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Ghanbarzadeh-Dagheyan A, van Helvert M, van de Velde L, Reijnen MMPJ, Versluis M, Groot Jebbink E. Swirling Flow Quantification in Helical Stents Using Ultrasound Velocimetry. J Endovasc Ther 2024:15266028241283326. [PMID: 39397375 DOI: 10.1177/15266028241283326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
OBJECTIVE Helical stents have been developed to treat peripheral arterial disease (PAD) in the superficial femoral artery (SFA), with the premise that their particular geometry could promote swirling flow in the blood. The aim of this work is to provide evidence on the existence of this swirling flow by quantifying its signatures. MATERIALS AND METHODS This study consists of in vitro and in vivo parts. For the in vitro part, 3 helical stent models of different helicity degrees and 1 straight model were fabricated, and the flow was assessed at the inlet and outlet of each model. For the in vivo part, only 1 patient, treated with the helical stent, was eligible to participate in the study. The stent implanted in the SFA of the patient was evaluated in 2 leg postures (straight and flexed), and flow was assessed in 12 locations along the SFA. The in vivo study was approved by an ethical board (NL80130.091.21) in the Netherlands. High-frame-rate ultrasound was used to acquire data from the regions of interest (ROIs), using microbubbles as contrast agents. After processing the data via a correlation-based algorithm (echo particle image velocimetry or echoPIV), the velocity vector field within each ROI was extracted and analyzed for parameters such as vector complexity and velocity profile skewedness. RESULTS The results show that in the outlet of the helical stents, when compared with the inlet, the flow vector field is more complex and the velocity profile is more skewed. For the in vivo case, the outcomes demonstrate more complexity and higher variability in the sign of skewedness inside the stent when compared with the flow in the proximal to the stent. CONCLUSIONS Helical stents make the vector field of the flow more complex and the velocity profile more skewed, both of which are signatures of swirling flow. Further studies are needed to evaluate whether these features can benefit patients in terms of patency rates. CLINICAL IMPACT This study demonstrates that helical stent models alter the blood flow when compared with straight stent models. Particularly, the flow grows more complex and its velocity profile becomes more skewed, both of which hint at the existence of swirling flow inside the helical stent. These observations, alongside with population-based studies that are currently being carried out, may provide the evidence that helical stents have some advantages over straight stents for the patients.
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Affiliation(s)
- Ashkan Ghanbarzadeh-Dagheyan
- Multi-Modality Medical Imaging, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
- Biomedical Photonic Imaging Group, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
- Physics of Fluids, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
| | - Majorie van Helvert
- Multi-Modality Medical Imaging, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Lennart van de Velde
- Multi-Modality Medical Imaging, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel M P J Reijnen
- Multi-Modality Medical Imaging, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel Versluis
- Physics of Fluids, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Multi-Modality Medical Imaging, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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Harte N, Obrist D, Caversaccio M, Lajoinie G, Wimmer W. Transverse flow under oscillating stimulation in helical square ducts with cochlea-like geometrical curvature and torsion. EUROPEAN JOURNAL OF MECHANICS. B, FLUIDS 2024; 107:165-174. [PMID: 39220585 PMCID: PMC11327769 DOI: 10.1016/j.euromechflu.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
The cochlea, situated within the inner ear, is a spiral-shaped, liquid-filled organ responsible for hearing. The physiological significance of its shape remains uncertain. Previous research has scarcely addressed the occurrence of transverse flow within the cochlea, particularly in relation to its unique shape. This study aims to investigate the impact of the geometric features of the cochlea on fluid dynamics by characterizing transverse flow induced by harmonically oscillating axial flow in square ducts with curvature and torsion resembling human cochlear anatomy. We examined four geometries to investigate curvature and torsion effects on axial and transverse flow components. Twelve frequencies from 0.125 Hz to 256 Hz were studied, covering infrasound and low-frequency hearing, with mean inlet velocity amplitudes representing levels expected for normal conversation or louder situations. Our simulations show that torsion contributes significantly to transverse flow in unsteady conditions, and that its contribution increases with increasing oscillation frequency. Curvature alone has a small effect on transverse flow strength, which decreases rapidly with increasing frequency. Strikingly, the combined effect of curvature and torsion on transverse flow is greater than expected from a simple superposition of the two effects, especially when the relative contribution of curvature alone becomes negligible. These findings may be relevant to understanding physiological processes in the cochlea, including metabolite transport and wall shear stress. Further studies are needed to investigate possible implications for cochlear mechanics.
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Affiliation(s)
- N.C. Harte
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - D. Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - M. Caversaccio
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - G.P.R. Lajoinie
- Physics of Fluids Group, Max Planck Center for Complex Fluid Dynamics, Technical Medical (TechMed) Center, University of Twente, Enschede, The Netherlands
| | - W. Wimmer
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
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Liu H, Yu Z, Xu Y, Zhou Y, Yang J, Qiu Y, Xing Y, Peng F, Tang W. Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature. BMC Cardiovasc Disord 2024; 24:281. [PMID: 38811879 PMCID: PMC11134645 DOI: 10.1186/s12872-024-03956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired). CASE PRESENTATION We report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward. CONCLUSIONS Acute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.
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Affiliation(s)
- Hanxuan Liu
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Zhangjie Yu
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Ying Xu
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Yan Zhou
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Juntao Yang
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Yinyin Qiu
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Yangbo Xing
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Fang Peng
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Weiliang Tang
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China.
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Xie Y, Zhu Y, Shi Y, Zhao Y, Zhang H, Li F, Song H, Chen L, Guo W. Impact of Cross-Limb Stent-Graft Configuration on Hemodynamics in Abdominal Aortic Aneurysm Interventional Therapy. Cardiovasc Eng Technol 2024; 15:137-146. [PMID: 37985614 DOI: 10.1007/s13239-023-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The cross-limb (CL) technique is a commonly used endovascular treatment for addressing unfavorable anatomical features in patients with abdominal aortic aneurysm (AAA). The configuration of CL stent-graft plays a critical role in determining the postoperative hemodynamic properties and physiological behaviors, which ultimately impact the efficacy and safety of endovascular AAA treatment. This study aims to investigate the relationship between hemodynamics and CL stent-graft configuration from a hemodynamic perspective. METHODS Five distinct geometric models of cross-limb (CL) stent-graft configurations were constructed by optimizing the real clinical computed tomography angiography (CTA) data. These models varied in main body lengths and cross angles and were used to perform numerical simulations to analyze various hemodynamic parameters. Flow pattern, distribution of wall shear stress (WSS)-related parameters, localized normalized helicity (LNH), pressure drop, and the displacement force of all models were examined in this paper. RESULTS In patient-specific cases, helical flow and WSS increase with the main body. However, it also generated secondary flow in localized areas, leading to increased oscillation in the WSS direction. Notably, increasing the stent graft's main body length or decreasing the cross angle reduced the displacement force exerted on the stent-graft. Reducing the cross angle did not significantly alter the hemodynamic characteristics. CONCLUSION In the clinical practice of CL deployment, it is crucial to carefully consider the stent-graft configuration and the patient specific to achieve optimal postoperative outcomes. This study provides valuable insights for guiding stent selection and treatment planning in patients with abdominal aortic aneurysm undergoing CL techniques, from a hemodynamic perspective.
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Affiliation(s)
- Yanqing Xie
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, 315020, China
| | - Yating Zhu
- Department of Vascular Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yike Shi
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Yawei Zhao
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Hongpeng Zhang
- Department of Vascular Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fen Li
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, 79 West Yingze Street, Taiyuan, 030024, China.
| | - Hui Song
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, 79 West Yingze Street, Taiyuan, 030024, China
| | - Lingfeng Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Wei Guo
- Department of Vascular Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Kwak D, Im Y, Nam H, Nam U, Kim S, Kim W, Kim HJ, Park J, Jeon JS. Analyzing the effects of helical flow in blood vessels using acoustofluidic-based dynamic flow generator. Acta Biomater 2024; 177:216-227. [PMID: 38253303 DOI: 10.1016/j.actbio.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
The effects of helical flow in a blood vessel are investigated in a dynamic flow generator using surface acoustic wave (SAW) in the microfluidic device. The SAW, generated by an interdigital transducer (IDT), induces acoustic streaming, resulting in a stable and consistent helical flow pattern in microscale channels. This approach allows rapid development of helical flow within the channel without directly contacting the medium. The precise design of the window enables the creation of distinct unidirectional vortices, which can be controlled by adjusting the amplitude of the SAW. Within this device, optimal operational parameters of the dynamic flow generator to preserve the integrity of endothelial cells are found, and in such settings, the actin filaments within the cells are aligned to the desired state. Our findings reveal that intracellular Ca2+ concentrations vary in response to flow conditions. Specifically, comparable maximum intensity and graphical patterns were observed between low-flow rate helical flow and high-flow rate Hagen-Poiseuille flow. These suggest that the cells respond to the helical flow through mechanosensitive ion channels. Finally, adherence of monocytes is effectively reduced under helical flow conditions in an inflammatory environment, highlighting the atheroprotective role of helical flow. STATEMENT OF SIGNIFICANCE: Helical flow in blood vessels is well known to prevent atherosclerosis. However, despite efforts to replicate helical flow in microscale channels, there is still a lack of in vitro models which can generate helical flow for analyzing its effects on the vascular system. In this study, we developed a method for generating steady and constant helical flow in microfluidic channel using acoustofluidic techniques. By utilizing this dynamic flow generator, we were able to observe the atheroprotective aspects of helical flow in vitro, including the enhancement of calcium ion flux and reduction of monocyte adhesion. This study paves the way for an in vitro model of dynamic cell culture and offers advanced investigation into helical flow in our circulatory system.
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Affiliation(s)
- Daesik Kwak
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Yongtaek Im
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Hyeono Nam
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Ungsig Nam
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Seunggyu Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Woohyuk Kim
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Hyun Jin Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Jinsoo Park
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jessie S Jeon
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea.
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Hazan Shenberger S, Avrahami I. The Effect of Mechanical Circulatory Support on Blood Flow in the Ascending Aorta: A Combined Experimental and Computational Study. Bioengineering (Basel) 2024; 11:238. [PMID: 38534512 DOI: 10.3390/bioengineering11030238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/11/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024] Open
Abstract
Percutaneous mechanical circulatory support (MCS) devices are designed for short-term treatment in cases of acute decompensated heart failure as a bridge to transplant or recovery. Some of the known complications of MCS treatments are related to their hemodynamics in the aorta. The current study investigates the effect of MCS on the aortic flow. The study uses combined experimental and numerical methods to delineate complex flow structures. Particle image velocimetry (PIV) is used to capture the vortical and turbulent flow characteristics in a glass model of the human aorta. Computational fluid dynamics (CFD) analyses are used to complete the 3D flow in the aorta. Three specific MCS configurations are examined: a suction pump with a counterclockwise (CCW) rotating impeller, a suction pump with a clockwise (CW) rotating impeller, and a discharge pump with a straight jet. These models were examined under varying flow rates (1-2.5 L/min). The results show that the pump configuration strongly influences the flow in the thoracic aorta. The rotating impeller of the suction pump induces a dominant swirling flow in the aorta. The swirling flow distributes the incoming jet and reduces the turbulent intensity near the aortic valve and in the aorta. In addition, at high flow rates, the local vortices formed near the pump are washed downstream toward the aortic arch. Specifically, an MCS device with a CCW rotating impeller induces a non-physiological CCW helical flow in the descending aorta (which is opposite to the natural helical flow), while CW swirl combines better with the natural helical flow.
