Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns

Susanne Schnell*, Danielle A. Smith, Alex Jonathan Barker, Pegah Entezari, Amir R. Honarmand, Maria L. Carr, S Chris Malaisrie, Patrick M McCarthy, Jeremy D Collins, James Carr, Michael Markl

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Scopus citations


Bicuspid aortic valve (BAV) is known to exhibit familial inheritance and is associated with aortopathy and altered aortic haemodynamics. However, it remains unclear whether BAV-related aortopathy can be inherited independently of valve morphology. Methods and results Four-dimensional flow magnetic resonance imaging for the in vivo assessment of thoracic aortic 3D blood flow was performed in 24 BAV relatives with trileaflet aortic valves (age = 40+14 years) and 15 healthy controls (age = 37+10 years). Data analysis included aortic dimensions, shape (round/gothic/cubic), and 3D blood flow characteristics (semiquantitative vortex/helix grading and peak velocities). Cubic and gothic aortic shapes were markedly more prevalent in BAV relatives compared with controls (38 vs. 7%). Ascending aorta (AAo) vortex flow in BAV relatives was significantly increased compared with controls (grading = 1.5+1.0 vs. 0.6+0.9, P = 0.015). Aortic haemodynamics were influenced by aortic shape: peak velocities were reduced for gothic aortas vs. round aortas (P = 0.003); vortex flow was increased for cubic aortas in the AAo (P , 0.001) and aortic arch (P = 0.004); vortex and helix flows were elevated for gothic aortas in the AAo and descending aorta (P = 0.003, P = 0.029). Logistic regression demonstrated significant associations of shape with severity of vortex flow in AAo (P , 0.001) and aortic arch (P = 0.016) in BAV relatives. Conclusion BAV relatives expressed altered aortic shape and increased vortex flow despite the absence of valvular disease or aortic dilatation. These data suggest a heritable component of BAV-related aortopathy affecting aortic shape and aberrant blood flow, independent of valve morphology.

Original languageEnglish (US)
Pages (from-to)1239-1247
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number11
StatePublished - Jan 1 2016


  • 4D flow mri
  • Bicuspid aortic valve
  • Haemodynamics
  • Relatives

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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