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. Author manuscript; available in PMC: 2016 Aug 25.
Published in final edited form as: J Am Coll Cardiol. 2015 Aug 25;66(8):892–900. doi: 10.1016/j.jacc.2015.06.1310

CENTRAL ILLUSTRATION. 4D Flow CMR and BAV Aortopathy.

CENTRAL ILLUSTRATION

Using 4-dimensional flow cardiac magnetic resonance imaging (4D flow CMR), we assessed the relation between wall shear stress (WSS) and regional aortic tissue remodeling in bicuspid aortic valve (BAV) patients. Elevated aortic WSS generated by aberrant flow from cusp fusion corresponded to more severe extracellular matrix (ECM) dysregulation than adjacent regions of normal WSS in the same patient's aorta. Characteristic medial degeneration was observed throughout the aorta, but elastic fiber degeneration was more severe in regions of elevated WSS (less elastin, thinner fibers, and greater distances between laminae), where higher concentrations of mediators of ECM dysregulation (matrix metalloproteinase [MMP] and transforming growth factor beta [TGFβ]) are also observed. These data implicate valve-related hemodynamics as a contributing factor to BAV aortopathy.