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Affiliation(s)
- Sapir Hazan Shenberger
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel 40700, Israel
| | - Idit Avrahami
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel 40700, Israel
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Baltazar S, Northrup H, Chang J, Somarathna M, Isayeva Waldrop T, Lee T, Shiu YT. Effects of endothelial nitric oxide synthase on mouse arteriovenous fistula hemodynamics. Sci Rep 2023; 13:22786. [PMID: 38123618 PMCID: PMC10733286 DOI: 10.1038/s41598-023-49573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Newly created arteriovenous fistulas (AVFs) often fail to mature for dialysis use due to disturbed blood flow at and near the AVF anastomosis. The disturbed flow inhibits the endothelial nitric oxide synthase (NOS3) pathway, thus decreasing the production of nitric oxide, a vasodilator. Previously, our group reported that NOS3 expression levels affect AVF lumen size in a mouse model. In this study, we performed MRI-based computational fluid dynamics simulations to investigate the hemodynamical parameters (velocity, wall shear stress (WSS), and vorticity) in a mouse AVF model at day 7 and day 21 post-AVF creation using three NOS3 strains: overexpression (OE), knockout (KO), and wild-type (WT) control. This study is the first to reveal hemodynamics over time in mouse AVFs, consider spatial heterogeneity along the vein, and reveal the effect of NOS3 on the natural history of mouse AVF hemodynamics. From day 7 to day 21, OE has smoother streamlines and had significantly lower vorticity and WSS than WT and KO, suggesting that WSS was attempting to return to pre-surgery baseline, respectively. Our results conclude that the overexpression of NOS3 leads to desired optimal hemodynamics during AVF remodeling. Future studies can investigate enhancing the NOS3 pathway to improve AVF development.
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Affiliation(s)
- Shelly Baltazar
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, 30 N Mario Capecchi Drive, 3rd Floor South, Salt Lake City, UT, 84112, USA
| | - Hannah Northrup
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, 30 N Mario Capecchi Drive, 3rd Floor South, Salt Lake City, UT, 84112, USA
| | - Joshua Chang
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, 30 N Mario Capecchi Drive, 3rd Floor South, Salt Lake City, UT, 84112, USA
| | - Maheshika Somarathna
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tatyana Isayeva Waldrop
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timmy Lee
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Yan-Ting Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, 30 N Mario Capecchi Drive, 3rd Floor South, Salt Lake City, UT, 84112, USA.
- Veterans Affairs Medical Center, Salt Lake City, UT, USA.
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Hülsmann J, Fraune T, Dodawatta B, Reuter F, Beutner M, Beck V, Hackert-Oschätzchen M, Ohl CD, Bettenbrock K, Janiga G, Wippermann J, Wacker M. Integrated biophysical matching of bacterial nanocellulose coronary artery bypass grafts towards bioinspired artery typical functions. Sci Rep 2023; 13:18274. [PMID: 37880281 PMCID: PMC10600183 DOI: 10.1038/s41598-023-45451-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Revascularization via coronary artery bypass grafting (CABG) to treat cardiovascular disease is established as one of the most important lifesaving surgical techniques worldwide. But the shortage in functionally self-adaptive autologous arteries leads to circumstances where the clinical reality must deal with fighting pathologies coming from the mismatching biophysical functionality of more available venous grafts. Synthetic biomaterial-based CABG grafts did not make it to the market yet, what is mostly due to technical hurdles in matching biophysical properties to the complex demands of the CABG niche. But bacterial Nanocellulose (BNC) Hydrogels derived by growing biofilms hold a naturally integrative character in function-giving properties by its freedom in designing form and intrinsic fiber architecture. In this study we use this integral to combine impacts on the luminal fiber matrix, biomechanical properties and the reciprocal stimulation of microtopography and induced flow patterns, to investigate biomimetic and artificial designs on their bio-functional effects. Therefore, we produced tubular BNC-hydrogels at distinctive designs, characterized the structural and biomechanical properties and subjected them to in vitro endothelial colonization in bioreactor assisted perfusion cultivation. Results showed clearly improved functional properties and gave an indication of successfully realized stimulation by artery-typical helical flow patterns.
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Affiliation(s)
- Jörn Hülsmann
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany.
| | - Theresa Fraune
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Baratha Dodawatta
- Laboratory of Fluid Dynamics and Technical Flows, Otto von Guericke University, Magdeburg, Germany
| | - Fabian Reuter
- Department Soft Matter, Otto von Guericke University, Magdeburg, Germany
| | - Martin Beutner
- Chair of Manufacturing Technology with Focus Machining, Institute of Manufacturing Technology and Quality Management, Otto von Guericke University, Magdeburg, Germany
| | - Viktoria Beck
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Matthias Hackert-Oschätzchen
- Chair of Manufacturing Technology with Focus Machining, Institute of Manufacturing Technology and Quality Management, Otto von Guericke University, Magdeburg, Germany
| | - Claus Dieter Ohl
- Department Soft Matter, Otto von Guericke University, Magdeburg, Germany
| | - Katja Bettenbrock
- Max Plank Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Gabor Janiga
- Laboratory of Fluid Dynamics and Technical Flows, Otto von Guericke University, Magdeburg, Germany
| | - Jens Wippermann
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Max Wacker
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
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Xiong Z, Yan Y, Wang X, Liu Z, Luo X, Zheng T. The effect of splenic vein diameter on the diagnosis of portal vein thrombosis. Med Phys 2023; 50:6614-6623. [PMID: 37227701 DOI: 10.1002/mp.16481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND It was still controversial that whether the increase of splenic vein (SV) diameter increased the risk of portal vein thrombosis (PVT), which was a severe disease with high mortality, in the clinic. PURPOSES This study, using computational fluid dynamics method, aimed to investigate how the increase of SV diameter affects the portal vein hemodynamics under different anatomical and geometric features of the portal venous system, thus how it induced to PVT. METHODS The ideal models of the portal system, including different anatomical structures according to the location of left gastric vein (LGV) and inferior mesenteric vein (IMV), and different geometric morphological parameters models were established to carry out numerical simulation in this study. In addition, the morphological parameters of real patients were measured to verify the numerical simulation results. RESULTS First, the wall shear stress (WSS) and helicity intensity, which were closely related to the occurrence of thrombosis, gradually decreased with the increase of SV diameter in all models. However, the degree of decrease was bigger in following models: (1) the models with LGV and IMV linking to SV compared with them linking to PV; (2) the models with big angle of PV and SV compared with small angle. In addition, the morbidity of PVT was higher when LGV and IMV linked to SV rather than them linked to PV in the real patients. Moreover, the angle of PV and SV was also different between PVT and non-PVT patients (125.53° ± 16.90° vs. 115.03° ± 16.10°, p = 0.01). CONCLUSION Whether the increase of SV diameter will result in PVT is depended on the anatomical structure of portal system and the angle between PV and SV, this is also the reason leading to the clinical controversy that the increase of SV diameter is the risk factor of PVT.
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Affiliation(s)
- Zhuxiang Xiong
- Department of Applied Mechanics, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
| | - Yuling Yan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhan Liu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
| | - Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
- West China Information Center, Sichuan University, Chengdu, China
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Racz AO, Szabo GT, Papp T, Csippa B, Gyurki D, Kracsko B, Koszegi Z, Kolozsvari R. Potential Clinical Usefulness of Post-Valvular Contrast Densities to Determine the Severity of Aortic Valve Stenosis Using Computed Tomography. J Cardiovasc Dev Dis 2023; 10:412. [PMID: 37887859 PMCID: PMC10607528 DOI: 10.3390/jcdd10100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Different methods are established for the changes in aortic valve stenosis with cardiac computed tomography angiography (CCTA), but the effect of the grade of stenosis on contrast densities around the valve has not been investigated. AIMS/METHODS Using the information from flow dynamics in cases of increased velocity through narrowed lumen, the hypothesis was formed that flow changes can alter the contrast densities in stenotic post-valvular regions, and the density changes might correlate with the grade of stenosis. Forty patients with severe aortic stenosis and fifteen with a normal aortic valve were enrolled. With echocardiography, the peak/mean transvalvular gradients, peak transvalvular velocity, and aortic valve opening area were obtained. With CCTA, densities 4-5 mm above the aortic valve; at the junction of the left, right, and noncoronary cusp to the annulus; at the middle level of the left, right, and noncoronary sinuses of Valsalva in the center and the lateral points; at the sinotubular junction; and 4 cm from the sinotubular junction at the midline were measured. First, a comparison of the densities between the normal and stenotic valve was performed, and then possible correlations between echocardiography and CCTA values were investigated in the stenotic group. RESULTS In all CCTA regions, significantly lower-density values were detected among stenotic valve patients compared to the normal aortic valve population. Additionally, in both groups, higher densities were measured in the peri-jet regions than in the lateral ones. Furthermore, a good correlation was found between the aortic valve opening area and the densities in almost all perivalvular areas. With regard to the densities at the junction of the non-coronary leaflet to the fibrotic annulus and at the most lateral point of the right sinus of Valsalva, a high level of correlation was found between all echocardiography and CCTA parameters. Lastly, with receiver operating characteristic curve measurements, area under the curve values were between 0.857 and 0.930. CONCLUSION Certain CCTA density values, especially 4-5mm above the valve opening, can serve as auxiliary information to echocardiography when the severity of aortic valve stenosis is unclear.
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Affiliation(s)
- Agnes Orsolya Racz
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
| | - Gabor Tamas Szabo
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
| | - Tamas Papp
- Department of Radiology, University of Debrecen, 4032 Debrecen, Hungary;
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, University of Technology and Economics, 1111 Budapest, Hungary; (B.C.); (D.G.)
| | - Daniel Gyurki
- Department of Hydrodynamic Systems, University of Technology and Economics, 1111 Budapest, Hungary; (B.C.); (D.G.)
| | - Bertalan Kracsko
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
| | - Zsolt Koszegi
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
- 3rd Department of Internal Medicine, Szabolcs-Szatmar-Bereg County Hospital, 4400 Nyíregyháza, Hungary
| | - Rudolf Kolozsvari
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
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11
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Bondesson J, Suh GY, Dake MD, Lee JT, Cheng CP. Cardiac Pulsatile Helical Deformation of the Thoracic Aorta Before and After Thoracic Endovascular Aortic Repair of Type B Dissections. J Endovasc Ther 2023:15266028231179592. [PMID: 37300396 DOI: 10.1177/15266028231179592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Type B aortic dissections propagate with either achiral (nonspiraling) or right-handed chiral (spiraling) morphology, have mobile dissection flaps, and are often treated with thoracic endovascular aortic repair (TEVAR). We aim to quantify cardiac-induced helical deformation of the true lumen of type B aortic dissections before and after TEVAR. MATERIAL AND METHODS Retrospective cardiac-gated computed tomography (CT) images before and after TEVAR of type B aortic dissections were used to construct systolic and diastolic 3-dimensional (3D) surface models, including true lumen, whole lumen (true+false lumens), and branch vessels. This was followed by extraction of true lumen helicity (helical angle, twist, and radius) and cross-sectional (area, circumference, and minor/major diameter ratio) metrics. Deformations between systole and diastole were quantified, and deformations between pre- and post-TEVAR were compared. RESULTS Eleven TEVAR patients (59.9±4.6 years) were included in this study. Pre-TEVAR, there were no significant cardiac-induced deformations of helical metrics; however, post-TEVAR, significant deformation was observed for the true lumen proximal angular position. Pre-TEVAR, cardiac-induced deformations of all cross-sectional metrics were significant; however, only area and circumference deformations remained significant post-TEVAR. There were no significant differences of pulsatile deformation from pre- to post-TEVAR. Variance of proximal angular position and cross-sectional circumference deformation decreased after TEVAR. CONCLUSION Pre-TEVAR, type B aortic dissections did not exhibit significant helical cardiac-induced deformation, indicating that the true and false lumens move in unison (do not move with respect to each other). Post-TEVAR, true lumens exhibited significant cardiac-induced deformation of proximal angular position, suggesting that exclusion of the false lumen leads to greater rotational deformations of the true lumen and lack of true lumen major/minor deformation post-TEVAR means that the endograft promotes static circularity. Population variance of deformations is muted after TEVAR, and dissection acuity influences pulsatile deformation while pre-TEVAR chirality does not. CLINICAL IMPACT Description of thoracic aortic dissection helical morphology and dynamics, and understanding the impact of thoracic endovascular aortic repair (TEVAR) on dissection helicity, are important for improving endovascular treatment. These findings provide nuance to the complex shape and motion of the true and false lumens, enabling clinicians to better stratify dissection disease. The impact of TEVAR on dissection helicity provides a description of how treatment alters morphology and motion, and may provide clues for treatment durability. Finally, the helical component to endograft deformation is important to form comprehensive boundary conditions for testing and developing new endovascular devices.
