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Bicuspid aortic valve is the most common congenital heart defect, affecting1-2% of the global population. Patients with bicuspid valves frequently developdilation and aneurysms of the ascending aorta. Both hemodynamic and geneticfactors are believed to contribute to dilation, yet the precise mechanismunderlying this progression remains under debate. Controlled comparisons ofhemodynamics in patients with different forms of bicuspid valve disease arechallenging because of confounding factors, and simulations offer theopportunity for direct and systematic comparisons. Using fluid-structureinteraction simulations, we simulate flows through multiple aortic valve modelsin a patient-specific geometry. The aortic geometry is based on a healthypatient with no known aortic or valvular disease, which allows us to isolatethe hemodynamic consequences of changes to the valve alone. Four fully-passive,elastic model valves are studied: a tricuspid valve and bicuspid valves withfusion of the left- and right-, right- and non-, and non- and left-coronarycusps. The resulting tricuspid flow is relatively uniform, with littlesecondary or reverse flow, and little to no pressure gradient across the valve.The bicuspid cases show localized jets of forward flow, excess streamwisemomentum, elevated secondary and reverse flow, and clinically significantlevels of stenosis. Localized high flow rates correspond to locations ofdilation observed in patients, with the location related to which valve cuspsare fused. Thus, the simulations support the hypothesis that chronic exposureto high local flow contributes to localized dilation and aneurysm formation.

Controlled Comparison of Simulated Hemodynamics across Tricuspid and Bicuspid Aortic Valves