Ascending thoracic aorta aneurysm repair induces positive hemodynamic outcomes in a patient with unchanged bicuspid aortic valve

International audienceWe report a patient-specific case of bicuspid aortic valve with fusion of right and left coronary leaflets (RLtype I BAV), moderate aortic valve deficiency and ascending thoracic aortic aneurysms (ATAA) who wastreated by only ascending aorta replacement preserving the BAV. The flow eccentricity, the helicity intensity(h2), the circumferential time averaged wall shear stress (TAWSScircumferential), the cumulative viscousenergy loss at the systolic peak (E0L) and the pulse wave velocity (PWV) were calculated by combining 4Dflow MRI and CFD analysis before (Stage I) and after (Stage II) the surgical procedure. CFD analysesassumed rigid walls, a non-Newtonian behavior for the blood and MRI measured patient-specific bloodflow profiles as inlet boundary conditions. Stage II results showed suppression of recirculation in theascending aorta, loss of jet flow impingement onto the aortic wall, maximum TAWSScircumferential decrease(from 6.69 Pa in Stage I to 6 Pa in Stage II), reduction of flow helicity (from 10.97 in Stage I to 8.47 in StageII) and E0L (from 15.8 mW in Stage I to 11.2mW in Stage II). However, Floweccentricity and PWV were foundhigher in Stage II due to the diameter reduction (Floweccentricity = 0.60 in Stage I and Floweccentricity = 0.91 inStage II; PWV = 3.80 m/s in Stage I and PWV = 9.37 m/s in Stage II).Our work has permitted to compute for the first time the hemodynamic alterations obtained afterrestoration of normal ascending aorta and sinotubular junction geometry even preserving an R-L type IBAV with still acceptable function