UCSF

Background

Bicuspid aortic valve-associated ascending thoracic aortic aneurysms (BAV-aTAAs) carry a risk of acute type A dissection. Biomechanically, dissection may occur when wall stress exceeds wall strength. Our aim was to develop patient-specific computational models of BAV-aTAAs to determine magnitudes of wall stress by anatomic regions.

Methods

Patients with BAV-aTAA diameter greater than 4.5 cm (n = 41) underwent electrocardiogram-gated computed tomography angiography. Three-dimensional aneurysm geometries were reconstructed after accounting for prestress and loaded to systemic pressure. Finite element analyses were performed with fiber-embedded hyperelastic material model using LS-DYNA software (LSTC Inc, Livermore, CA) to obtain wall stress distributions. The 99th percentile longitudinal and circumferential stresses were determined at systole.

Results

The 99th percentile longitudinal wall stresses for BAV-aTAAs at sinuses of Valsalva, sinotubular junction (STJ), and ascending aorta were 361 ± 59.8 kPa, 295 ± 67.2 kPa, and 224 ± 37.6 kPa, respectively, with significant differences in ascending aorta vs sinuses (P< 1 × 10^-13) and STJ (P < 1 × 10^-6). The 99th percentile circumferential wall stresses were 474 ± 88.2 kPa, 634 ± 181.9 kPa, and 381 ± 54.0 kPa for sinuses, the STJ, and the ascending aorta, respectively, with significant differences in the ascending aorta vs sinuses (P = .002) and STJ (P < 1 × 10^-13).

Conclusions

Wall stresses, both circumferential and longitudinal, were greater in the aortic root, sinuses, and STJ than in the ascending aorta on BAV-aTAAs. These results fill a fundamental knowledge gap regarding biomechanical stress distribution in BAV-aTAA patients, which when related to wall strength may provide prognostication of aTAA dissection risk by patient-specific modeling.