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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 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

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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