Experimental and computational study of pulsatile flow characteristics in Romanesque and gothic aortic arch models

Zhang, Yan; Zhang, Ruihang; Thomas, Nick L.; Ullah, Al Habib; Eichholz, Benjamin; Estevadeordal, Jordi; Suzen, Yildirim

doi:10.1016/j.medengphy.2022.103784

Cited by 8 publications

(3 citation statements)

References 45 publications

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“…The 2022 American Heart Association (ACC)/American College of Cardiology (AHA) report states that TTE showing the peak systolic pressure gradient (PSPG) >20 mmHg based on upper extremity hypertension or left ventricular hypertrophy confirms the diagnosis of CoA ( 25 ). As shown in Figure 3 , the aortic arch in this case is a gothic arch, with high pressure of about 125 mmHg from the ascending aorta to the distal of the stenosis, excessive blood supply to the brain and upper limb, sharp decrease in pressure at the stenosis, low blood pressure of the descending aorta, and insufficient blood supply to the lower body, according to which the clinical results such as oliguria and weakened femoral pulse could be explained from kinetics ( 26 ). The flow rate of the section of the aorta from ascending aorta to stenosis is uniform, about 1.2–1.7 m/s, and the blood flow is in a good laminar flow state.…”

Section: Discussionmentioning

confidence: 80%

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

et al. 2023

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ObjectiveTo study the differences in computed tomography angiography (CTA) imaging of gothic arches, crenel arches, and romanesque arches in children with Aortic Coarctation (CoA), and to apply computational fluid dynamics (CFD) to study hemodynamic changes in CoA children with gothic arch aorta.MethodsThe case data and CTA data of children diagnosed with CoA (95 cases) in our hospital were retrospectively collected, and the morphology of the aortic arch in the children was defined as gothic arch (n = 27), crenel arch (n = 25) and romanesque arch (n = 43). The three groups were compared with D1/AOA, D2/AOA, D3/AOA, D4/AOA, D5/AOA, and AAO-DAO angle, TAO-DAO angle, and aortic arch height to width ratio (A/T). Computational fluid dynamics was applied to assess hemodynamic changes in children with gothic arches.ResultsThere were no significant differences between D1/AOA and D2/AOA among gothic arch, crenel arch, and romanesque arch (P > 0.05). The differences in D3/AOA, D4/AOA, and D5/AOA among the three groups were statistically significant (P < 0.05), D4/AOA, D5/AOA of the gothic arch group were smaller than the crenel arch group, and the D3/AOA and D5/AOA of the gothic arch group were smaller than the romanesque arch group (P < 0.05). The difference in AAO-DAO angle among the three groups was statistically significant (P < 0.05), and the AAO-DAO angle of gothic arch was smaller than that of romanesque arch and crenel arch group (P < 0.05). There was no significant difference in the TAO-DAO angle between the three groups (P > 0.05). The difference in A/T values among the three groups was statistically significant (P < 0.05), and the A/T values: gothic arch > romanesque arch > crenel arch (P < 0.05). The CFD calculation of children with gothic arch showed that the pressure drop between the distal stenosis and the descending aorta was 58 mmHg, and the flow rate at the isthmus and descending aorta was high and turbulent.ConclusionGothic aortic arch is common in CoA, it may put adverse effects on the development of the aortic isthmus and descending aorta, and its A/T value and AAO-DAO angle are high. CFD could assess hemodynamic changes in CoA.

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Section: Discussionmentioning

confidence: 80%

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

et al. 2023

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“…Elzenga and Gittenberger-de Groot et al studied 45 CoA specimens obtained at surgery. CoA specimens were characterised by the presence of intimal thickening, with ductal tissue forming half of the total circumference of the CoA segments in comparison to normal aortas where it formed less than one-third of the circumference [23].…”

Section: Pathophysiology and Geneticsmentioning

confidence: 99%

“…CMR has also been utilised in the research setting to refine our understanding of operated aortic anatomy and haemodynamics, including the impact of aortic arch shape [ 43 ] on wall shear stress [ 44 ] and subsequent downstream secondary flow patterns. [ 45 ] Individual geometry has been shown to have consequences in terms of the incidence of later complications, with a correlation between a ‘gothic’ arch, characterised by a more angulated arch with an increased height-to-width ratio, and resting and exercise-induced hypertension, as well as increased aortic wall stiffness. [ 46 , 47 , 48 ] Bruse et al utilised 3D printed models of individual aortic arches in patients with repaired CoA, utilising a novel shape analysis method to derive 3D shape characteristics most correlated to left ventricular ejection fraction and left ventricular diastolic volume.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Coarctation of the Aorta: Diagnosis and Management

et al. 2023

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Coarctation of the aorta (CoA) accounts for approximately 5–8% of all congenital heart defects. Depending on the severity of the CoA and the presence of associated cardiac lesions, the clinical presentation and age vary. Developments in diagnosis and management have improved outcomes in this patient population. Even after timely repair, it is important to regularly screen for hypertension. Patients with CoA require lifelong follow-up with a congenital heart disease specialist as these patients may develop recoarctation and complications at the repair site and remain at enhanced cardiovascular risk throughout their lifetime.

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Effect of Ascending Aortic Curvature on Flow in the Sinus and Neo-sinus Following TAVR: A Patient-Specific Study

Kim,

Sadri,

Chen

et al. 2023

Ann Biomed Eng

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Experimental and computational study of pulsatile flow characteristics in Romanesque and gothic aortic arch models

Cited by 8 publications

References 45 publications

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

Coarctation of the Aorta: Diagnosis and Management

Effect of Ascending Aortic Curvature on Flow in the Sinus and Neo-sinus Following TAVR: A Patient-Specific Study

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