Elevated WSS is atheroprotective but implies greater medial degradation. Lower WSS degenerates endothelium and determines aneurysm area with lower dilation and rupture risk. OSI distinguishes aneurysm for rupture. Through 4D-flow MRI we analyze WSS and OSI ascending aortic regional differences in 27 BAV patients and 11 controls. Despite average WSS and OSI do not different among TAV and BAV, RL-BAV and RN-BAV and dilated and non-dilated BAV, regional differences have been found. Of most interest, dilated BAVs have partially overlapping regions of lower WSS and high OSI in the distal-anterior ascending aorta which may explain ascending aorta dilation morphotype
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