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Updated: May 4, 2026

Biaxial Mechanical Characterizations of Atrioventricular Heart Valves
Published on: April 9, 2019
Bicuspid aortic valves experience increased strain as compared to tricuspid aortic valves
Kai Szeto1, Peter Pastuszko, Juan C del Álamo
1Department of Pediatrics (Cardiology), University of California San Diego, La Jolla, CA, USA.
Objective:
To determine whether the leaflets of bicuspid aortic valve (BAV) experience increased strain when compared to tricuspid aortic valve (TAV) leaflets.
Background:
The population at highest risk of aortic valve calcification (AVC) are individuals with BAVs. Currently, efforts to medically treat AVC are hampered by a limited understanding of the biomechanical forces involved in the molecular pathogenesis of AVC.
Methods:
Surgically created BAVs and control TAVs were placed into a left heart simulator. Strains were calculated by comparing the distances between points on the aortic valve (AoV) leaflet during various time points during a simulated cardiac cycle.
Results:
The fused leaflets of BAVs experience significantly more strain during systole when compared to TAVs. Specifically, BAVs experience 24% strain (P < .0001) in the radial direction, parallel to the direction of blood flow, as compared to TAVs. There was peak difference of 4% (P < .001) in the circumferential direction.
Discussion:
Based upon the data presented here, we are in the process of identifying how increased strain activates calcification-associated pathways in AoV cells. Future studies will examine whether these stretch responsive pathways can be blocked to inhibit calcification of BAVs.
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