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Affiliation(s)
- Johan Bondesson
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
- Division of Dynamics, Chalmers University of Technology, Gothenburg, Sweden
| | - Ga-Young Suh
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
- Department of Biomedical Engineering, California State University, Long Beach, CA, USA
| | - Michael D Dake
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
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12
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Calò K, Capellini K, De Nisco G, Mazzi V, Gasparotti E, Gallo D, Celi S, Morbiducci U. Impact of wall displacements on the large-scale flow coherence in ascending aorta. J Biomech 2023; 154:111620. [PMID: 37178494 DOI: 10.1016/j.jbiomech.2023.111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
In the context of aortic hemodynamics, uncertainties affecting blood flow simulations hamper their translational potential as supportive technology in clinics. Computational fluid dynamics (CFD) simulations under rigid-walls assumption are largely adopted, even though the aorta contributes markedly to the systemic compliance and is characterized by a complex motion. To account for personalized wall displacements in aortic hemodynamics simulations, the moving-boundary method (MBM) has been recently proposed as a computationally convenient strategy, although its implementation requires dynamic imaging acquisitions not always available in clinics. In this study we aim to clarify the real need for introducing aortic wall displacements in CFD simulations to accurately capture the large-scale flow structures in the healthy human ascending aorta (AAo). To do that, the impact of wall displacements is analyzed using subject-specific models where two CFD simulations are performed imposing (1) rigid walls, and (2) personalized wall displacements adopting a MBM, integrating dynamic CT imaging and a mesh morphing technique based on radial basis functions. The impact of wall displacements on AAo hemodynamics is analyzed in terms of large-scale flow patterns of physiological significance, namely axial blood flow coherence (quantified applying the Complex Networks theory), secondary flows, helical flow and wall shear stress (WSS). From the comparison with rigid-wall simulations, it emerges that wall displacements have a minor impact on the AAo large-scale axial flow, but they can affect secondary flows and WSS directional changes. Overall, helical flow topology is moderately affected by aortic wall displacements, whereas helicity intensity remains almost unchanged. We conclude that CFD simulations with rigid-wall assumption can be a valid approach to study large-scale aortic flows of physiological significance.
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Affiliation(s)
- Karol Calò
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Katia Capellini
- BioCardioLab, Bioengineering Unit - Heart Hospital, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe De Nisco
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Valentina Mazzi
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Emanuele Gasparotti
- BioCardioLab, Bioengineering Unit - Heart Hospital, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Simona Celi
- BioCardioLab, Bioengineering Unit - Heart Hospital, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy.
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Xenakis A, Ruiz-Soler A, Keshmiri A. Multi-Objective Optimisation of a Novel Bypass Graft with a Spiral Ridge. Bioengineering (Basel) 2023; 10:489. [PMID: 37106676 PMCID: PMC10136357 DOI: 10.3390/bioengineering10040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The low long-term patency of bypass grafts is a major concern for cardiovascular treatments. Unfavourable haemodynamic conditions in the proximity of distal anastomosis are closely related to thrombus creation and lumen lesions. Modern graft designs address this unfavourable haemodynamic environment with the introduction of a helical component in the flow field, either by means of out-of-plane helicity graft geometry or a spiral ridge. While the latter has been found to lack in performance when compared to the out-of-plane helicity designs, recent findings support the idea that the existing spiral ridge grafts can be further improved in performance through optimising relevant design parameters. In the current study, robust multi-objective optimisation techniques are implemented, covering a wide range of possible designs coupled with proven and well validated computational fluid dynamics (CFD) algorithms. It is shown that the final set of suggested design parameters could significantly improve haemodynamic performance and therefore could be used to enhance the design of spiral ridge bypass grafts.
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Affiliation(s)
- Antonios Xenakis
- School of Engineering, The University of Manchester, Manchester M13 9PL, UK
| | - Andres Ruiz-Soler
- School of Engineering, The University of Manchester, Manchester M13 9PL, UK
| | - Amir Keshmiri
- School of Engineering, The University of Manchester, Manchester M13 9PL, UK
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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14
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Loose S, Solou D, Strecker C, Hennemuth A, Hüllebrand M, Grundmann S, Asmussen A, Treppner M, Urbach H, Harloff A. Characterization of aortic aging using 3D multi-parametric MRI-long-term follow-up in a population study. Sci Rep 2023; 13:6285. [PMID: 37072440 PMCID: PMC10111081 DOI: 10.1038/s41598-023-33219-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
We comprehensively studied morphological and functional aortic aging in a population study using modern three-dimensional MR imaging to allow future comparison in patients with diseases of the aortic valve or aorta. We followed 80 of 126 subjects of a population study (20 to 80 years of age at baseline) using the identical methodology 6.0 ± 0.5 years later. All underwent 3 T MRI of the thoracic aorta including 3D T1 weighted MRI (spatial resolution 1 mm3) for measuring aortic diameter and plaque thickness and 4D flow MRI (spatial/temporal resolution = 2 mm3/20 ms) for calculating global and regional aortic pulse wave velocity (PWV) and helicity of aortic blood flow. Mean diameter of the ascending aorta (AAo) decreased and plaque thickness increased significantly in the aortic arch (AA) and descending aorta (DAo) in females. PWV of the thoracic aorta increased (6.4 ± 1.5 to 7.0 ± 1.7 m/s and 6.8 ± 1.5 to 7.3 ± 1.8 m/s in females and males, respectively) over time. Local normalized helicity volumes (LNHV) decreased significantly in the AAo and AA (0.33 to 0.31 and 0.34 to 0.32 in females and 0.34 to 0.32 and 0.32 to 0.28 in males). By contrast, helicity increased significantly in the DAo in both genders (0.28 to 0.29 and 0.29 to 0.30, respectively). 3D MRI was able to characterize changes in aortic diameter, plaque thickness, PWV and helicity during six years in our population. Aortic aging determined by 3D multi-parametric MRI is now available for future comparisons in patients with diseases of the aortic valve or aorta.
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Affiliation(s)
- Sophie Loose
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Demetris Solou
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Strecker
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anja Hennemuth
- Fraunhofer MEVIS, Bremen, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Hüllebrand
- Fraunhofer MEVIS, Bremen, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Grundmann
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Alexander Asmussen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Martin Treppner
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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15
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Li D, Wang J, Zeng W, Zeng X, Liu Z, Cao H, Yuan D, Zheng T. The loss of helical flow in the thoracic aorta might be an identifying marker for the risk of acute type B aortic dissection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 230:107331. [PMID: 36621070 DOI: 10.1016/j.cmpb.2022.107331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/06/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The occurrence of acute type B aortic dissection (TBAD) remained unclear. This study aimed to investigate the association between flow features and hemodynamic parameters in aortas that demonstrated the risk of TBAD occurrence. METHODS The geometries of 15 hyperacute TBAD and 12 control patients (with healthy aorta) were reconstructed from computed tomography angiography images. Pre-TBAD models were then obtained by eliminating the dissection flaps. Flow features and hemodynamic parameters, including wall shear stress-related parameters and helicities, were compared between pre-TBAD and control models using computational fluid dynamics. RESULTS There were no significant differences in baseline characteristics and anatomical parameters between the two groups. Significant contralateral helical blood flow was present in the healthy thoracic aorta, while almost no helical flow was observed in the pre-TBAD group. In addition, the mean normal transverse wall shear stress (NtransWSS) was significantly higher in the pre-TBAD group (aortic arch 0.49±0.09 vs. 0.40±0.05, P = 0.04; descending aorta: 0.46±0.05 vs. 0.33±0.02, P<0.01). Moreover, a significantly negative correlation was found between helicity and NtransWSS in the descending aorta. Moreover, the location of primary tears in 12 pre-TABD subjects matched well with regions of high NtransWSS. CONCLUSIONS Loss of helical flow in the aortic arch and descending aorta may be a major flow feature in patients with underlying TBAD, resulting in increased flow disturbance and wall lesions.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Jiarong Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Wen Zeng
- Division of radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangguo Zeng
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China
| | - Zhan Liu
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Haoyao Cao
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Ding Yuan
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Med-X center for informatics, Sichuan University, Chengdu, China.
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China; Med-X center for informatics, Sichuan University, Chengdu, China.
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16
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Cunnane CV, Houston JG, Moran DT, Broderick SP, Ross RA, Walsh MT. Spiral Laminar Flow is Associated with a Reduction in Disturbed Shear in Patient-Specific Models of an Arteriovenous Fistula. Cardiovasc Eng Technol 2023; 14:152-165. [PMID: 36151366 DOI: 10.1007/s13239-022-00644-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Areas of disturbed shear that arise following arteriovenous fistula (AVF) creation are believed to contribute to the development of intimal hyperplasia (IH). The presence of helical flow can suppress areas of disturbed shear, which may protect the vasculature from IH. Therefore, the aim of this study is to determine if helical flow, specifically spiral laminar flow (SLF), is present in patient-specific AVF models and is associated with a reduction in exposure to disturbed shear. METHODS Four AVF were imaged using MRI within the first two weeks following fistula creation. Patient-specific boundary conditions were obtained using phase-contrast MRI and applied at the inlet and outlets of each model. Computational fluid dynamics was used to analyse the hemodynamics in each model and compare the helical content of the flow to the distribution of disturbed shear. RESULTS BC-1 and RC-2 are characterised by the presence of SLF, which coincides with the lowest distribution of disturbed shear. Contrastingly, SLF is absent from BC-2 and RC-1 and experience the largest amount of disturbed shear. Interestingly, BC-2 and RC-1 developed an anastomosis stenosis, while BC-1 and RC-2 remained stenosis free. CONCLUSION These findings are in agreement with previous clinical studies and further highlight the clinical potential of SLF as a prognostic marker for a healthy AVF, as its presence correlates with an overall reduction in exposure to disturbed shear and a decrease in the incidence of AVF dysfunction, albeit in a small sample size.
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Affiliation(s)
- Connor V Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | - J Graeme Houston
- Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Daniel T Moran
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | - Stephen P Broderick
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | - Rose A Ross
- NHS Tayside Vascular Department, Ninewells Hospital, Dundee, UK
| | - Michael T Walsh
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland.
- School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
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17
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Dyverfeldt P, Trenti C, Ziegler M, Bjarnegård N, Lindenberger M. Helical flow in tortuous aortas and its relationship to turbulence: A whole-aorta 4D flow MRI study. Front Cardiovasc Med 2023; 10:1124604. [PMID: 37034318 PMCID: PMC10073741 DOI: 10.3389/fcvm.2023.1124604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Increased vascular tortuosity is a hallmark of ageing of the vascular system, including the aorta. However, the impact of tortuosity on aortic blood flow is unknown. We hypothesized that increased tortuosity would be associated with increased blood flow helicity and with decreased degree of blood flow turbulence as measured by the turbulent kinetic energy (TKE). Methods 4D Flow MR images covering the entire aorta from the aortic valve to the iliac bifurcation were acquired in 23 normal volunteers aged 18-30 years ("Young") and 23 normal volunteers aged 66-76 years ("Old") without aortic disease. The aorta was segmented and divided into four regions: the ascending, descending, suprarenal abdominal and infrarenal abdominal aorta. Tortuosity, helicity, TKE, flow velocity, and Reynolds number were computed for the whole aorta and for each section. Results Tortuosity and helicity were higher whereas TKE, velocity, and Reynolds number were lower in Old than in Young, for all aortic regions (p < 0.05) except for helicity in the descending aorta. Tortuosity correlated positively with helicity and negatively with TKE for all aortic regions (Spearman rho=±0.45-±0.72, p < =0.002) except for TKE in the ascending aorta. Further, helicity correlated with TKE in the descending, suprarenal abdominal and infrarenal abdominal aorta (Spearman rho=-0.56--0.77). Conclusion Tortuosity increases with age and blood flow in tortuous aortas is more helical. Increasing helicity, in turn, is associated with decreasing TKE.
