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

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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.

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Abbreviations

ALE:

Arbitrary Lagrangian–Eulerian

AoSA:

Aortoseptal angle

AR:

Aortic regurgitation

AV:

Aortic valve

CCW:

Counterclockwise

CTRL:

Control group

CW:

Clockwise

DSS:

Discrete subaortic stenosis

EOA:

Effective orifice area

FSI:

Fluid-structure interaction

LV:

Left ventricle

LVOT:

Left ventricular outflow tract

OSI:

Oscillatory shear index

RF:

Regurgitant fraction

RMS:

Root mean square

TSM:

Temporal shear magnitude

WSS:

Wall shear stress

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Acknowledgments

The authors would like to thank Dr. Matt Sherwood and Mr. Aaron Madaris (Wright State University) for their assistance in acquiring the MRI data.

Funding

This work was supported in part by the National Institutes of Health (NIH) Grant R01HL140305, and the College of Engineering and Computer Science at Wright State University.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Authors and Affiliations

  1. Department of Mechanical and Materials Engineering, Wright State University, Dayton, USA

    Jason A. Shar

  2. Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, USA

    Sundeep G. Keswani

  3. Department of Bioengineering, Rice University, Houston, USA

    K. Jane Grande-Allen

  4. Department of Mechanical Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA, 30060, USA

    Philippe Sucosky

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  1. Jason A. Shar
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  2. Sundeep G. Keswani
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  3. K. Jane Grande-Allen
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  4. Philippe Sucosky
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Correspondence to Philippe Sucosky.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Shar, J.A., Keswani, S.G., Grande-Allen, K.J. et al. Computational Assessment of Valvular Dysfunction in Discrete Subaortic Stenosis: A Parametric Study. Cardiovasc Eng Tech 12, 559–575 (2021). https://doi.org/10.1007/s13239-020-00513-8

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