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Parikh S, Giudici A, Huberts W, Delhaas T, Bidar E, Spronck B, Reesink K. Significance of Dynamic Axial Stretching on Estimating Biomechanical Behavior and Properties of the Human Ascending Aorta. Ann Biomed Eng 2024; 52:2485-2495. [PMID: 38836979 PMCID: PMC11329543 DOI: 10.1007/s10439-024-03537-6] [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: 12/08/2023] [Accepted: 05/02/2024] [Indexed: 06/06/2024]
Abstract
Contrary to most vessels, the ascending thoracic aorta (ATA) not only distends but also elongates in the axial direction. The purpose of this study is to investigate the biomechanical behavior of the ascending thoracic aorta (ATA) in response to dynamic axial stretching during the cardiac cycle. In addition, the implications of neglecting this dynamic axial stretching when estimating the constitutive model parameters of the ATA are investigated. The investigations were performed through in silico simulations by assuming a Gasser-Ogden-Holzapfel (GOH) constitutive model representative of ATA tissue material. The GOH model parameters were obtained from biaxial tests performed on four human ATA tissues in a previous study. Pressure-diameter curves were simulated as synthetic data to assess the effect of neglecting dynamic axial stretching on estimating constitutive model parameters. Our findings reveal a significant increase in axial stress (~ 16%) and stored strain energy (~ 18%) in the vessel when dynamic axial stretching is considered, as opposed to assuming a fixed axial stretch. All but one artery showed increased volume compliance while considering a dynamic axial stretching condition. Furthermore, we observe a notable difference in the estimated constitutive model parameters when dynamic axial stretching of the ATA is neglected, compared to the ground truth model parameters. These results underscore the critical importance of accounting for axial deformations when conducting in vivo biomechanical characterization of the ascending thoracic aorta.
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Affiliation(s)
- Shaiv Parikh
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Alessandro Giudici
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, Cardiovascular Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Faculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, Australia
| | - Koen Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
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2
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Raviol J, Plet G, Hasegawa R, Yu K, Kosukegawa H, Ohta M, Magoariec H, Pailler-Mattei C. Towards the mechanical characterisation of unruptured intracranial aneurysms: Numerical modelling of interactions between a deformation device and the aneurysm wall. J Mech Behav Biomed Mater 2024; 153:106469. [PMID: 38402693 DOI: 10.1016/j.jmbbm.2024.106469] [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: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
Intracranial aneurysm is a critical pathology related to the arterial wall deterioration. This work is an essential aspect of a large scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool regarding the rupture risk assessment. A machine learning algorithm links the aneurysm shape observed and a database of UIA clinical images associated with in vivo wall mechanical properties and rupture characterisation. The database constitution is derived from a device prototype coupled with medical imaging. It provides the mechanical characterisation of the aneurysm from the wall deformation obtained by inverse analysis based on the variation of luminal volume. Before performing in vivo tests of the device on small animals, a numerical model was built to quantify the device's impact on the aneurysm wall under natural blood flow conditions. As the clinician will never be able to precisely situate the device, several locations were considered. In preparation for the inverse analysis procedure, artery material laws of increasing complexity were studied (linear elastic, hyper elastic Fung-like). Considering all the device locations and material laws, the device induced relative displacements to the Systole peak (worst case scenario with the highest mechanical stimulus linked to the blood flow) ranging from 375 μm to 1.28 mm. The variation of luminal volume associated with the displacements was between 0.95 % and 4.3 % compared to the initial Systole volume of the aneurysm. Significant increase of the relative displacements and volume variations were found with the study of different cardiac cycle moments between the blood flow alone and the device application. For forthcoming animal model studies, Spectral Photon CT Counting, with a minimum spatial resolution of 250 μm, was selected as the clinical imaging technique. Based on this preliminary study, the displacements and associated volume variations (baseline for inverse analyse), should be observable and exploitable.
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Affiliation(s)
- J Raviol
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - G Plet
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - R Hasegawa
- Graduate School of Engineering, Tohuku University, 980-8579, Sendai Miyagi, Japan; Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - K Yu
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - H Kosukegawa
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - M Ohta
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan; ElyT MaX, CNRS UMI 3537, Université de Lyon, Tohoku University, France, Japan
| | - H Magoariec
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - C Pailler-Mattei
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France; ISPB-Faculté de Pharmacie, Université Claude Bernard Lyon 1, Université de Lyon, France.
