Computerized virtual surgery based on computational fluid dynamics simulation for planning coronary revascularization with aortic root replacement in adult congenital heart disease: a case report

Abstract

A 38-year-old woman presented with exertional dyspnea and chest compression. She had undergone repair of congenital supravalvular aortic stenosis at 8 years of age. Contrast-enhanced computed tomography showed re-stenosis in the ascending aorta, bilateral coronary arterial aneurysm, and a highly thickened left ventricular wall. Release of stenosis was necessary to avoid left ventricular functional deterioration; however, it could cause demand–supply mismatch in coronary flow due to substantial left ventricular hypertrophy. Sufficient statistical evidence was not available in this situation; therefore, computerized virtual surgery based on computational fluid dynamics (CFD) was performed to predict the postoperative hemodynamics. Consequently, root replacement with in situ Carrel patch coronary reconstruction was considered a better option than coronary artery graft bypass in the left-side coronary flow supply. The patient underwent root replacement with in situ Carrel patch coronary reconstruction as planned based on CFD without any complication and was discharged 15 days postoperatively.

Blood flow assessment technology in aortic surgery: a narrative review

“…We used this technology to decide whether to pursue concomitant coronary revascularization during aortic root replacement for a patient with supravalvular aortic root stenosis. After comparing postoperative coronary flow volume following a Bentall procedure with and without concomitant coronary artery bypass grafting (CABG), a preoperative decision to perform an isolated Bentall was made ( Figure 7 ) ( 80 ). Virtual surgery with CFD analysis can help determine the optimal surgical procedure personalized to an individual during preoperative planning.…”

“…In contrast, in the in-situ revascularization model, the systolic coronary blood flow decreased due to the reduction in the Valsalva pressure but with sufficiently increased coronary flow during diastole. Figure adapted with permission from Hohri et al ( 80 ). Pre-op, preoperative model; CABG, coronary artery bypass grafting; LAD, left anterior descending artery; Cx, circumflex branches; RCA, right coronary artery; ITA, internal thoracic artery; CFD, computational fluid dynamic.…”

Commentary: A picture is worth a thousand words, but only tells one story

“…CFD has a role in cardiac surgery, and with time we're confident it will find its place. 3 , 4 , 5 In the meantime, when making decisions, we should be cautious about the relative weight we give theoretical models when faced with contradictory clinical outcomes. The past does not always predict the future, particularly when it's built on assumptions.…”