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Affiliation(s)
- Petter Dyverfeldt
- Cardiovascular Sciences; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Correspondence: Petter Dyverfeldt
| | - Chiara Trenti
- Cardiovascular Sciences; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Magnus Ziegler
- Cardiovascular Sciences; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Niclas Bjarnegård
- Cardiovascular Sciences; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Lindenberger
- Cardiovascular Sciences; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Manenti A, Farinetti A, Manco G, Mattioli AV, Coppi F. Inside Hemodynamics of Bifurcated Aortic Graft. Ann Vasc Surg 2023; 88:e2-e3. [PMID: 36309165 DOI: 10.1016/j.avsg.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Antonio Manenti
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy.
| | - Alberto Farinetti
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianrocco Manco
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Francesca Coppi
- Department of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
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19
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Yan Y, Xiong Z, Wang X, Yang L, Zheng T, Luo X. A novel potential mechanism for the development of portal vein thrombosis in cirrhosis based on portal hemodynamics. Insights Imaging 2022; 13:192. [PMID: 36512292 PMCID: PMC9748017 DOI: 10.1186/s13244-022-01330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Marked changes in hemodynamics have been suggested to be a potential contributing factor to portal vein thrombosis (PVT) development. This study investigated the effect of portal hemodynamics based on the anatomical structure of the portal venous system on PVT development. METHODS The morphological features of portal venous system in patients with PVT and those without PVT subgroups were compared. In addition, idealized PV models were established to numerically evaluate the effect of the variation in the angulation of superior mesenteric vein (SMV) and splenic vein (SV) on the hemodynamics of portal venous system. RESULTS The angle α (angulation of SMV and SV) in patients with PVT was lower than that in patients without PVT (p < 0.0001), which was the only independent risk factor (odds ratio (OR), 0.90 (95% CI 0.84-0.95); p < 0.0001) for the presence of PVT. With the change in angle α, the flow pattern of blood flow changed greatly, especially the helical flow. When α = 80°, helical flow only appeared at the local PV near the intersection of SMV and SV. When α = 120°, most regions were occupied by the helical flow. In addition, the h2 gradually increased with increasing α, when α = 80°, h2 = 12.6 m/s2; when α = 120°, h2 = 29.3 m/s2. CONCLUSIONS The angulation of SV and SMV was closely associated with PVT development. Helical flow changed following the varying angulation of SV and SMV. Therefore, angulation of SV and SMV may help to identify high-risk cohorts for future PVT development earlier.
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Affiliation(s)
- Yuling Yan
- grid.412901.f0000 0004 1770 1022Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041 Sichuan People’s Republic of China ,grid.13291.380000 0001 0807 1581Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu, Sichuan People’s Republic of China
| | - Zhuxiang Xiong
- grid.13291.380000 0001 0807 1581Department of Applied Mechanics, Sichuan University. No, 24 South Section of First Ring Road,, Chengdu, 610065 Sichuan Province People’s Republic of China ,grid.413041.30000 0004 1808 3369Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, People’s Republic of China
| | - Xiaoze Wang
- grid.412901.f0000 0004 1770 1022Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041 Sichuan People’s Republic of China ,grid.13291.380000 0001 0807 1581Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu, Sichuan People’s Republic of China
| | - Li Yang
- grid.412901.f0000 0004 1770 1022Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041 Sichuan People’s Republic of China ,grid.13291.380000 0001 0807 1581Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu, Sichuan People’s Republic of China
| | - Tinghui Zheng
- grid.13291.380000 0001 0807 1581Department of Applied Mechanics, Sichuan University. No, 24 South Section of First Ring Road,, Chengdu, 610065 Sichuan Province People’s Republic of China ,grid.413041.30000 0004 1808 3369Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, People’s Republic of China
| | - Xuefeng Luo
- grid.412901.f0000 0004 1770 1022Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041 Sichuan People’s Republic of China ,grid.13291.380000 0001 0807 1581Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu, Sichuan People’s Republic of China
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20
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Richards CE, Parker AE, Alfuhied A, McCann GP, Singh A. The role of 4-dimensional flow in the assessment of bicuspid aortic valve and its valvulo-aortopathies. Br J Radiol 2022; 95:20220123. [PMID: 35852109 PMCID: PMC9793489 DOI: 10.1259/bjr.20220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Bicuspid aortic valve is the most common congenital cardiac malformation and the leading cause of aortopathy and aortic stenosis in younger patients. Aortic wall remodelling secondary to altered haemodynamic flow patterns, changes in peak velocity, and wall shear stress may be implicated in the development of aortopathy in the presence of bicuspid aortic valve and dysfunction. Assessment of these parameters as potential predictors of disease severity and progression is thus desirable. The anatomic and functional information acquired from 4D flow MRI can allow simultaneous visualisation and quantification of the pathological geometric and haemodynamic changes of the aorta. We review the current clinical utility of haemodynamic quantities including velocity, wall sheer stress and energy losses, as well as visual descriptors such as vorticity and helicity, and flow direction in assessing the aortic valve and associated aortopathies.
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Affiliation(s)
- Caryl Elizabeth Richards
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Alex E Parker
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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21
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Shen C, Gharleghi R, Li DD, Beier S. Helical Flow in Healthy and Diseased Patient-specific Coronary Bifurcations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3977-3980. [PMID: 36086059 DOI: 10.1109/embc48229.2022.9871374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Helical flow (HF) exists in healthy and diseased coronary bifurcations and was found to have a protective atherosclerotic vascular effect in other vessels. However, the role of HF in patient-specific human coronary arteries still needs further study, and is therefore the objective of this study in both healthy and diseased bifurcations. Computational studies were conducted on 16 patient-specific coronary bifurcations, including eight healthy and eight identical cases with idealized narrowing to represent disease. In general, higher HF intensity may have a favorable effect as it corelated to the reduction of the percentage vessel area exposed to adverse time averaged wall shear stress (TAWSS%) in both healthy and diseased models. The HF intensity and distribution of each model varies due to the complex shape of patient-specific models. The presence of disease appears to have an important impact on the downstream HF patterns and the TAWSS distributions. Clinical Relevance- By understanding the relationship between HF and hemodynamics, HF may be used as a predictor for the formation and progression of atherosclerotic plaque in coronary arteries instead of near-wall WSS measures, which can be determined with higher accuracy in vivo.
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22
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Association between blood flow pattern and rupture risk of abdominal aortic aneurysm based on computational fluid dynamics. Eur J Vasc Endovasc Surg 2022; 64:155-164. [PMID: 35605907 DOI: 10.1016/j.ejvs.2022.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/21/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aimed to derive a novel classification of blood flow pattern in AAA based on computational fluid dynamics, and determine the predicting value of flow pattern in abdominal aortic aneurysm (AAA) rupture. DESIGN Age, gender matched case-control study MATERIALS: Case patients were identified as those who underwent emergent endovascular or open repair due to ruptured or impending rupture AAA. Control patients were those age and gender matched AAA patients who were asymptomatic and confirmed unruptured from CTA images from the same period. METHODS Classification of blood flow pattern (Type I: non-helical main flow channel with multiple vortices; Type II: non-helical main flow channel with single vortices; Type III, helical main flow channel with helical vortices) and hemodynamic parameters [areas of low wall shear stress (A low WSS), aneurysm pressure drop (Δ pressure), etc.] were derived from computational fluid dynamic (CFD) analyses. Multivariate regression was used to determine independent risk factors of AAA rupture. The incremental discriminant and reclassification abilities for AAA rupture were compared among different models. RESULTS This study included 53 ruptured and 53 intact AAA patients. Ruptured AAA showed higher prevalence of type III flow pattern (60.38% vs. 15.09%, P<.001) compared to intact AAA. Type III flow pattern was associated with a significantly increased risk of aneurysm rupture (OR 10.22, 95%CI 3.43-30.49). Among all predicting models, combination of AAA diameter, hemodynamic parameters (A low WSS or Δ pressure) and flow pattern showed highest discriminant abilities in both overall population (concordance statistic [c-index] .862) and subgroup patients with AAAs <55mm (c-index .972). Compared to AAA diameter, adding flow pattern could significantly improve the reclassification abilities in both overall population (net reclassification index [NRI] .321; p<.001) and subgroup of AAAs < 55mm (NRI .732, P<.001). CONCLUSION Type III flow pattern was associated with a significantly increased risk of AAA rupture. Integration of blood flow pattern may improve the identification of high-risk aneurysms in both overall population and AAAs smaller than 55mm.
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23
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Warmerdam EG, Neijzen RL, Voskuil M, Leiner T, Grotenhuis HB. Four-dimensional flow CMR in tetralogy of fallot: current perspectives. Br J Radiol 2022; 95:20210298. [PMID: 35073171 PMCID: PMC10993958 DOI: 10.1259/bjr.20210298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 11/06/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect, accounting for 10% of all CHD. Despite most patients now surviving well into adulthood, morbidity and mortality rates continue to be high. Surgical and percutaneous pulmonary valve replacement are procedures that are performed to prevent long-term complications from occurring. Unfortunately, pulmonary valve replacement based on current CMR criteria does not prevent postoperative ventricular arrhythmia, heart failure, and sudden cardiac death. Thus, a more advanced and comprehensive hemodynamic evaluation is needed to better understand right ventricular (dys)function in tetralogy of Fallot patients and to optimize the timing of valve replacement. Recently, four-dimensional flow CMR has emerged as a promising and non-invasive imaging technique that can provide comprehensive quantitative evaluation of flow in an entire volume within the chest in a single imaging session. With velocity-encoding in all three spatial directions throughout the complete cardiac cycle, it can provide analysis of cardiac, pulmonary artery and aortic flow volumes, flow velocities, flow patterns, as well as more advanced hemodynamic parameters. Four-dimensional flow CMR could therefore provide insights into the complex hemodynamics of tetralogy of Fallot and could potentially provide novel criteria for pulmonary valve replacement in these patients. The aim of this review is to provide an overview of available research on four-dimensional flow CMR research in tetralogy of Fallot patients.
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Affiliation(s)
- Evangeline Gerdine Warmerdam
- Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan, Utrecht,
The Netherlands
- Department of Paediatric Cardiology, University Medical Center
Utrecht, Heidelberglaan, Utrecht,
The Netherlands
| | - Rosalie Lucy Neijzen
- Department of Paediatric Cardiology, University Medical Center
Utrecht, Heidelberglaan, Utrecht,
The Netherlands
- Honours Program Faculty of Medicine, University Medical Center
Utrecht, Utrecht, The
Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan, Utrecht,
The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht,
Heidelberglaan, Utrecht,
The Netherlands
| | - Heynric B Grotenhuis
- Department of Paediatric Cardiology, University Medical Center
Utrecht, Heidelberglaan, Utrecht,
The Netherlands
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24
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Liu J, Cai X, Zhan Y, Zhu H, Ao H, Wan Y, Luo H, Yang Z, Zhang Q. Hemodynamic evaluation of different stent graft schemes in aortic arch covered stent implantation. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2021.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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25
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Sunderland K, Jiang J, Zhao F. Disturbed flow's impact on cellular changes indicative of vascular aneurysm initiation, expansion, and rupture: A pathological and methodological review. J Cell Physiol 2022; 237:278-300. [PMID: 34486114 PMCID: PMC8810685 DOI: 10.1002/jcp.30569] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
Aneurysms are malformations within the arterial vasculature brought on by the structural breakdown of the microarchitecture of the vessel wall, with aneurysms posing serious health risks in the event of their rupture. Blood flow within vessels is generally laminar with high, unidirectional wall shear stressors that modulate vascular endothelial cell functionality and regulate vascular smooth muscle cells. However, altered vascular geometry induced by bifurcations, significant curvature, stenosis, or clinical interventions can alter the flow, generating low stressor disturbed flow patterns. Disturbed flow is associated with altered cellular morphology, upregulated expression of proteins modulating inflammation, decreased regulation of vascular permeability, degraded extracellular matrix, and heightened cellular apoptosis. The understanding of the effects disturbed flow has on the cellular cascades which initiate aneurysms and promote their subsequent growth can further elucidate the nature of this complex pathology. This review summarizes the current knowledge about the disturbed flow and its relation to aneurysm pathology, the methods used to investigate these relations, as well as how such knowledge has impacted clinical treatment methodologies. This information can contribute to the understanding of the development, growth, and rupture of aneurysms and help develop novel research and aneurysmal treatment techniques.
