A Combined In Vivo, In Vitro, In Silico Approach for Patient-Specific Haemodynamic Studies of Aortic Dissection

Abstract

The optimal treatment of Type-B aortic dissection (AD) is still a subject of debate, with up to 50% of the cases developing late-term complications requiring invasive intervention. A better understanding of the patient-specific haemodynamic features of AD can provide useful insights on disease progression and support clinical management. In this work, a novel in vitro and in silico framework to perform personalised studies of AD, informed by non-invasive clinical data, is presented. A Type-B AD was investigated in silico using computational fluid dynamics (CFD) and in vitro by means of a state-of-the-art mock circulatory loop and particle image velocimetry (PIV). Both models not only reproduced the anatomical features of the patient, but also imposed physiologically-accurate and personalised boundary conditions. Experimental flow rate and pressure waveforms, as well as detailed velocity fields acquired via PIV, are extensively compared against numerical predictions at different locations in the aorta, showing excellent agreement. This work demonstrates how experimental and numerical tools can be developed in synergy to accurately reproduce patient-specific AD blood flow. The combined platform presented herein constitutes a powerful tool for advanced haemodynamic studies for a range of vascular conditions, allowing not only the validation of CFD models, but also clinical decision support, surgical planning as well as medical device innovation.

Using a reduced‐order model to investigate the effect of the heart rate on the aortic dissection

“…Similar oscillations were observed in a 0D model reported by Reference [24]. Usually, the oscillations are filtered out in experimental results 25 . Our study shows that this oscillation may not be merely an artifact; especially if the oscillation of the wall is significant.…”

“…Usually, the oscillations are filtered out in experimental results. 25 Our study shows that this oscillation may not be merely an artifact; especially if the oscillation of the wall is significant. Comparing the results in Figure 5 shows that the boundary condition has a significant effect on the fluctuation of the pressure and the flow rates.…”

An in vitro Assessment of the Haemodynamic Features Occurring Within the True and False Lumens Separated by a Dissection Flap for a Patient-Specific Type B Aortic Dissection

“…Pirola et al ( 18 ) also compared their computational analysis with four-dimensional (4D) MRI. Bonfanti et al ( 19 ) conducted pulsatile in silico and in vitro analysis on the patient-specific Type B aortic dissection models. At present, no fluid-structure interaction (FSI) studies have been published on aortic dissections ( 20 ).…”

The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

“…In recent years, several studies have reported the importance of personalised computational fluid dynamics (CFD) methods along with imaging techniques to develop diagnosis and controlling approaches of aortic disease, in order to customize patient-specific treatment outcomes 23 – 29 . Some studies have shown the importance of the combination of particle image velocimetry and CFD simulations in type-B AD in pre-procedural planning, clinical decision support, and CFD models validation 30 , 31 . Several studies have focused on TEVAR based on the prediction of thrombus formation and growth of the FL 13 , 32 – 35 .…”