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3
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Raviol J, Plet G, Langlois JB, Si-Mohamed S, Magoariec H, Pailler-Mattei C. In vivo mechanical characterization of arterial wall using an inverse analysis procedure: application on an animal model of intracranial aneurysm. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231936. [PMID: 38633347 PMCID: PMC11022001 DOI: 10.1098/rsos.231936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/19/2024]
Abstract
Intracranial aneurysm is a pathology related to the deterioration of the arterial wall. This work is an essential part of a large-scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool to facilitate the rupture risk assessment. It will lean on the link between the aneurysm shape clinically observed and a database derived from the in vivo mechanical characterization of aneurysms. To supply this database, a deformation device prototype of the arterial wall was developed. Its use coupled with medical imaging (spectral photon-counting computed tomography providing a spatial resolution down to 250 μm) is used to determine the in vivo mechanical properties of the wall based on the inverse analysis of the quantification of the wall deformation observed experimentally. This study presents the in vivo application of this original procedure to an animal model of aneurysm. The mechanical properties of the aneurysm wall identified were consistent with the literature, and the errors between the numerical and experimental results were less than 10%. Based on these parameters, this study allows the assessment of the aneurysm stress state for a known solicitation and points towards the definition of a rupture criterion.
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Affiliation(s)
- J. Raviol
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | - G. Plet
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | | | - S. Si-Mohamed
- Université de Lyon, INSA Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Villeurbanne69100, France
- Département de Radiologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron69677, France
| | - H. Magoariec
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | - C. Pailler-Mattei
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
- Université de Lyon, Université Claude Bernard Lyon 1, ISPB-Faculté de Pharmacie, Lyon69008, France
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Catalano C, Turgut T, Zahalka O, Götzen N, Cannata S, Gentile G, Agnese V, Gandolfo C, Pasta S. On the Material Constitutive Behavior of the Aortic Root in Patients with Transcatheter Aortic Valve Implantation. Cardiovasc Eng Technol 2024; 15:95-109. [PMID: 37985617 PMCID: PMC10884088 DOI: 10.1007/s13239-023-00699-7] [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: 05/13/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat patients with severe aortic valve stenosis. However, there is limited knowledge on the material properties of the aortic root in TAVI patients, and this can impact the credibility of computer simulations. This study aimed to develop a non-invasive inverse approach for estimating reliable material constituents for the aortic root and calcified valve leaflets in patients undergoing TAVI. METHODS The identification of material parameters is based on the simultaneous minimization of two cost functions, which define the difference between model predictions and cardiac-gated CT measurements of the aortic wall and valve orifice area. Validation of the inverse analysis output was performed comparing the numerical predictions with actual CT shapes and post-TAVI measures of implanted device diameter. RESULTS A good agreement of the peak systolic shape of the aortic wall was found between simulations and imaging, with similarity index in the range in the range of 83.7% to 91.5% for n.20 patients. Not any statistical difference was observed between predictions and CT measures of orifice area for the stenotic aortic valve. After TAVI simulations, the measurements of SAPIEN 3 Ultra (S3) device diameter were in agreement with those from post-TAVI angio-CT imaging. A sensitivity analysis demonstrated a modest impact on the S3 diameters when altering the elastic material property of the aortic wall in the range of inverse analysis solution. CONCLUSIONS Overall, this study demonstrates the feasibility and potential benefits of using non-invasive imaging techniques and computational modeling to estimate material properties in patients undergoing TAVI.
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Affiliation(s)
- Chiara Catalano
- Department of Engineering, Università degli Studi di Palermo, Viale delle Scienze, Palermo, Italy
| | - Tahir Turgut
- 4RealSim Services BV, Groene Dijk 2B, 3401 NJ, IJsselstein, The Netherlands
| | - Omar Zahalka
- 4RealSim Services BV, Groene Dijk 2B, 3401 NJ, IJsselstein, The Netherlands
| | - Nils Götzen
- 4RealSim Services BV, Groene Dijk 2B, 3401 NJ, IJsselstein, The Netherlands
| | - Stefano Cannata
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Giovanni Gentile
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Valentina Agnese
- 3D printing and Virtual Reality Laboratory, Department of Research, IRCCS-ISMETT, IRCCS Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Via Tricomi, 5, Palermo, Italy
| | - Caterina Gandolfo
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, Università degli Studi di Palermo, Viale delle Scienze, Palermo, Italy.
