal stresses on BAV (B) and TAV (D). The Journal of Thoracic and Cardiovascular Surgery 2010 140, 890-896.e2DOI: (10.1016/j.jtcvs.2010.01.016) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Maximum principal stress distributions on the aortic leaflets for 2 different models of the conjoint cusp. A, NT model without raphe. B, T model with raphe (ie, a thicker region at the site of cusp fusion). The Journal of Thoracic and Cardiovascular Surgery 2010 140, 890-896.e2DOI: (10.1016/j.jtcvs.2010.01.016) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Aortic root. A, sinus heights (hI = intermediate level, hm = maximum width level, hSTJ = sinotubular junction level = height of the sinus) and angles of aorta orientation. B, Example of sinus width measurement at the hm level: Lines passing through the point of maximum width of each sinus and its opposite commissure indicate the orientations of the 3 longitudinal views (Dr for the right coronary, Dl for the left coronary, and Dn for the noncoronary sinus) where sinus measurements were performed. C, Example of a sinotubular diameter measurement (DSTJ) on a long-axis view MRI scan oriented in the Dr plane. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 890-896.e2DOI: (10.1016/j.jtcvs.2010.01.016) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Finite element mesh of the aortic root with BAV: frontal (A) and aortic (B) views. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 890-896.e2DOI: (10.1016/j.jtcvs.2010.01.016) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions