Computational fluid dynamics simulations as a complementary study for transcatheter endovascular stent implantation for re-coarctation of the aorta associated with minimal pressure drop: an aneurysmal ductal ampulla with aortic isthmus narrowing

Guillot, Martin; Ascuitto, R.J.; Ross-Ascuitto, Nancy; Mallula, Kiran K.; Siwik, Ernest

doi:10.1017/s1047951119000751

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…Regarding the latter area, the flow separates from the aortic wall exactly after leaving the tapered region. It goes through vortex formation leading to low-velocity flow, which eventually provoked low and multidirectional WSS vectors, leading to high RRT at the descending aorta, seen in other studies too 72 – 74 . For the severe CoA case, RRT contours show the disturbed hemodynamics in the lower parts of the descending aorta, which means that a larger portion of the vessel needs to be treated.…”

Section: Discussionmentioning

confidence: 62%

The effect of coarctation degrees on wall shear stress indices

Rafieianzab

Abazari

Soltani

et al. 2021

Sci Rep

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Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid–solid interaction models are developed. Since there is no clear approach for managing the CoA regarding its severity, this study proposes the use of WSS indices and pressure gradient to better establish a framework for treatment procedures in CoA patients with different severities. This provides a platform for improving CoA therapy on a patient-specific level, in which physicians can perform treatment methods based on WSS indices on top of using a mere experience. Results show how severe CoA affects the aorta in comparison to the milder cases, which can give the medical community valuable information before and after any intervention.

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Section: Discussionmentioning

confidence: 62%

The effect of coarctation degrees on wall shear stress indices

Rafieianzab

Abazari

Soltani

et al. 2021

Sci Rep

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show abstract

Section: Discussionmentioning

confidence: 60%

The Effect of Coarctation Degrees on Wall Shear Stress Indices: An FSI Study

Rafieianzab¹,

Abazari²,

Soltani³

et al. 2021

Preprint

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Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid-solid interaction (FSI) models are developed. Since there is no specific routine for managing the CoA regarding its severity, this study investigates haemodynamics in regions where clinicians do not have any information that would help physicians introduce a framework when and where initiating the intervention.

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“…For instance, WSS changes can be related to areas of plaque formation in locations influenced by surgical CoA repair, such as resection with end-to-end anastomosis (19). The modeling literature suggests that simulations can be used to assess changes in aortic wall biomechanics after a percutaneous procedure (e.g., stenting) (21), to detect unfavorable flow patterns in patients with re-CoA (22), and to plan interventions in complex scenarios (23). In the present study, a computational approach was chosen to isolate the effect of aortic arch geometry (based on representative anatomical configurations of the aortic arch derived from a statistical shape modeling framework, rather than individual patients' anatomies) and offer new insights into the hemodynamic effect of aortic arch architecture, particularly in the presence of a repaired CoA.…”

Section: Discussionmentioning

confidence: 99%

Isolating the Effect of Arch Architecture on Aortic Hemodynamics Late After Coarctation Repair: A Computational Study

Ardakani

Goordoyal

Ordóñez

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesEffective management of aortic coarctation (CoA) affects long-term cardiovascular outcomes. Full appreciation of CoA hemodynamics is important. This study aimed to analyze the relationship between aortic shape and hemodynamic parameters by means of computational simulations, purposely isolating the morphological variable.MethodsComputational simulations were run in three aortic models. MRI-derived aortic geometries were generated using a statistical shape modeling methodology. Starting from n = 108 patients, the mean aortic configuration was derived in patients without CoA (n = 37, “no-CoA”), with surgically repaired CoA (n = 58, “r-CoA”) and with unrepaired CoA (n = 13, “CoA”). As such, the aortic models represented average configurations for each scenario. Key hemodynamic parameters (i.e., pressure drop, aortic velocity, vorticity, wall shear stress WSS, and length and number of strong flow separations in the descending aorta) were measured in the three models at three time points (peak systole, end systole, end diastole).ResultsComparing no-CoA and CoA revealed substantial differences in all hemodynamic parameters. However, simulations revealed significant increases in vorticity at the site of CoA repair, higher WSS in the descending aorta and a 12% increase in power loss, in r-CoA compared to no-CoA, despite no clinically significant narrowing (CoA index >0.8) in the r-CoA model.ConclusionsSmall alterations in aortic morphology impact on key hemodynamic indices. This may contribute to explaining phenomena such as persistent hypertension in the absence of any clinically significant narrowing. Whilst cardiovascular events in these patients may be related to hypertension, the role of arch geometry may be a contributory factor.

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Computational fluid dynamics simulations as a complementary study for transcatheter endovascular stent implantation for re-coarctation of the aorta associated with minimal pressure drop: an aneurysmal ductal ampulla with aortic isthmus narrowing

Cited by 3 publications

References 30 publications

The effect of coarctation degrees on wall shear stress indices

The effect of coarctation degrees on wall shear stress indices

The Effect of Coarctation Degrees on Wall Shear Stress Indices: An FSI Study

Isolating the Effect of Arch Architecture on Aortic Hemodynamics Late After Coarctation Repair: A Computational Study

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