- 3D printing and Virtual Reality Laboratory, Department of Research, IRCCS-ISMETT, IRCCS Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Via Tricomi, 5, Palermo, Italy.
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Image-Based Finite Element Modeling Approach for Characterizing In Vivo Mechanical Properties of Human Arteries. J Funct Biomater 2022; 13:jfb13030147. [PMID: 36135582 PMCID: PMC9505727 DOI: 10.3390/jfb13030147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Mechanical properties of the arterial walls could provide meaningful information for the diagnosis, management and treatment of cardiovascular diseases. Classically, various experimental approaches were conducted on dissected arterial tissues to obtain their stress-stretch relationship, which has limited value clinically. Therefore, there is a pressing need to obtain biomechanical behaviors of these vascular tissues in vivo for personalized treatment. This paper reviews the methods to quantify arterial mechanical properties in vivo. Among these methods, we emphasize a novel approach using image-based finite element models to iteratively determine the material properties of the arterial tissues. This approach has been successfully applied to arterial walls in various vascular beds. The mechanical properties obtained from the in vivo approach were compared to those from ex vivo experimental studies to investigate whether any discrepancy in material properties exists for both approaches. Arterial tissue stiffness values from in vivo studies generally were in the same magnitude as those from ex vivo studies, but with lower average values. Some methodological issues, including solution uniqueness and robustness; method validation; and model assumptions and limitations were discussed. Clinical applications of this approach were also addressed to highlight their potential in translation from research tools to cardiovascular disease management.
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Cikach FS, Germano E, Roselli EE, Svensson LG. Ascending aorta mechanics and dimensions in aortopathy – from science to application. Indian J Thorac Cardiovasc Surg 2022; 38:7-13. [PMID: 35463697 PMCID: PMC8980982 DOI: 10.1007/s12055-020-01092-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022] Open
Abstract
The ascending aorta has a unique microstructure and biomechanical properties that allow it to absorb energy during systole and return energy during diastole (Windkessel effect). Derangements in aortic architecture can result in changes to biomechanics and inefficiencies in function. Ultimately biomechanical failure may occur resulting in aortic dissection or rupture. By measuring aortic biomechanics with either in vivo or ex vivo methods, one may be able to predict tissue failure in patients with aortic disease such as aneurysms. An understanding of the biomechanical changes that lead to these tissue-level failures may help guide therapy, disease surveillance, surgical intervention, and aid in the development of new treatments for this deadly condition.
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7
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Kozuń M, Chwiłkowska A, Pezowicz C, Kobielarz M. Influence of atherosclerosis on anisotropy and incompressibility of the human thoracic aortic wall. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Condemi F, Campisi S, Viallon M, Croisille P, Avril S. Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties. IEEE Trans Biomed Eng 2020; 67:949-956. [DOI: 10.1109/tbme.2019.2924955] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Borghi A, Rodriguez Florez N, Ruggiero F, James G, O'Hara J, Ong J, Jeelani O, Dunaway D, Schievano S. A population-specific material model for sagittal craniosynostosis to predict surgical shape outcomes. Biomech Model Mechanobiol 2019; 19:1319-1329. [PMID: 31571084 PMCID: PMC7424404 DOI: 10.1007/s10237-019-01229-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/17/2019] [Indexed: 11/26/2022]
Abstract
Sagittal craniosynostosis consists of premature fusion (ossification) of the sagittal suture during infancy, resulting in head deformity and brain growth restriction. Spring-assisted cranioplasty (SAC) entails skull incisions to free the fused suture and insertion of two springs (metallic distractors) to promote cranial reshaping. Although safe and effective, SAC outcomes remain uncertain. We aimed hereby to obtain and validate a skull material model for SAC outcome prediction. Computed tomography data relative to 18 patients were processed to simulate surgical cuts and spring location. A rescaling model for age matching was created using retrospective data and validated. Design of experiments was used to assess the effect of different material property parameters on the model output. Subsequent material optimization-using retrospective clinical spring measurements-was performed for nine patients. A population-derived material model was obtained and applied to the whole population. Results showed that bone Young's modulus and relaxation modulus had the largest effect on the model predictions: the use of the population-derived material model had a negligible effect on improving the prediction of on-table opening while significantly improved the prediction of spring kinematics at follow-up. The model was validated using on-table 3D scans for nine patients: the predicted head shape approximated within 2 mm the 3D scan model in 80% of the surface points, in 8 out of 9 patients. The accuracy and reliability of the developed computational model of SAC were increased using population data: this tool is now ready for prospective clinical application.