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Affiliation(s)
- Kevin Sunderland
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
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26
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Raptis A, Tasso P, Batzalexis K, Gallo D, Xenos M, Morbiducci U, Giannoukas A. Remodeling effects of carotid artery stenting versus endarterectomy with patch angioplasty in terms of morphology and hemodynamics. Comput Biol Med 2022; 140:105072. [PMID: 34856465 DOI: 10.1016/j.compbiomed.2021.105072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) remains the first-line treatment option of symptomatic and asymptomatic carotid stenosis, while stenting (CAS) is reserved for selected patients at high surgical risk. Here, we compare the vascular remodeling process in CEA- and CAS-treated patients with respect to morphological and hemodynamic features, because of their possible engagement in carotid atherosclerosis. METHODS Twelve (12) patients were included, half with patched CEA and half with CAS. Pre- and post-operative 3D image-based models of the carotid bifurcation were anatomically characterized in terms of flare, tortuosity, and curvature. Individual computational fluid dynamics simulations allowed to quantify the postoperative hemodynamic milieu in terms of (1) wall shear stress and (2) helical flow. RESULTS Carotid flare increased in all cases, but a more marked increase emerged after CEA compared to CAS. Tortuosity and curvature increased after CEA but decreased after CAS. CEA patients presented with significantly higher postoperative tortuosity than CAS patients. CEA was associated with a worse (non-statistically significant) score in all flow disturbance indicators vs. CAS. CONCLUSION The increased flare and tortuosity of the carotid bifurcation after CEA vs. CAS is a marked difference in the vascular remodeling process between the two modalities. CAS seems to induce a less pro-restenosis hemodynamic environment compared to CEA. The emerged differences stimulate further analysis on a larger cohort with long-term outcomes, to shed light on the clinical impact of the observations.
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Affiliation(s)
- Anastasios Raptis
- Laboratory for Vascular Simulations, Institute of Vascular Diseases, Larissa, Greece
| | - Paola Tasso
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Konstantinos Batzalexis
- Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Michalis Xenos
- Laboratory for Vascular Simulations, Institute of Vascular Diseases, Larissa, Greece; Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Athanasios Giannoukas
- Laboratory for Vascular Simulations, Institute of Vascular Diseases, Larissa, Greece; Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece.
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27
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Camarda JA, Dholakia RJ, Wang H, Samyn MM, Cava JR, LaDisa JF. A Pilot Study Characterizing Flow Patterns in the Thoracic Aorta of Patients With Connective Tissue Disease: Comparison to Age- and Gender-Matched Controls via Fluid Structure Interaction. Front Pediatr 2022; 10:772142. [PMID: 35601426 PMCID: PMC9114664 DOI: 10.3389/fped.2022.772142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Prior computational and imaging studies described changes in flow patterns for patients with Marfan syndrome, but studies are lacking for related populations. This pilot study addresses this void by characterizing wall shear stress (WSS) indices for patients with Loeys-Dietz and undifferentiated connective tissue diseases. Using aortic valve-based velocity profiles from magnetic resonance imaging as input to patient-specific fluid structure interaction (FSI) models, we determined local flow patterns throughout the aorta for four patients with various connective tissue diseases (Loeys-Dietz with the native aorta, connective tissue disease of unclear etiology with native aorta in female and male patients, and an untreated patient with Marfan syndrome, as well as twin patients with Marfan syndrome who underwent valve-sparing root replacement). FSI simulations used physiological boundary conditions and material properties to replicate available measurements. Time-averaged WSS (TAWSS) and oscillatory shear index (OSI) results are presented with localized comparison to age- and gender-matched control participants. Ascending aortic dimensions were greater in almost all patients with connective tissue diseases relative to their respective control. Differences in TAWSS and OSI were driven by local morphological differences and cardiac output. For example, the model for one twin had a more pronounced proximal descending aorta in the vicinity of the ductus ligamentum that impacted WSS indices relative to the other. We are optimistic that the results of this study can serve as a foundation for larger future studies on the connective tissue disorders presented in this article.
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Affiliation(s)
- Joseph A Camarda
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ronak J Dholakia
- Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hongfeng Wang
- Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Margaret M Samyn
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joseph R Cava
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - John F LaDisa
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States.,Departments of Medicine, Division of Cardiovascular Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
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28
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Wen J, Wu W, Peng L. 'Heart-like' cross-sectional shape can better improve the hemodynamics in spiral laminar flow graft for small-caliber bypass application: a numerical study. Comput Methods Biomech Biomed Engin 2021; 25:1487-1498. [PMID: 34937461 DOI: 10.1080/10255842.2021.2017905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Small-caliber grafts remain disappointed in the long-term bypass surgeries of coronary and peripheral arterial diseases. In order to improve the hemodynamics in small-caliber artery bypass grafts (ABGs), an improved spiral laminar flow (improved-SLF) graft with a 'heart-like' cross-sectional shape was proposed and verified by computational fluid dynamics simulation in this study. The results show that such graft can indeed induce a spiral flow and enhance the WSS distribution on the graft section. Furthermore, the helically distributed ribbon of unfavorable WSS observed in the original SLF graft was eliminated in the improved-SLF graft due to its smoothed and gentle helical ridge. On the other hand, improved-SLF ABG improved the WSS distribution in the distal anastomosis as well, because it maintained the strength of spiral flow when entering the anastomosis region. Finally, the improved-SLF ABG slightly increased the pressure drop along the bypass due to its small change of the general graft structure. As a proof-of-concept study, it can be concluded that improved-SLF graft can not only evenly enhance the WSS distribution in the graft section, but also improve the hemodynamic environment in the distal anastomosis without significantly increasing the pressure drop along the bypass, indicating such new helical-type graft may be more suitable to be used in the small-caliber graft bypass surgeries.
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Affiliation(s)
- Jun Wen
- Department of Mechanics, Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, China
| | - Wenqing Wu
- Department of Mathematics, School of Science, Southwest University of Science and Technology, Mianyang, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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29
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Qing M, Qiu Y, Wang J, Zheng T, Yuan D. A Comparative Study on the Hemodynamic Performance Within Cross and Non-cross Stent-Grafts for Abdominal Aortic Aneurysms With an Angulated Neck. Front Physiol 2021; 12:795085. [PMID: 34925075 PMCID: PMC8674644 DOI: 10.3389/fphys.2021.795085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: Cross-limb stent grafts for endovascular aneurysm repair (EVAR) are often employed for abdominal aortic aneurysms (AAAs) with significant aortic neck angulation. Neck angulation may be coronal or sagittal; however, previous hemodynamic studies of cross-limb EVAR stent grafts (SGs) primarily utilized simplified planar neck geometries. This study examined the differences in flow patterns and hemodynamic parameters between crossed and non-crossed limb SGs at different spatial neck angulations. Methods: Ideal models consisting of 13 cross and 13 non-cross limbs were established, with coronal and sagittal angles ranging from 0 to 90°. Computational fluid dynamics (CFD) was used to capture the hemodynamic information, and the differences were compared. Results: With regards to the pressure drop index, the maximum difference caused by the configuration and angular direction was 4.6 and 8.0%, respectively, but the difference resulting from the change in aneurysm neck angle can reach 27.1%. With regards to the SAR-TAWSS index, the maximum difference caused by the configuration and angular direction was 7.8 and 9.8%, respectively, but the difference resulting from the change in aneurysm neck angle can reach 26.7%. In addition, when the aneurysm neck angle is lower than 45°, the configuration and angular direction significantly influence the OSI and helical flow intensity index. However, when the aneurysm neck angle is greater than 45°, the hemodynamic differences of each model at the same aneurysm neck angle are reduced. Conclusion: The main factor affecting the hemodynamic index was the angle of the aneurysm neck, while the configuration and angular direction had little effect on the hemodynamics. Furthermore, when the aneurysm neck was greatly angulated, the cross-limb technique did not increase the risk of thrombosis.
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Affiliation(s)
- Ming Qing
- Department of Applied Mechanics, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China
| | - Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Ding Yuan
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
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30
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Delaney M, Cleveland V, Mass P, Capuano F, Mandell JG, Loke YH, Olivieri L. Right ventricular afterload in repaired D-TGA is associated with inefficient flow patterns, rather than stenosis alone. Int J Cardiovasc Imaging 2021; 38:653-662. [PMID: 34727253 DOI: 10.1007/s10554-021-02436-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Treatment of D- transposition of great arteries (DTGA) involves the Arterial Switch Operation (ASO), which can create PA branch stenosis (PABS) and alter PA blood flow energetics. This altered PA flow may contribute to elevated right ventricular (RV) afterload more significantly than stenosis alone. Our aim was to correlate RV afterload and PA flow characteristics using 4D flow cardiac magnetic resonance (CMR) imaging of a mock circulatory system (MCS) incorporating 3D printed replicas. CMR imaging and clinical characteristics were analyzed from 22 ASO patients (age 11.9 ± 8.7 years, 68% male). Segmentation was performed to create 3D printed PA replicas that were mounted in an MRI-compatible MCS. Pressure drop across the PA replica was recorded and 4D flow CMR acquisitions were analyzed for blood flow inefficiency (energy loss, vorticity). In post-ASO patients, there is no difference in RV mass (p = 0.07), nor RV systolic pressure (p = 0.26) in the presence or absence of PABS. 4D flow analysis of MCS shows energy loss is correlated to RV mass (p = 0.01, r = 0.67) and MCS pressure differential (p = 0.02, r = 0.57). Receiver operating characteristic curve shows energy loss detects elevated RV mass above 30 g/m2 (p = 0.02, AUC 0.88) while index of PA dimensions (Nakata) does not (p = 0.09, AUC 0.79). PABS alone does not account for differences in RV mass or afterload in post-ASO patients. In MCS simulations, energy loss is correlated with both RV mass and PA pressure, and can moderately detect elevated RV mass. Inefficient PA flow may be an important predictor of RV afterload in this population.
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Affiliation(s)
- Marc Delaney
- Division of Pediatrics, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
| | - Vincent Cleveland
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Francesco Capuano
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, Bari, Italy
| | - Jason G Mandell
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Laura Olivieri
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
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Pandey PK, Das MK. Effect of foam insertion in aneurysm sac on flow structures in parent lumen: relating vortex structures with disturbed shear. Phys Eng Sci Med 2021; 44:1231-1248. [PMID: 34581959 DOI: 10.1007/s13246-021-01058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
Numerous studies suggest that disturbed shear, causing endothelium dysfunction, can be related to neighboring vortex structures. With this motivation, this study presents a methodology to characterize the vortex structures. Precisely, we use mapping and characterization of vortex structures' changes to relate it with the hemodynamic indicators of disturbed shear. Topological features of vortex core lines (VCLs) are used to quantify the changes in vortex structures. We use the Sujudi-Haimes algorithm to extract the VCLs from the flow simulation results. The idea of relating vortex structures with disturbed shear is demonstrated for cerebral arteries with aneurysms virtually treated by inserting foam in the sac. To get physiologically realistic flow fields, we simulate blood flow in two patient-specific geometries before and after foam insertion, with realistic velocity waveform imposed at the inlet, using the Carreau-Yasuda model to mimic the shear-thinning behavior. With homogenous porous medium assumption, flow through the foam is modeled using the Forchheimer-Brinkman extended Darcy model. Results show that foam insertion increases the number of VCLs in the parent lumen. The average length of VCL increases by 168.9% and 55.6% in both geometries. For both geometries under consideration, results demonstrate that the region with increased disturbed shear lies in the same arterial segment exhibiting an increase in the number of oblique VCLs. Based on the findings, we conjecture that an increase in oblique VCLs is related to increased disturbed shear at the neighboring portion of the arterial wall.
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Affiliation(s)
- Pawan Kumar Pandey
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, 208016, Uttar Pradesh, India
| | - Malay Kumar Das
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, 208016, Uttar Pradesh, India.
