Abnormal Haemodynamic Flow Patterns in Bicuspid Pulmonary Valve Disease

Area of Science:

• Cardiovascular Imaging
• Hemodynamics
• Congenital Heart Disease

Background:

• Abnormal aortic flow patterns in bicuspid aortic valves (BAVs) are linked to aortic dilatation.
• Pulmonary flow patterns in bicuspid pulmonary valves (BPVs) remain unstudied.
• BPV disease is rare, but case reports suggest pulmonary artery dilation.

Purpose of the Study:

• To investigate pulmonary artery flow patterns in patients with BPV disease.
• To compare these patterns with healthy volunteers and patients with BAV and tricuspid pulmonary valves.
• To explore the role of hemodynamics in BPV-related vessel dilation.

Main Methods:

• Utilized time-resolved 3D cardiac MRI (4D flow) for anatomical and functional imaging.
• Assessed pulmonary valve, pulmonary artery, and right ventricle.
• Included three BPV cases, 10 healthy controls, and 10 BAV patients with tricuspid pulmonary valves.

Main Results:

• BPV patients exhibited pulmonary artery dilation and distinct helical flow abnormalities.
• Increased rotational flow and flow displacement were observed in BPV patients.
• Asymmetrical systolic wall shear stress (WSS) was noted, unlike in BAV patients with normal pulmonary valves.

Conclusions:

• BPV disease is associated with abnormal pulmonary artery hemodynamics, including helical flow and altered WSS.
• These findings mirror those in BAV disease, suggesting flow pattern importance in both conditions.
• Hemodynamic alterations may be a key factor in the pathogenesis of vessel dilation in bicuspid valve disease.