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Affiliation(s)
- Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
| | - Naiara Rodriguez Florez
- Surface Technologies Group, Department of Biomedical Engineering, Mondragon Unibertsitatea, Mondragón, Spain
| | - Federica Ruggiero
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Justine O'Hara
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Juling Ong
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - David Dunaway
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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10
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Liu M, Liang L, Sulejmani F, Lou X, Iannucci G, Chen E, Leshnower B, Sun W. Identification of in vivo nonlinear anisotropic mechanical properties of ascending thoracic aortic aneurysm from patient-specific CT scans. Sci Rep 2019; 9:12983. [PMID: 31506507 PMCID: PMC6737100 DOI: 10.1038/s41598-019-49438-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/24/2019] [Indexed: 12/15/2022] Open
Abstract
Accurate identification of in vivo nonlinear, anisotropic mechanical properties of the aortic wall of individual patients remains to be one of the critical challenges in the field of cardiovascular biomechanics. Since only the physiologically loaded states of the aorta are given from in vivo clinical images, inverse approaches, which take into account of the unloaded configuration, are needed for in vivo material parameter identification. Existing inverse methods are computationally expensive, which take days to weeks to complete for a single patient, inhibiting fast feedback for clinicians. Moreover, the current inverse methods have only been evaluated using synthetic data. In this study, we improved our recently developed multi-resolution direct search (MRDS) approach and the computation time cost was reduced to 1~2 hours. Using the improved MRDS approach, we estimated in vivo aortic tissue elastic properties of two ascending thoracic aortic aneurysm (ATAA) patients from pre-operative gated CT scans. For comparison, corresponding surgically-resected aortic wall tissue samples were obtained and subjected to planar biaxial tests. Relatively close matches were achieved for the in vivo-identified and ex vivo-fitted stress-stretch responses. It is hoped that further development of this inverse approach can enable an accurate identification of the in vivo material parameters from in vivo image data.
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Affiliation(s)
- Minliang Liu
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Liang Liang
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Computer Science, University of Miami, Coral Gables, FL, USA
| | - Fatiesa Sulejmani
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Xiaoying Lou
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Glen Iannucci
- Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Chen
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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Cosentino F, Agnese V, Raffa GM, Gentile G, Bellavia D, Zingales M, Pilato M, Pasta S. On the role of material properties in ascending thoracic aortic aneurysms. Comput Biol Med 2019; 109:70-78. [DOI: 10.1016/j.compbiomed.2019.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/20/2019] [Accepted: 04/20/2019] [Indexed: 12/31/2022]
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12
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Cosentino F, Scardulla F, D'Acquisto L, Agnese V, Gentile G, Raffa G, Bellavia D, Pilato M, Pasta S. Computational modeling of bicuspid aortopathy: Towards personalized risk strategies. J Mol Cell Cardiol 2019; 131:122-131. [PMID: 31047985 DOI: 10.1016/j.yjmcc.2019.04.026] [Citation(s) in RCA: 5] [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: 02/26/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 11/18/2022]
Abstract
This paper describes current advances on the application of in-silico for the understanding of bicuspid aortopathy and future perspectives of this technology on routine clinical care. This includes the impact that artificial intelligence can provide to develop computer-based clinical decision support system and that wearable sensors can offer to remotely monitor high-risk bicuspid aortic valve (BAV) patients. First, we discussed the benefit of computational modeling by providing tangible examples of in-silico software products based on computational fluid-dynamic (CFD) and finite-element method (FEM) that are currently transforming the way we diagnose and treat cardiovascular diseases. Then, we presented recent findings on computational hemodynamic and structural mechanics of BAV to highlight the potentiality of patient-specific metrics (not-based on aortic size) to support the clinical-decision making process of BAV-associated aneurysms. Examples of BAV-related personalized healthcare solutions are illustrated.