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32
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Characteristics of atherosclerosis in femoropopliteal artery and its clinical relevance. Atherosclerosis 2021; 335:31-40. [PMID: 34547588 DOI: 10.1016/j.atherosclerosis.2021.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/28/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is a systemic disease with different faces. Despite identical or similar pathogenetic mechanisms, atherosclerotic lesions and their clinical manifestations vary in different parts of the vascular system. Peripheral arterial disease (PAD) represents one of the most frequent clinical manifestations of atherosclerosis with predominant location in the superficial femoral artery (SFA). Morphological characteristics of atherosclerotic plaques in peripheral arteries differ from lesions in the coronary and carotid arteries. Plaques in SFA have more fibrotic components, less lipids and inflammatory cells, which makes them more stable and less prone to rupture. Factors that determine the different structure of plaques in SFA compared to coronary arteries include hemodynamic forces, vasa vasorum and calcification. Low shear stress in SFA in the adductor canal is one of the factors which determines frequent atherosclerotic lesions in this region. Lower lipid content and fewer inflammatory cells explain higher stability of SFA plaques. The specific structure of SFA plaques may require preventive and therapeutic measures, which to some extent differ from prevention of coronary atherosclerosis and may include inhibition of fibrotic proliferation in SFA plaques and calcification. Revascularization of PAD differs from procedures used in coronary arteries and requires specific technical expertise and devices.
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33
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Liu S, Deng X, Zhang P, Wang X, Fan Y, Zhou S, Mu S, Mehta JL, Ding Z. Blood flow patterns regulate PCSK9 secretion via MyD88-mediated pro-inflammatory cytokines. Cardiovasc Res 2021; 116:1721-1732. [PMID: 31593224 DOI: 10.1093/cvr/cvz262] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/29/2019] [Accepted: 10/01/2019] [Indexed: 12/30/2022] Open
Abstract
AIMS Blood flow patterns play an important role in the localization of atherosclerosis in the sense that low-flow state is pro-atherogenic, and helical flow is protective against atherosclerosis. Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates cholesterol metabolism via low-density lipoprotein receptor (LDLr) degradation and is highly expressed in the atherosclerotic tissues. This study was designed to investigate the role of different blood flow patterns in the regulation of PCSK9 expression. METHODS AND RESULTS We designed an experimental model guider to generate stable helical flow. Our data showed that compared with normal flow, low-flow state induces whereas helical flow inhibits PCSK9 expression in the rabbit thoracic aorta in an inflammatory state. Our data also identified that TLR4-MyD88-NF-κB signalling plays an important role in PCSK9 expression. On the other hand, TRIF pathway had almost no effect. Further studies showed that the signals downstream of NF-κB, such as pro-inflammatory cytokines (IL-1β, IL-18, MCP-1, IL-6, TNF-α, IL-12, IFNγ, and GM-CSF) directly influence PCSK9 expression. Interestingly, high fat diet further enhanced PCSK9 expression in an inflammatory milieu. CONCLUSIONS These observations suggest a link between abnormal flow patterns and PCSK9 expression in inflammatory states, which may qualify helical flow and pro-inflammatory cytokines as potential targets to treat PCSK9-related cardiovascular diseases.
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Affiliation(s)
- Shijie Liu
- College of Basic Medical Sciences, Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, China.,Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Peng Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xianwei Wang
- Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Sichang Zhou
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Shengyu Mu
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jawahar L Mehta
- Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zufeng Ding
- College of Basic Medical Sciences, Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, China.,Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
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34
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De Nisco G, Chiastra C, Hartman EMJ, Hoogendoorn A, Daemen J, Calò K, Gallo D, Morbiducci U, Wentzel JJ. Comparison of Swine and Human Computational Hemodynamics Models for the Study of Coronary Atherosclerosis. Front Bioeng Biotechnol 2021; 9:731924. [PMID: 34409022 PMCID: PMC8365882 DOI: 10.3389/fbioe.2021.731924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Coronary atherosclerosis is a leading cause of illness and death in Western World and its mechanisms are still non completely understood. Several animal models have been used to 1) study coronary atherosclerosis natural history and 2) propose predictive tools for this disease, that is asymptomatic for a long time, aiming for a direct translation of their findings to human coronary arteries. Among them, swine models are largely used due to the observed anatomical and pathophysiological similarities to humans. However, a direct comparison between swine and human models in terms of coronary hemodynamics, known to influence atherosclerotic onset/development, is still lacking. In this context, we performed a detailed comparative analysis between swine- and human-specific computational hemodynamic models of coronary arteries. The analysis involved several near-wall and intravascular flow descriptors, previously emerged as markers of coronary atherosclerosis initiation/progression, as well as anatomical features. To do that, non-culprit coronary arteries (18 right–RCA, 18 left anterior descending–LAD, 13 left circumflex–LCX coronary artery) from patients presenting with acute coronary syndrome were imaged by intravascular ultrasound and coronary computed tomography angiography. Similarly, the three main coronary arteries of ten adult mini-pigs were also imaged (10 RCA, 10 LAD, 10 LCX). The geometries of the imaged coronary arteries were reconstructed (49 human, 30 swine), and computational fluid dynamic simulations were performed by imposing individualized boundary conditions. Overall, no relevant differences in 1) wall shear stress-based quantities, 2) intravascular hemodynamics (in terms of helical flow features), and 3) anatomical features emerged between human- and swine-specific models. The findings of this study strongly support the use of swine-specific computational models to study and characterize the hemodynamic features linked to coronary atherosclerosis, sustaining the reliability of their translation to human vascular disease.
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Affiliation(s)
- Giuseppe De Nisco
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Eline M J Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Ayla Hoogendoorn
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Joost Daemen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Karol Calò
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
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Shinge SAU, Zhang D, Achu Muluh T, Nie Y, Yu F. Mechanosensitive Piezo1 Channel Evoked-Mechanical Signals in Atherosclerosis. J Inflamm Res 2021; 14:3621-3636. [PMID: 34349540 PMCID: PMC8328000 DOI: 10.2147/jir.s319789] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/03/2021] [Indexed: 12/18/2022] Open
Abstract
Recently, more and more works have focused and used extensive resources on atherosclerosis research, which is one of the major causes of death globally. Alongside traditional risk factors, such as hyperlipidemia, smoking, hypertension, obesity, and diabetes, mechanical forces, including shear stress, pressure and stretches exerted on endothelial cells by flow, is proved to be crucial in atherosclerosis development. Studies have recognized the mechanosensitive Piezo1 channel as a special sensor and transducer of various mechanical forces into biochemical signals, and recent studies report its role in atherosclerosis through different mechanical forces in pressure, stretching and turbulent shear stress. Based on our expertise in this field and considering the recent advancement of atherosclerosis research, we will be focusing on the function of Piezo1 and its involvement in various cellular mechanisms and consequent involvement in the development of atherosclerosis in this review. Also, we will discuss various functions of Piezo1 involvement in atherosclerosis and come up with new mechanistic insight for future research. Based on the recent findings, we suggest Piezo1 as a valid candidate for novel therapeutic innovations, in which deep exploration and translating its findings into the clinic will be a new therapeutic strategy for cardiovascular diseases, particularly atherosclerosis.
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Affiliation(s)
- Shafiu A Umar Shinge
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Daifang Zhang
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Clinical Research Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Tobias Achu Muluh
- Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Yongmei Nie
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Fengxu Yu
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
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Ruiz-Muñoz A, Guala A, Rodriguez-Palomares J, Dux-Santoy L, Servato L, Lopez-Sainz A, La Mura L, Granato C, Limeres J, Gonzalez-Alujas T, Galián-Gay L, Gutiérrez L, Johnson K, Wieben O, Sao-Aviles A, Ferreira-Gonzalez I, Evangelista A, Teixido-Tura G. Aortic flow dynamics and stiffness in Loeys-Dietz syndrome patients: a comparison with healthy volunteers and Marfan syndrome patients. Eur Heart J Cardiovasc Imaging 2021; 23:641-649. [PMID: 34104946 DOI: 10.1093/ehjci/jeab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess aortic flow and stiffness in patients with Loeys-Dietz syndrome (LDS) by 4D flow and cine cardiovascular magnetic resonance (CMR) and compare the results with those of healthy volunteers (HV) and Marfan syndrome (MFS) patients. METHODS AND RESULTS Twenty-one LDS and 44 MFS patients with no previous aortic dissection or surgery and 35 HV underwent non-contrast-enhanced 4D flow CMR. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR), and aortic diameters were obtained at 20 planes from the ascending (AAo) to the proximal descending aorta (DAo). IRF and SFRR were also quantified for aortic regions (proximal and distal AAo, arch and proximal DAo). Peak-systolic wall shear stress (WSS) maps were also estimated. Aortic stiffness was quantified using pulse wave velocity (PWV) and proximal AAo longitudinal strain. Compared to HV, LDS patients had lower rotational flow at the distal AAo (P = 0.002), arch (P = 0.002), and proximal DAo (P < 0.001) even after adjustment for age, stroke volume, and local diameter. LDS patients had higher SFRR in the proximal DAo compared to both HV (P = 0.024) and MFS patients (P = 0.015), even after adjustment for age and local diameter. Axial and circumferential WSS in LDS patients were lower than in HV. AAo circumferential WSS was lower in LDS compared to MFS patients. AAo and DAo PWV and proximal AAo longitudinal strain revealed stiffer aortas in LDS patients compared to HV (P = 0.007, 0.005, and 0.029, respectively) but no differences vs. MFS patients. CONCLUSION Greater aortic stiffness as well as impaired IRF and WSS were present in LDS patients compared to HV. Conversely, similar aortic stiffness and overlapping aortic flow features were found in Loeys-Dietz and Marfan patients.
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Affiliation(s)
- Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | | | - Luz Servato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Angela Lopez-Sainz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Lucia La Mura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Advanced Biomedical Sciences, University Federico II. Naples, Naples, Italy
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Limeres
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Teresa Gonzalez-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Galián-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Kevin Johnson
- Department of Medical Physics and Radiology, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics and Radiology, University of Wisconsin, Madison, WI, USA
| | - Augusto Sao-Aviles
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
- CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Instituto del Corazón. Quirónsalud-Teknon. Barcelona, Spain
| | - Gisela Teixido-Tura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Combining 4D Flow MRI and Complex Networks Theory to Characterize the Hemodynamic Heterogeneity in Dilated and Non-dilated Human Ascending Aortas. Ann Biomed Eng 2021; 49:2441-2453. [PMID: 34080100 PMCID: PMC8455395 DOI: 10.1007/s10439-021-02798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
Motivated by the evidence that the onset and progression of the aneurysm of the ascending aorta (AAo) is intertwined with an adverse hemodynamic environment, the present study characterized in vivo the hemodynamic spatiotemporal complexity and organization in human aortas, with and without dilated AAo, exploring the relations with clinically relevant hemodynamic and geometric parameters. The Complex Networks (CNs) theory was applied for the first time to 4D flow magnetic resonance imaging (MRI) velocity data of ten patients, five of them presenting with AAo dilation. The time-histories along the cardiac cycle of velocity-based quantities were used to build correlation-based CNs. The CNs approach succeeded in capturing large-scale coherent flow features, delimiting flow separation and recirculation regions. CNs metrics highlighted that an increasing AAo dilation (expressed in terms of the ratio between the maximum AAo and aortic root diameter) disrupts the correlation in forward flow reducing the correlation persistence length, while preserving the spatiotemporal homogeneity of secondary flows. The application of CNs to in vivo 4D MRI data holds promise for a mechanistic understanding of the spatiotemporal complexity and organization of aortic flows, opening possibilities for the integration of in vivo quantitative hemodynamic information into risk stratification and classification criteria.
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38
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Han L, Ren Q, Lian J, Luo L, Liu H, Ma T, Li X, Deng X, Liu X. Numerical analysis of the hemodynamics of rat aorta based on magnetic resonance imaging and fluid-structure interaction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3457. [PMID: 33750033 DOI: 10.1002/cnm.3457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
Murine models have been widely used to investigate the mechanobiology of aortic atherosclerosis and dissections, which develop preferably at different anatomic locations of aorta. Based MRI and finite element analysis with fluid-structure interaction, we numerically investigated factors that may affect the blood flow and structural mechanics of rat aorta. The results indicated that aortic root motion greatly increases time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), displacement of the aorta, and enhances helical flow pattern but has limited influence on effective stress, which is highly modulated by blood pressure. Moreover, the influence of the motion component on these indicators is different with axial motion more obvious than planar motion. Surrounding fixation of the intercostal arteries and the branch vessels on aortic arch would reduce the influence of aortic root motion. The compliance of the aorta has different influences at different regions, leading to decrease in TAWSS and helical flow, increase in OSI, RRT at the aortic arch, but has reversed effects on the branch vessels. When compared with the steady flow, the pulsatile blood flow would obviously increase the WSS, the displacement, and the effective stress in most regions. In conclusion, to accurately quantify the blood flow and structural mechanics of rat aorta, the motion of the aortic root, the compliance of aortic wall, and the pulsation of blood flow should be considered. However, when only focusing on the effective stress in rat aorta, the motion of the aortic root may be neglected.
