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Left main Stenosis Stenting Normalizes Wall Shear Stress of Ascending Aorta in Bicuspid Aortic Valve

Published Online: December 23rd 2020 Heart International. 2020;14(2):Online ahead of journal publication
Authors: Gianluca Rigatelli, Marco Zuin
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Abstract:
Overview

Introduction: Bicuspid aortic valve (BAV) is associated with dilation and dissection of the ascending aorta. The high shear forces within the ascending aorta lumen seem to have a pivotal role on the development of such complications. We describe the Time- Averaged Wall Shear Stress(TAWSS) forces in a patient with normally functioning BAV and significant ostial/mid-shaft left main (LM) stenosis using computational fluid dynamic analysis (CFD).

Case report: A 47-year-old female patient, with normally functioning BAV with fusion of right and noncoronary cusps was investigated for unstable angina. CFD and stress mapping of the ascending aorta before LM stenting showed a mean TAWSS of 9.4 Pa and was associated with higher TAWSS values at the site of LM stenosis. The LM lesion was treated by stent implantation of an a Orsiro 4.0 × 12 mm at 18 atm preceded with a pre-dilation with noncompliant Euphora (Medtronic Inc, USA) balloon 3.0 × 12 mm at 16 atm and followed by an over-dilation with 4.5 × 12 mm noncompliant Euphora (Medtronic Inc, USA) balloon at 20 atm. The reconstructed post-procedural model revealed a decrease of the mean ascending aorta TAWSS to 5.6 Pa.

Conclusions: As suggested by our case, stenting of LM lesion in BAV patient has the potential to improve the TAWSS in the ascending aorta protecting ascending aorta from the well-known complications of BAV.

Keywords

Bicuspid aorta, Left Main; Stenting; Angioplasty; Wall shear stress.

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**This manuscript has been accepted for publication, but not yet copyedited or typeset, and may be subject to minor changes during the production process.**

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Disclosure

Gianluca Rigatelli and Marco Zuin have no financial or non-financial relationships or activities to declare in relation to this article.

Compliance With Ethics

Informed consent was received from the patient for publication of this case report and accompanying images. No identifying information has been included.

Review Process

Double-blind peer review.

Authorship

The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Correspondence

Gianluca Rigatelli, MD, PhD, EBIR, FACC, FSCAI Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital Viale tre Martiri, Rovigo 45100, Italy E: jackyheart@libero.it

Support

No funding was received in the publication of this article.

Open Access

This article is freely accessible at touchCARDIO.com © Touch Medical Media 2020.

Received

2020-09-11

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