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Affiliation(s)
- Federica Cosentino
- Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, n.2, 90128 Palermo, Italy; Fondazione Ri.MED, Via Bandiera n.11, 90133 Palermo, Italy
| | - Francesco Scardulla
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy
| | - Leonardo D'Acquisto
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy
| | - Valentina Agnese
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Via Tricomi n.5, 90127 Palermo, Italy
| | - Giovanni Gentile
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Via Tricomi n.5, 90127 Palermo, Italy
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Via Tricomi n.5, 90127 Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Via Tricomi n.5, 90127 Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Via Tricomi n.5, 90127 Palermo, Italy
| | - Salvatore Pasta
- Fondazione Ri.MED, Via Bandiera n.11, 90133 Palermo, Italy; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Via Tricomi n.5, 90127 Palermo, Italy.
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13
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Farzaneh S, Trabelsi O, Chavent B, Avril S. Identifying Local Arterial Stiffness to Assess the Risk of Rupture of Ascending Thoracic Aortic Aneurysms. Ann Biomed Eng 2019; 47:1038-1050. [DOI: 10.1007/s10439-019-02204-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/09/2019] [Indexed: 01/18/2023]
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14
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Campobasso R, Condemi F, Viallon M, Croisille P, Campisi S, Avril S. Evaluation of Peak Wall Stress in an Ascending Thoracic Aortic Aneurysm Using FSI Simulations: Effects of Aortic Stiffness and Peripheral Resistance. Cardiovasc Eng Technol 2018; 9:707-722. [DOI: 10.1007/s13239-018-00385-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022]
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15
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Mousavi SJ, Farzaneh S, Avril S. Computational predictions of damage propagation preceding dissection of ascending thoracic aortic aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2944. [PMID: 29171175 DOI: 10.1002/cnm.2944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/10/2017] [Accepted: 11/12/2017] [Indexed: 06/07/2023]
Abstract
Dissections of ascending thoracic aortic aneurysms (ATAAs) cause significant morbidity and mortality worldwide. They occur when a tear in the intima-media of the aorta permits the penetration of the blood and the subsequent delamination and separation of the wall in 2 layers, forming a false channel. To predict computationally the risk of tear formation, stress analyses should be performed layer-specifically and they should consider internal or residual stresses that exist in the tissue. In the present paper, we propose a novel layer-specific damage model based on the constrained mixture theory, which intrinsically takes into account these internal stresses and can predict appropriately the tear formation. The model is implemented in finite-element commercial software Abaqus coupled with user material subroutine. Its capability is tested by applying it to the simulation of different exemplary situations, going from in vitro bulge inflation experiments on aortic samples to in vivo overpressurizing of patient-specific ATAAs. The simulations reveal that damage correctly starts from the intimal layer (luminal side) and propagates across the media as a tear but never hits the adventitia. This scenario is typically the first stage of development of an acute dissection, which is predicted for pressures of about 2.5 times the diastolic pressure by the model after calibrating the parameters against experimental data performed on collected ATAA samples. Further validations on a larger cohort of patients should hopefully confirm the potential of the model in predicting patient-specific damage evolution and possible risk of dissection during aneurysm growth for clinical applications.
