Patient-Specific Numerical Analysis of Coronary Flow in Children With Intramural Anomalous Aortic Origin of Coronary Arteries

Patient-specific fluid–structure simulations of anomalous aortic origin of right coronary arteries

“… 9 , 31 Meanwhile, computational fluid dynamics simulations with rigid geometries showed how the narrowed intramural course caused significant hemodynamic abnormalities. 19 , 20 , 32 A 3D-printed model of an intramural AAORCA had an abnormally low FFR that normalized in a separate model of the postoperative geometry. 33 A cine CTA of an interarterial (but not intramural) anomalous left coronary found no luminal compression nor perfusion defect during dobutamine-stress.…”

“…Other analyses in rigid-wall computational fluid dynamics studies found significant sources of uncertainty in the coronary lumped-parameter network values, especially the microvascular resistance. 19 , 30 Despite the various sources of input variability, the resulting hemodynamic output was acceptably accurate such that the FFR predicted by CTA-based computational fluid dynamics is approved in the United States and the United Kingdom to guide clinical management of coronary artery disease. 17 Although adequately accurate for coronaries with normal origins, the robustness of computation simulations has yet to be proven for anomalous coronaries.…”

“…We can also preoperatively model the postoperative coronary anatomy and resulting hemodynamics to confirm that adequate coronary perfusion would be restored. 16 , 19 …”

“… 16 , 17 More recently, computational fluid dynamics has also been used to model the FFR and hemodynamics in AAOCA, but such methods have yet to be validated with direct measurements for anomalous coronaries. 18 , 19 , 20 Also, computational fluid dynamics modeling fails to simulate the coronary lumen compression that may occur during exercise. Meanwhile, advancements in fluid–structure interaction (FSI) modeling enable simultaneous modeling of blood flow and tissue deformation, but to our knowledge, this approach has not been applied to AAOCA.…”

Anomalous aortic origin of a coronary artery: 2020 year in review

“…The clinical relevance and validity of this model in real life remain to be determined. Another study by Razavi and colleagues 18 assessed coronary wall sheer stress using computational flow dynamics models in 6 patients after surgical repair of AAOCA (2 of them also had preoperative models). Coronary wall shear stress usually normalized after unroofing.…”