{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:19:50Z","timestamp":1790770790623,"version":"4.1.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Ascending aortic dilation is important in bicuspid aortic valve (BAV) disease, with increased risk of aortic dissection. We used cardiovascular MR to understand the pathophysiology better by examining the links between 3-dimensional flow abnormalities, aortic function, and aortic dilation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              A total of 142 subjects underwent cardiovascular MR (mean age, 40 years; 95 with BAV, 47 healthy volunteers). Patients with BAV had predominantly abnormal right-handed helical flow in the ascending aorta, larger ascending aortas (18.3\u00b13.3 versus 15.2\u00b12.2 mm\/m\n              <jats:sup>2<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and higher rotational (helical) flow (31.7\u00b115.8 versus 2.9\u00b13.9 mm\n              <jats:sup>2<\/jats:sup>\n              \/s;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), systolic flow angle (23.1\u00b0\u00b112.5\u00b0 versus 7.0\u00b0\u00b14.6\u00b0;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and systolic wall shear stress (0.85\u00b10.28 versus 0.59\u00b10.17 N\/m\n              <jats:sup>2<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) compared with healthy volunteers. BAV with right-handed flow and right-non coronary cusp fusion (n=31) showed more severe flow abnormalities (rotational flow, 38.5\u00b116.5 versus 27.8\u00b112.4 mm\n              <jats:sup>2<\/jats:sup>\n              \/s;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; systolic flow angle, 29.4\u00b0\u00b110.9\u00b0 versus 19.4\u00b0\u00b111.4\u00b0;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; in-plane wall shear stress, 0.64\u00b10.23 versus 0.47\u00b10.22 N\/m\n              <jats:sup>2<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and larger aortas (19.5\u00b13.4 versus 17.5\u00b13.1 mm\/m\n              <jats:sup>2<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05) than right\u2013left cusp fusion (n=55). Patients with BAV with normal flow patterns had similar aortic dimensions and wall shear stress to healthy volunteers and younger patients with BAV showed abnormal flow patterns but no aortic dilation, both further supporting the importance of flow pattern in the pathogenesis of aortic dilation. Aortic function measures (distensibility, aortic strain, and pulse wave velocity) were similar across all groups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Flow abnormalities may be a major contributor to aortic dilation in BAV. Fusion type affects the severity of flow abnormalities and may allow better risk prediction and selection of patients for earlier surgical intervention.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.113.000528","type":"journal-article","created":{"date-parts":[[2013,6,15]],"date-time":"2013-06-15T03:12:10Z","timestamp":1371265930000},"page":"499-507","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":342,"title":["Aortic Dilation in Bicuspid Aortic Valve Disease"],"prefix":"10.1161","volume":"6","author":[{"given":"Malenka M.","family":"Bissell","sequence":"first","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron T.","family":"Hess","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Biasiolli","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffan J.","family":"Glaze","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Loudon","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Pitcher","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Davis","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Prendergast","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Markl","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex J.","family":"Barker","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Neubauer","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saul G.","family":"Myerson","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (M.M.B., A.T.H., L.B., S.J.G., M.L., A.P., A.D., S.N., S.G.M.); Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (B.P., S.G.M.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M., A.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.1.81"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2011.02.007"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.31872"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2011.01.001"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.07.044"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.09.118"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2011.05.004"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.112.973370"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.01.039"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.03.005"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.108.768911"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(78)80601-5"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32835a8eb1"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.20871"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.rct.0000232918.45158.c9"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.21778"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.09091437"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/13.11.607"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-15-S1-E36"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-15-S1-O79"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-009-9495-5"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00133570"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.22124"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.10.014"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-14-84"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(02)00441-4"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2008.12.033"},{"key":"e_1_3_3_29_2","article-title":"Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study.","author":"Meierhofer C","year":"2012","unstructured":"Meierhofer C, Schneider EP, Lyko C, Hutter A, Martinoff S, Markl M, Hager A, Hess J, Stern H, Fratz S. 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