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Affiliation(s)
- Longzhu Han
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Quan Ren
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jianxiu Lian
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Liyi Luo
- School of Instrumentation Science & Opto-electronics Engineering, Beihang University, Beijing, China
| | - Huawei Liu
- Department of Stomatology, Chinese PLA General Hospital, Beijing, China
| | - Tianxiang Ma
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xin Li
- Miyun Hospital, Peking University First Hospital, Beijing, China
| | - Xiaoyan Deng
- Artificial Intelligence Key Laboratory of Sichuan Province, School of Automation and Information Engineering, Sichuan University of Science and Engineering, Zigong, China
| | - Xiao Liu
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Jamaleddin Mousavi S, Jayendiran R, Farzaneh S, Campisi S, Viallon M, Croisille P, Avril S. Coupling hemodynamics with mechanobiology in patient-specific computational models of ascending thoracic aortic aneurysms. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 205:106107. [PMID: 33933713 DOI: 10.1016/j.cmpb.2021.106107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevention of ascending thoracic aortic aneurysms (ATAAs), which affect thousands of persons every year worldwide, remains a major issue. ATAAs may be caused by anything that weakens the aortic wall. Altered hemodynamics, which concerns a majority of patients with bicuspid aortic valves, has been shown to be related to such weakening and to contribute to ATAA development and progression. However the underlying mechanisms remain unclear and computational modeling in this field could help significantly to elucidate how hemodynamics and mechanobiology interact in ATAAs. METHODS Accordingly, we propose a numerical framework combining computational fluid dynamics and 4D flow magnetic resonance imaging (MRI) coupled with finite element (FE) analyses to simulate growth and remodeling (G&R) occurring in patient-specific aortas in relation with altered hemodynamics. The geometries and the blood velocities obtained from 4D flow MRI are used as boundary conditions for CFD simulations. CFD simulations provide an estimation of the wall shear stress (WSS) and relative residence time (RRT) distribution across the luminal surface of the wall. An initial insult is then applied to the FE model of the aortic wall, assuming that the magnitude of the insult correlates spatially with the normalized RRT distribution obtained from CFD simulations. G&R simulations are then performed. The material behavior of each Gauss point in these FE models is evolved continuously to compensate for the deviation of the actual wall stress distribution from the homeostatic state after the initial insult. The whole approach is illustrated on two healthy and two diseased subjects. The G&R parameters are calibrated against previously established statistical models of ATAA growth rates. RESULTS Among the variety of results provided by G&R simulations, the analysis focused especially on the evolution of the wall stiffness, which was shown to be a major risk factor for ATAAs. It was shown that the G&R parameters, such as for instance the rate of collagen production or cell mechanosensitivity, play a critical role in ATAA progression and remodeling. CONCLUSIONS These preliminary findings show that patient-specific computational modeling coupling hemodynamics with mechanobiology is a promising approach to explore aneurysm progression.
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Affiliation(s)
- S Jamaleddin Mousavi
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Saint-Étienne F - 42023 France
| | - Raja Jayendiran
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Saint-Étienne F - 42023 France
| | - Solmaz Farzaneh
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Saint-Étienne F - 42023 France
| | - Salvatore Campisi
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Saint-Étienne F - 42023 France; University Hospital of Saint-Étienne, Department of Cardiovascular Surgery, Saint-Étienne cedex, France
| | - Magalie Viallon
- Université de Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Étienne,F-42023 France; University Hospital of Saint-Étienne, Department of Radiology, Saint-Étienne, France
| | - Pierre Croisille
- Université de Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Étienne,F-42023 France; University Hospital of Saint-Étienne, Department of Radiology, Saint-Étienne, France
| | - Stéphane Avril
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Saint-Étienne F - 42023 France.
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40
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Wasson EM, Dubbin K, Moya ML. Go with the flow: modeling unique biological flows in engineered in vitro platforms. LAB ON A CHIP 2021; 21:2095-2120. [PMID: 34008661 DOI: 10.1039/d1lc00014d] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Interest in recapitulating in vivo phenomena in vitro using organ-on-a-chip technology has grown rapidly and with it, attention to the types of fluid flow experienced in the body has followed suit. These platforms offer distinct advantages over in vivo models with regards to human relevance, cost, and control of inputs (e.g., controlled manipulation of biomechanical cues from fluid perfusion). Given the critical role biophysical forces play in several tissues and organs, it is therefore imperative that engineered in vitro platforms capture the complex, unique flow profiles experienced in the body that are intimately tied with organ function. In this review, we outline the complex and unique flow regimes experienced by three different organ systems: blood vasculature, lymphatic vasculature, and the intestinal system. We highlight current state-of-the-art platforms that strive to replicate physiological flows within engineered tissues while introducing potential limitations in current approaches.
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Affiliation(s)
- Elisa M Wasson
- Material Engineering Division, Lawrence Livermore National Laboratory, 7000 East Ave L-222, Livermore, CA 94551, USA.
| | - Karen Dubbin
- Material Engineering Division, Lawrence Livermore National Laboratory, 7000 East Ave L-222, Livermore, CA 94551, USA.
| | - Monica L Moya
- Material Engineering Division, Lawrence Livermore National Laboratory, 7000 East Ave L-222, Livermore, CA 94551, USA.
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Takahashi K, Sekine T, Miyagi Y, Shirai S, Otsuka T, Kumita S, Ishii Y. Four-dimensional flow analysis reveals mechanism and impact of turbulent flow in the dissected aorta. Eur J Cardiothorac Surg 2021; 60:1064-1072. [PMID: 34000001 DOI: 10.1093/ejcts/ezab201] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to explore the flow dynamics factors affecting turbulence formation in the false lumen (FL) of aortic dissection using four-dimensional flow magnetic resonance imaging (4D flow MRI). This study also aimed to uncover risk factors affecting late complications of aortic dissection. METHODS Thirty-three aortic dissection patients were examined using 4D flow MRI for quantitative flow dynamics (gross flow, velocity and regurgitant fraction) and turbulence visualization (helix and vortex with three-point visual grading) in the FL. The incidence of late complications (rupture or prophylactic intervention) was also obtained prospectively. RESULTS The helix grade was correlated with FL gross flow (rS = 0.55, P < 0.001) and FL velocity (rS = 0.45, P = 0.008). The vortex grade was also correlated with FL gross flow (rS = 0.70, P < 0.001) and FL velocity (rS = 0.67, P < 0.001). Comparative analysis of patients with complications and stable patients revealed that patients with complications exhibited higher FL gross flow [41.7 (interquartile range, IQR 29.1-59.7) vs 17.7 (IQR 9.0-42.0) ml/s; P = 0.01], higher helix grade [2 (IQR 1.25-2) vs 0 (IQR 0-1); P = 0.001] and higher vortex grade [2 (IQR 1-2) vs 0 (IQR 0-2); P = 0.01]. CONCLUSIONS Using 4D flow MRI analysis, we showed that turbulence formation depends on flow volume and velocity in the FL. Patients with high-volume turbulent flow in their FL are at higher risk of late complications; therefore, close follow-up and aggressive prophylactic intervention may improve their survival. CLINICAL TRIAL REGISTRATION NUMBER Nippon Medical School Hospital Institutional Review Board approved this observational study in September 2018 (No. 30-08-986).
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Affiliation(s)
- Kenichiro Takahashi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Yasuo Miyagi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Sayaka Shirai
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Shinichiro Kumita
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Morphogenic fields: A coming of age. Explore (NY) 2021; 18:187-194. [PMID: 33903061 DOI: 10.1016/j.explore.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022]
Abstract
Morphogenesis, the coming-into-being of living organisms, was first described in the 4th century BC by Aristotle, progenitor of biology and embryology. Over the centuries it has been the subject of innumerable commentaries by philosophers, theologians and scientists but no consensus has ever been reached as to its causes. In the late 19th century, along with the emergence of cellular and molecular biology, embryology underwent a renaissance and became a topic of great interest and research. Early on the discipline divided into two opposing factions, those who attempted to explain fetal development on the basis of cellular and molecular mechanisms, and those who invoked the presence of organizing fields. The morphogenic field was first articulated in the early decades of the 20th century by multiple researchers independently of each other. The field became an extremely useful conceptual tool by which to explain a wide range of developmental phenomena. While embryology and genetics originally formed a unified discipline, during the 1930s 40 s geneticists became progressively skeptical of the field notion. The discovery of the DNA structure by Watson and Crick in the early 1950s decisively settled matters and thereafter the two disciplines pursued different lines of inquiry. After World War II embryology and the field concept went into a decades-long decline. By the 1980s an increasing number of scientists began to critically reexamine the morphogenic field concept and it underwent a second renaissance. In this paper I examine the development and evolution of the field concept, both experimentally and conceptually, and highlight the failure of genetic mechanisms to explain morphogenesis. I provide three instances from the medical literature of developmental phenomena which are only explainable on the basis of morphogenic field dynamics and argue that the field concept must be readmitted into mainstream scientific discourse.
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Effects of Ageing on Aortic Circulation During Atrial Fibrillation; a Numerical Study on Different Aortic Morphologies. Ann Biomed Eng 2021; 49:2196-2213. [PMID: 33655419 PMCID: PMC8455405 DOI: 10.1007/s10439-021-02744-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/01/2021] [Indexed: 01/21/2023]
Abstract
Atrial fibrillation (AF) can alter intra-cardiac flow and cardiac output that subsequently affects aortic flow circulation. These changes may become more significant where they occur concomitantly with ageing. Aortic ageing is accompanied with morphological changes such as dilation, lengthening, and arch unfolding. While the recognition of AF mechanism has been the subject of numerous studies, less focus has been devoted to the aortic circulation during the AF and there is a lack of such investigation at different ages. The current work aims to address the present gap. First, we analyse aortic flow distribution in three configurations, which attribute to young, middle and old people, using geometries constructed via clinical data. We then introduce two transient inlet flow conditions representative of key AF-associated defects. Results demonstrate that both AF and ageing negatively affect flow circulation. The main consequence of concomitant occurrence is enhancement of endothelial cell activation potential (ECAP) throughout the vascular domain, mainly at aortic arch and descending thoracic aorta, which is consistent with some clinical observations. The outcome of the current study suggests that AF exacerbates the vascular defects occurred due to the ageing, which increases the possibility of cardiovascular diseases per se.
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Effect of Geometric Accuracy at the Proximal Landing Zone on Simulation Results for Thoracic Endovascular Repair Patients. Cardiovasc Eng Technol 2020; 11:679-688. [PMID: 33145725 DOI: 10.1007/s13239-020-00498-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Existing hemodynamic studies on aortic dissection after thoracic endovascular aortic repair (TEVAR) apply geometric simplifications. This study aims to evaluate the necessity of more accurate geometries at the proximal landing zone in computational fluid dynamic (CFD) studies. METHODS Three patient-specific 3D aortic dissection models with different geometric accuracies at the proximal landing zone were manually fabricated for CFD simulations: (i) model 1 without the stent graft (SG), (ii) model 2 with the metal stent, and (iii) model 3 with the SG. The flow distribution, flow pattern, and wall shear stress (WSS)-related indicators in these three models were compared. RESULTS The flow distributions were quite similar for the three models, with a maximum absolute difference of 0.27% at the left suclavian artery (LSA) between models 1 and 3 because of partial coverage. A more chaotic flow pattern was observed at the proximal landing zone in model 3, with significant regional differences in the WSS-related indicator distributions. The upstream and downstream WSS-related indicator distributions were quite similar for the three models. CONCLUSIONS The flow pattern and hemodynamic parameter distributions were affected by the geometric accuracy only in a small region near the proximal landing zone. The flow split was hardly affected by the LSA partial coverage, indicating that the coverage may have slight effects on short-term blood perfusion. However, this conclusion needs to be verified in future studies with larger sample sizes.
