Table 1.

Summary of hemodynamic and biomechanical influences in TAV, BAV R/L, and BAV R/NC.

Indices	Normal TAV	BAV R/L Configuration	BAV R/NC Configuration	References
Hemodynamics Studies
Valve Orifice Shape/Size	Circular, round orifice, large valve opening area	Elliptical, clamshell-shaped orifice, reduced opening area	Elliptical, clamshell-shaped orifice, reduced opening area	(28, 36)
Systolic Jet Velocity/Direction	Centrally-aligned velocity jet at physiologic magnitudes	High velocity jet skewed towardz right-anterior wall of AAo	High velocity skewed towardz right-posterior wall AAo	(36, 41, 47, 55)
Vortex and Helical Structures	Symmetrical vortical structures in cusp sinuses Absence of abnormal helical flow downstream in AAo	Larger, low velocity vortex in fused cusp sinus; smaller, high velocity vortex in non-fused sinus Right-handed helical flow in AAo	Larger, low velocity vortex in fused cusp sinus; smaller, high velocity vortex in non-fused sinus Left-handed helical flow in AAo	(13, 29, 32, 33, 43, 53)
Cusp Wall Shear Stress (WSS)	High magnitude & unidirectional WSS on ventricularis Low magnitude & oscillatory WSS on fibrosa Magnitude gradually decreases from tip to attachment region	High magnitude & unidirectional WSS on ventricularis of fused and non-fused cusps Elevated WSS on non-fused cusp fibrosa; Sub-physiologic WSS on fused cusp fibrosa	*	(28, 29, 34, 42, 53, 56, 57)
Biomechanics Studies
Stress/Strain	Cusp stretch and strain are greatest during diastole and in the radial direction High strain along tip region and high von Mises stress along attachment and commissural region	Increased radial strain on fused cusp while circumferential strain is similar to TAV High principal stress on the fused leaflet in attachment and commissural region	*	(28, 29)

TAV, tricuspid aortic valve; BAV, bicuspid aortic valve; R, right coronary; L, left coronary; NC, noncoronary; AAo, ascending aorta.

^*Limited data to support conclusions.