Fluid-Structure Interaction Predictions of Ascending Aorta Hemodynamics Under Tricuspid and Bicuspid Aortic Valve Flows

The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is present in 2–3% of the general population. As compared to the normal tricuspid aortic valve (TAV) which consists of three leaflets, the most prevalent type-I BAV morphology forms with two as a result of left-/right-coronary cusp fusion. While the BAV anatomy may not intrinsically hamper valvular function, it is associated with a spectrum of secondary aortopathy such as aortic dilation and subsequent dissection. The dilation and thinning of the ascending aorta downstream of a BAV is marked by structural wall abnormalities including smooth muscle cell depletion, elastic fiber degeneration and abnormal extracellular matrix remodeling, which localize to the convexity of the aortic wall.