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Shar JA, Keswani SG, Grande-Allen KJ, et al. Computational Assessment of Valvular Dysfunction in Discrete Subaortic Stenosis: A Parametric Study. Cardiovasc Eng Technol. 2021;12(6):559-575doi: 10.1007/s13239-020-00513-8.
Shar, J. A., Keswani, S. G., Grande-Allen, K. J., & Sucosky, P. (2021). Computational Assessment of Valvular Dysfunction in Discrete Subaortic Stenosis: A Parametric Study. Cardiovascular engineering and technology, 12(6), 559-575. https://doi.org/10.1007/s13239-020-00513-8
Shar, Jason A, et al. "Computational Assessment of Valvular Dysfunction in Discrete Subaortic Stenosis: A Parametric Study." Cardiovascular engineering and technology vol. 12,6 (2021): 559-575. doi: https://doi.org/10.1007/s13239-020-00513-8
Shar JA, Keswani SG, Grande-Allen KJ, Sucosky P. Computational Assessment of Valvular Dysfunction in Discrete Subaortic Stenosis: A Parametric Study. Cardiovasc Eng Technol. 2021 Dec;12(6):559-575. doi: 10.1007/s13239-020-00513-8. Epub 2021 Jan 11. PMID: 33432514; PMCID: PMC8272786.
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Cardiovasc Eng Technol. 2021 Dec;12(6):559-575. doi: 10.1007/s13239-020-00513-8. Epub 2021 Jan 11.

Computational Assessment of Valvular Dysfunction in Discrete Subaortic Stenosis: A Parametric Study.

Cardiovascular engineering and technology

Jason A Shar, Sundeep G Keswani, K Jane Grande-Allen, Philippe Sucosky

Affiliations

  1. Department of Mechanical and Materials Engineering, Wright State University, Dayton, USA.
  2. Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, USA.
  3. Department of Bioengineering, Rice University, Houston, USA.
  4. Department of Mechanical Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA, 30060, USA. [email protected].

PMID: 33432514 PMCID: PMC8272786 DOI: 10.1007/s13239-020-00513-8

Abstract

PURPOSE: Discrete subaortic stenosis (DSS) is a left-ventricular outflow tract (LVOT) obstruction caused by a membranous lesion. DSS is associated with steep aortoseptal angles (AoSAs) and is a risk factor for aortic regurgitation (AR). However, the etiology of AR secondary to DSS remains unknown. This study aimed at quantifying computationally the impact of AoSA steepening and DSS on aortic valve (AV) hemodynamics and AR.

METHODS: An LV geometry reconstructed from cine-MRI data was connected to an AV geometry to generate a unified 2D LV-AV model. Six geometrical variants were considered: unobstructed (CTRL) and DSS-obstructed LVOT (DSS), each reflecting three AoSA variations (110°, 120°, 130°). Fluid-structure interaction simulations were run to compute LVOT flow, AV leaflet dynamics, and regurgitant fraction (RF).

RESULTS: AoSA steepening and DSS generated vortex dynamics alterations and stenotic flow conditions. While the CTRL-110° model generated the highest degree of leaflet opening asymmetry, DSS preferentially altered superior leaflet kinematics, and caused leaflet-dependent alterations in systolic fluttering. LVOT steepening and DSS subjected the leaflets to increasing WSS overloads (up to 94% increase in temporal shear magnitude), while DSS also increased WSS bidirectionality on the inferior leaflet belly (+ 0.30-point in oscillatory shear index). Although AoSA steepening and DSS increased diastolic transvalvular backflow, regurgitant fractions (RF < 7%) remained below the threshold defining clinical mild AR.

CONCLUSIONS: The mechanical interactions between AV leaflets and LVOT steepening/DSS hemodynamic derangements do not cause AR. However, the leaflet WSS abnormalities predicted in those anatomies provide new support to a mechanobiological etiology of AR secondary to DSS.

© 2021. Biomedical Engineering Society.

Keywords: Aortic regurgitation; Aortic valve; Discrete subaortic stenosis; Fluid-structure interaction modeling; Hemodynamics

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