Hemodynamics alteration in patient-specific dilated ascending thoracic aortas with tricuspid and bicuspid aortic valves

Jayendiran, R.; Campisi, Salvatore; Viallon, Magalie; Croisille, Pierre; Avril, Stéphane

doi:10.1016/j.jbiomech.2020.109954

Cited by 14 publications

(5 citation statements)

References 63 publications

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“…Although all the donors had a tricuspid aortic valve (Tab. 1), both AnevPrim2 and AnevPrim3 donors had aortic valve dysfunctions (AnevPrim3 donor harbored a mechanical prosthesis) inducing significant hemodynamic disturbance, which are traditionally typical of bicuspid aortic valves, and which were shown to induce significant remodelling in the aortic wall (Guzzardi et al 2015;Michel et al 2018;Jayendiran et al 2020).…”

Section: Differences Between Healthy and Aneurysmal Smcsmentioning

confidence: 99%

Regulation of SMC traction forces in human aortic thoracic aneurysms

Petit

Yousefi

Moussa

et al. 2021

Biomech Model Mechanobiol

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Smooth muscle cells (SMCs) usually express a contractile phenotype in the healthy aorta. However, aortic SMCs have the ability to undergo profound changes in phenotype in response to changes in their extracellular environment, as occurs in ascending thoracic aortic aneurysms (ATAA). Accordingly, there is a pressing need to quantify the mechanobiological effects of these changes at single cell level. To address this need, we applied Traction Force Microscopy (TFM) on 759 cells coming from three primary healthy (AoPrim) human SMC lineages and three primary aneurysmal (AnevPrim) human SMC lineages, from age and gender matched donors. We measured the basal traction forces applied by each of these cells onto compliant hydrogels of different stiffness (4, 8, 12, 25 kPa). Although the range of force generation by SMCs suggested some heterogeneity, we observed that: 1. the traction forces were significantly larger on substrates of larger stiffness; 2. traction forces in AnevPrim were significantly higher than in AoPrim cells. We modelled computationally the dynamic force generation process in SMCs using the motor-clutch model and found that it accounts well for the stiffness-dependent traction forces. The existence of larger traction forces in the AnevPrim SMCs were related to the larger size of cells in these lineages. We conclude that phenotype changes occurring in ATAA, which were previously known to reduce the expression of elongated and contractile SMCs (rendering SMCs less responsive to vasoactive agents), tend also to induce stronger SMCs. Future work aims at understanding the causes of this alteration process in aortic aneurysms.

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Section: Differences Between Healthy and Aneurysmal Smcsmentioning

confidence: 99%

Regulation of SMC traction forces in human aortic thoracic aneurysms

Petit

Yousefi

Moussa

et al. 2021

Biomech Model Mechanobiol

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“…The hemodynamic patterns depend on the blood flow eccentricity at the aortic root regardless of the aortic valve phenotype [ 43 ]. The blood flow vortices produce the excessive mechanical stresses at certain aortic wall locations, which further become the foci of the dilatation and, eventually, they become the entry sites for acute aortic dissections in patients with aortic arch variants.…”

Section: Biomechanical Properties Of Ascending Aortamentioning

confidence: 99%

Existing and Emerging Approaches to Risk Assessment in Patients with Ascending Thoracic Aortic Dilatation

et al. 2022

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Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966–2022, Web of Science 1975–2022, Scopus 1975–2022, and RSCI 1994–2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young’s elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient’s genotypes and phenotypes in this heterogeneous pathology.

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“…13 Ascending Aorta Computational Fluid Dynamics (CFD) is a well known engineering tool used in a wide range of applications which has recently been considered for use in medical applications. It has quickly become an invaluable tool and has been used to achieve multiple advances and breakthroughs 17,18 . A framework was determined to use patient-specific CFD to improve the design of prosthetic heart vales and the implantation procedures 17 , whilst research also used patient-specific CFD to conclude that eccentricity at the aortic root is a major determinant of the haemodynamic patterns in ascending thoracic aortic aneurysm patients 18 .…”

Section: Studymentioning

confidence: 99%

The Impact of 4D-Flow MRI Spatial Resolution on Patient-Specific CFD Simulations of the Thoracic Aorta

Cherry

Khatir

Khan

et al. 2022

Preprint

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Magnetic Resonance Imaging (MRI) is considered the gold standard of medical imaging technologies as it allows for accurate imaging of blood vessels. 4-Dimensional Flow Magnetic Resonance Imaging (4D-Flow MRI) is built on conventional MRI, and provides flow data in the three vector directions and a time resolved magnitude data set. As such it can be used to retrospectively calculate haemodynamic parameters of interest, such as Wall Shear Stress (WSS). However, multiple studies have indicated that a significant limitation of the imaging technique is the spatiotemporal resolution that is currently available. Recent advances have proposed and successfully integrated 4D-Flow MRI imaging techniques with Computational Fluid Dynamics (CFD) to produce patient-specific simulations that have the potential to aid in treatments,surgical decision making, and risk stratification. However, the consequences of using insufficient 4D-Flow MRI spatial resolutions on any patient-specific CFD simulations is currently unclear, despite being a recognised limitation. The research presented in this study aims to quantify the error in patient-specific 4D-Flow MRI based CFD simulations that can be attributed to insufficient spatial resolutions when acquiring 4D-Flow MRI data. For this research, a patient has undergone four 4D-Flow MRI scans acquired at various isotropic spatial resolutions and patient-specific CFD simulations have subsequently been run using geometry and velocity data produced from each scan. It was found that compared to CFD simulations based on a 1.5mm x 1.5mm x 1.5mm, using a spatial resolution of 4mm x 4mm x 4mm substantially underestimated the maximum velocity magnitude at peak systole by 110.55%. The impacts of 4D-Flow MRI spatial resolution on WSS calculated from CFD simulations have been investigated and it has been shown that WSS is underestimated in CFD simulations that are based on a coarse 4D-Flow MRI spatial resolution. The authors have concluded that a minimum 4D-Flow MRI spatial resolution of 1.5mm x 1.5mm x 1.5mm must be used when acquiring 4D-Flow MRI data to perform patient-specific CFD simulations. A coarser spatial resolution will produce substantial errors within the flow field and geometry.

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Hemodynamics alteration in patient-specific dilated ascending thoracic aortas with tricuspid and bicuspid aortic valves

Cited by 14 publications

References 63 publications

Regulation of SMC traction forces in human aortic thoracic aneurysms

Regulation of SMC traction forces in human aortic thoracic aneurysms

Existing and Emerging Approaches to Risk Assessment in Patients with Ascending Thoracic Aortic Dilatation

The Impact of 4D-Flow MRI Spatial Resolution on Patient-Specific CFD Simulations of the Thoracic Aorta

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