Different levels of spatiotemporal heterogeneity characterize the aneurysmal and healthy ascending aorta hemodynamics, reflecting on wall shear stress topological skeleton. Peculiar wall shear stress topological skeleton features are linked to local ascending thoracic aortic aneurysms stiffness. The topological shear variation index, a measure of wall shear stress luminal contraction/expansion action variation along the cardiac cycle, is an indicator of local aortic wall degradation, performing better than canonical wall shear stress-based descriptors of flow disturbances. Wall shear stress topological skeleton analysis, combined with Complex Networks theory, contributes to better determine whether arterial wall degeneration, in combination with hemodynamic insult, leads to aneurysmal progression/rupture.

We present a comprehensive and original framework for the biomechanical analysis of patients affected by ascending thoracic aorta aneurysm and aortic insufficiency. Our aim is to obtain crucial indications about the role played by deranged hemodynamics on the ATAAs risk of rupture. Computational fluid dynamics analysis was performed using patient-specific geometries and boundary conditions derived from 4D MRI. Blood flow helicity and wall shear stress descriptors were assessed. A bulge inflation test was carried out in vitro on the 4 ATAAs after surgical repair. The healthy volunteers showed no eccentric blood flow, a mean TAWSS of 1.5 ± 0.3 Pa and mean OSI of 0.325 ± 0.025. In 3 aneurismal patients, jet flow impingement on the aortic wall resulted in large TAWSS values and low OSI which were amplified by the AI degree. However, the tissue strength did not appear to be significantly reduced. The fourth patient, which showed the lowest TAWSS due to the absence of jet flow, had the smallest strength in vitro. Interestingly this patient presented a bovine arch abnormality. Jet flow impingement with high WSS values is frequent in ATAAs and our methodology seems to be appropriate for determining whether it may increase the risk of rupture or not.