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He Y, Northrup H, Roy-Chaudhury P, Cheung AK, Berceli SA, Shiu YT. Analyses of hemodialysis arteriovenous fistula geometric configuration and its associations with maturation and reintervention. J Vasc Surg 2020; 73:1778-1786.e1. [PMID: 33091518 DOI: 10.1016/j.jvs.2020.09.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/22/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE An arteriovenous fistula (AVF) is the preferred vascular access for chronic hemodialysis; however, the rates of AVF maturation failure and reintervention remain high. We investigated the AVF geometric parameters and their associations with AVF physiologic maturation and reintervention in a prospective multicenter study. METHODS From 2011 to 2016, patients undergoing vein end-to-artery side upper extremity AVF creation surgery were recruited. Contrast-free dark blood and phase-contrast magnetic resonance imaging (MRI) scans were performed using 3.0T scanners to obtain the AVF lumen geometry and flow rates, respectively, at postoperative day 1, week 6, and month 6. The arteriovenous anastomosis angle, nonplanarity, and tortuosity of the fistula were calculated according to the lumen centerlines. AVFs were considered physiologically matured if, using the week 6 MRI data, the flow rate was ≥500 mL/min and the minimum vein lumen diameter was ≥5 mm. The associations of these geometric parameters with AVF maturation and reintervention due to perianastomotic and mid-vein stenosis within 1 year were assessed. RESULTS A total of 111 patients had a usable day 1 MRI scan, with most having upper arm AVFs (n = 73). Compared with the forearm AVFs, upper arm AVFs had greater anastomosis angles (P < .001), larger deviations from a plane (nonplanarity; P = .002), and more prominent tortuosity (P = .038) at day 1. These parameters significantly increased between day 1 and week 6 in upper arm AVFs. In contrast, significant changes in these parameters in forearm AVFs were not observed. The rate of maturation was 54% and 86% for forearm and upper arm AVFs, respectively. None of the geometric parameters at day 1 were associated with AVF maturation in either location. The rate of reintervention was 24% and 30% for forearm and upper arm AVFs, respectively, with a larger nonplanarity angle at day 1 associated with less reintervention (30° ± 15° vs 21° ± 10°; P = .034) in upper arm AVFs only. This relationship was unchanged after adjusting for age, sex, race, dialysis status, or diabetes. CONCLUSIONS In our study, upper arm fistulas had a larger anastomosis angle, were more nonplanar, and had more tortuous veins than forearm fistulas. For upper arm fistulas, a larger nonplanarity angle is associated with a lower rate of reintervention within 1 year. Once confirmed, vascular surgeons could consider increasing the nonplanarity angle by incorporating a tension-free gentle curvature in the proximal segment of the mobilized vein to reduce reinterventions when creating an upper arm fistula.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Hannah Northrup
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Prabir Roy-Chaudhury
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC; Department of Medicine, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah; Renal Section, Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla; Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, Fla
| | - Yan-Ting Shiu
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah; Renal Section, Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah.
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Hemodynamics alteration in patient-specific dilated ascending thoracic aortas with tricuspid and bicuspid aortic valves. J Biomech 2020; 110:109954. [DOI: 10.1016/j.jbiomech.2020.109954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/03/2023]
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Deciphering ascending thoracic aortic aneurysm hemodynamics in relation to biomechanical properties. Med Eng Phys 2020; 82:119-129. [DOI: 10.1016/j.medengphy.2020.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/19/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
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Jayendiran R, Condemi F, Campisi S, Viallon M, Croisille P, Avril S. Computational prediction of hemodynamical and biomechanical alterations induced by aneurysm dilatation in patient-specific ascending thoracic aortas. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3326. [PMID: 32087044 DOI: 10.1002/cnm.3326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
The aim of the present work is to propose a robust computational framework combining computational fluid dynamics (CFD) and 4D flow MRI to predict the progressive changes in hemodynamics and wall rupture index (RPI) induced by aortic morphological evolutions in patients harboring ascending thoracic aortic aneurysms (ATAAs). An analytical equation has been proposed to predict the aneurysm progression based on age, sex, and body surface area. Parameters such as helicity, wall shear stress (WSS), time-averaged WSS, oscillatory shear index, relative residence time, and viscosity were evaluated for two patients at different stages of aneurysm growth, and compared with age-sex-matched healthy subjects. The study shows that evolution of hemodynamics and RPI, despite being very slow in ATAAs, is strongly affected by morphological alterations and, in turn could impact biomechanical factors and aortic mechanobiology. An aspect of the current work is that the patient-specific 4D MRI data sets were obtained with a follow-up of 1 year and the measured time-averaged velocity maps and flow eccentricity were compared with the CFD simulation for validation. The computational framework presented here is capable of capturing the blood flow patterns and the hemodynamic descriptors during the various stages of aneurysm growth. Further investigations will be conducted in order to verify these results on a larger cohort of patients and with long follow-up times to finally elucidate the link between deranged hemodynamics, AA geometry, and wall mechanical properties in ATAAs.
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Affiliation(s)
- Raja Jayendiran
- Mines Saint-Etienne, Université de Lyon, INSERM, U1059, SAINBIOSE, Saint-Etienne F-42023, France
| | | | - Salvatore Campisi
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Magalie Viallon
- UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Université de Lyon, Saint-Etienne, France
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pierre Croisille
- UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Université de Lyon, Saint-Etienne, France
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stéphane Avril
- Mines Saint-Etienne, Université de Lyon, INSERM, U1059, SAINBIOSE, Saint-Etienne F-42023, France
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Ortega J, Antón R, Ramos JC, Rivas A, Larraona GS, Sangro B, Bilbao JI, Aramburu J. On the importance of spiral-flow inflow boundary conditions when using idealized artery geometries in the analysis of liver radioembolization: A parametric study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3337. [PMID: 32212316 DOI: 10.1002/cnm.3337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 06/10/2023]
Abstract
In the last decades, the numerical studies on hemodynamics have become a valuable explorative scientific tool. The very first studies were done over idealized geometries, but as numerical methods and the power of computers have become more affordable, the studies tend to be patient specific. We apply the study to the numerical analysis of tumor-targeting during liver radioembolization (RE). RE is a treatment for liver cancer, and is performed by injecting radiolabeled microspheres via a catheter placed in the hepatic artery. The objective of the procedure is to maximize the release of radiolabeled microspheres into the tumor and avoid a healthy tissue damage. Idealized virtual arteries can serve as a generalist approach that permits to separately analyze the effect of a variable in the microsphere distribution with respect to others. However, it is important to use proper physiological boundary conditions (BCs). It is not obvious, the need to account for the effect of tortuosity when using an idealized virtual artery. We study the use of idealized geometry of a hepatic artery as a valid research tool, exploring the importance of using realistic spiral-flow inflow BC. By using a literature-based cancer scenario, we vary two parameters to analyze the microsphere distribution through the outlets of the geometry. The parameters varied are the type of microspheres injected and the microsphere injection velocity. The results with realistic inlet velocity profile showed that the particle distribution in the liver segments is not affected by the analyzed injection velocity values neither by the particle density. NOVELTY STATEMENT: In this article, we assessed the use of idealized geometries as a valid research tool and applied the use of an idealized geometry to the case of an idealized hepatic artery to study the particle-hemodynamics during radioembolization (RE). We studied three different inflow boundary conditions (BCs) to assess the usefulness of the geometry, two types of particle injection velocities and two types of commercially available microspheres for RE treatment. In recent years, the advent in computational resources allowed for more detailed patient-specific geometry generation and discretization and hemodynamics simulations. However, general studies based on idealized geometries can be performed in order to provide medical doctors with some basic and general guidelines when using a given catheter for a given cancer scenario. Moreover, using an idealized geometry can be a reasonable approach which allows us to isolate a given parameter and control other parameters, so that parameters can be independently assessed. Even though an idealized geometry does not match any patient's geometry, the use of an idealized geometry can be valid when drawing general conclusions that may be useful in patient-specific cases. However, we believe that even if an idealized hepatic artery geometry is used for the study, it is necessary to account for the upstream and downstream tortuosity of vessels through the BCs. In this work, we highlighted the need of modeling the tortuosity of upstream and downstream vasculatures through the BCs.
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Affiliation(s)
- Julio Ortega
- Escuela de Ingeniería Mecánica, Pontificia Universidad Católica de Valparaíso, Quilpué, Chile
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Raul Antón
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Juan C Ramos
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Alejandro Rivas
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Gorka S Larraona
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Bruno Sangro
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose I Bilbao
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge Aramburu
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
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Hu L, Ouyang R, Sun A, Wang Q, Guo C, Peng Y, Qin Y, Zhang Y, Xiang Y, Zhong Y. Pulmonary artery hemodynamic assessment of blood flow characteristics in repaired tetralogy of Fallot patients versus healthy child volunteers. Quant Imaging Med Surg 2020; 10:921-933. [PMID: 32489917 DOI: 10.21037/qims.2020.03.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background This study aimed to assess the severity of helix and vortex flow in pulmonary artery hemodynamic using 4-dimensional flow cardiac magnetic resonance (4D flow CMR) in patients with repaired tetralogy of Fallot (rTOF) and healthy child volunteers and to explore the relationship between pulmonary hemodynamic changes and right heart function. Methods CMR studies were performed in 25 rTOF patients (15 M/10 F; 8.44±4.52 years) and 10 normal child volunteers (7 M/3 F; 8.2±1.22 years) on 3.0T MR scanners. Cardiac function was calculated in the patient and control groups. Systolic diameter, peak velocity, net flow, and regurgitation was quantified in the main pulmonary artery (MPA) plane, left pulmonary artery (LPA) plane, and right pulmonary artery (RPA) plane. The relationship between the hemodynamic parameters and quantitative flow indices and right ventricular (RV) function were analyzed through simple linear regression analysis using Pearson R-values. We analyzed differences in flow patterns between the 2 groups for the same slice. According to the severity of the helix and vortex flow in the 4D flow CMR, we categorized rTOF patients into the following groups: group 1, severe flow grading; group 2, mild flow grading; group 3, no flow grading; the control cases with no flow grade were included in group 4. We compared RV cardiac function, wall shear stress (WSS), and viscous energy loss (EL) between group 1+2 and group 3+4 using unpaired t-test analysis for normally distributed data and the Mann-Whitney test for non-normally distributed continuous variables. Results RV end-diastolic volume index (EDVi) (127.8±36.13 vs. 83.11±6.18, respectively; P<0.001), RV end-systolic volume index (ESVi) (65.14±27.02 vs. 36.13±5.95, respectively; P<0.001), and ejection fraction (EF) (49.97±6.39 vs. 56.71±4.56, respectively; P=0.006,) were significantly different between the groups. The rTOF diameters of the MPA and RPA were significantly larger than those of the control group (19.74±4.01 vs. 14.97±2.37 for MPA, P=0.001; 12.04±3.28 vs. 8.99±1.23 for RPA, P=0.004, respectively). There were correlations between peak WSS and pulmonary regurgitation (PR) in the MPA (R=0.48, P=0.014), correlations between peak systolic EL and RVEDV (R=0.51, P=0.008), and between peak systolic EL and RVESV (R=0.51, P=0.009). The peak systole and diastole WSS of group 1+2 were significantly different compared to group 3+4 in the MPA (P<0.05). The peak systole and diastole EL of group 1+2 was significantly different from group 3+4 in the MPA (P<0.05). The peak systole EL of group 1+2 was significantly different from group 3+4 in the RPA (P<0.01). Conclusions Increased peak WSS and EL were associated with pulmonary hemodynamic changes in the MPA and RPA. There might be an earlier marker of evolving hemodynamic inefficiency than that in traditional parameters. The better understanding of pulmonary artery hemodynamic assessment in rTOF may lead to a greater insight into pulmonary artery (PA)-RV interactions and how they ultimately impact RV function.
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Affiliation(s)
- Liwei Hu
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Rongzhen Ouyang
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Aimin Sun
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Qian Wang
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Chen Guo
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yafeng Peng
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yan Qin
- Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yong Zhang
- MR research, GE Healthcare, Shanghai 201203, China
| | - Yang Xiang
- J.C. Wu Center for Aerodynamics, School of Aeronautics and Astronautics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yumin Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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