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Affiliation(s)
- S Jamaleddin Mousavi
- CIS-EMSE, Ecole des Mines de Saint-Étienne, F-42023 Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, F-42023 Saint-Étienne, France
- Université de Lyon, F-69000 Lyon, France
| | - Solmaz Farzaneh
- CIS-EMSE, Ecole des Mines de Saint-Étienne, F-42023 Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, F-42023 Saint-Étienne, France
- Université de Lyon, F-69000 Lyon, France
| | - Stéphane Avril
- CIS-EMSE, Ecole des Mines de Saint-Étienne, F-42023 Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, F-42023 Saint-Étienne, France
- Université de Lyon, F-69000 Lyon, France
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16
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A non-invasive methodology for ATAA rupture risk estimation. J Biomech 2018; 66:119-126. [DOI: 10.1016/j.jbiomech.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/13/2017] [Accepted: 11/09/2017] [Indexed: 01/05/2023]
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17
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Liu M, Liang L, Sun W. Estimation of in vivo mechanical properties of the aortic wall: A multi-resolution direct search approach. J Mech Behav Biomed Mater 2017; 77:649-659. [PMID: 29101897 DOI: 10.1016/j.jmbbm.2017.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022]
Abstract
The patient-specific biomechanical analysis of the aorta requires in vivo mechanical properties of individual patients. Existing approaches for estimating in vivo material properties often demand high computational cost and mesh correspondence of the aortic wall between different cardiac phases. In this paper, we propose a novel multi-resolution direct search (MRDS) approach for estimation of the nonlinear, anisotropic constitutive parameters of the aortic wall. Based on the finite element (FE) updating scheme, the MRDS approach consists of the following three steps: (1) representing constitutive parameters with multiple resolutions using principal component analysis (PCA), (2) building links between the discretized PCA spaces at different resolutions, and (3) searching the PCA spaces in a 'coarse to fine' fashion following the links. The estimation of material parameters is achieved by minimizing a node-to-surface error function, which does not need mesh correspondence. The method was validated through a numerical experiment by using the in vivo data from a patient with ascending thoracic aortic aneurysm (ATAA), the results show that the number of FE iterations was significantly reduced compared to previous methods. The approach was also applied to the in vivo CT data from an aged healthy human patient, and using the estimated material parameters, the FE-computed geometry was well matched with the image-derived geometry. This novel MRDS approach may facilitate the personalized biomechanical analysis of aortic tissues, such as the rupture risk analysis of ATAA, which requires fast feedback to clinicians.
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MESH Headings
- Aged
- Algorithms
- Anisotropy
- Aorta/diagnostic imaging
- Aorta/physiology
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/physiology
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/physiology
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/pathology
- Blood Pressure
- Computer Simulation
- Elasticity
- Endothelium, Vascular/pathology
- Finite Element Analysis
- Humans
- Models, Cardiovascular
- Principal Component Analysis
- Software
- Stress, Mechanical
- Tomography, X-Ray Computed
- Ultrasonography
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Affiliation(s)
- Minliang Liu
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Liang Liang
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States.
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18
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Pasta S, Agnese V, Di Giuseppe M, Gentile G, Raffa GM, Bellavia D, Pilato M. In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging. Ann Biomed Eng 2017; 45:2911-2920. [DOI: 10.1007/s10439-017-1915-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/31/2017] [Indexed: 01/13/2023]
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19
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Patient-specific stress analyses in the ascending thoracic aorta using a finite-element implementation of the constrained mixture theory. Biomech Model Mechanobiol 2017; 16:1765-1777. [DOI: 10.1007/s10237-017-0918-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 05/06/2017] [Indexed: 12/18/2022]
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20
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A new inverse method for estimation of in vivo mechanical properties of the aortic wall. J Mech Behav Biomed Mater 2017; 72:148-158. [PMID: 28494272 DOI: 10.1016/j.jmbbm.2017.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 01/02/2023]
Abstract
The aortic wall is always loaded in vivo, which makes it challenging to estimate the material parameters of its nonlinear, anisotropic constitutive equation from in vivo image data. Previous approaches largely relied on either computationally expensive finite element models or simplifications of the geometry or material models. In this study, we investigated a new inverse method based on aortic wall stress computation. This approach consists of the following two steps: (1) computing an "almost true" stress field from the in vivo geometries and loading conditions, (2) building an objective function based on the "almost true" stress fields, constitutive equations and deformation relations, and estimating the material parameters by minimizing the objective function. The method was validated through numerical experiments by using the in vivo data from four ascending aortic aneurysm (AsAA) patients. The results demonstrated that the method is computationally efficient. This novel approach may facilitate the personalized biomechanical analysis of aortic tissues in clinical applications, such as in the rupture risk analysis of ascending aortic aneurysms.
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21
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Biomechanical Characterization of Ascending Aortic Aneurysms. Biomech Model Mechanobiol 2016; 16:705-720. [DOI: 10.1007/s10237-016-0848-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022]
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22
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Biaxial rupture properties of ascending thoracic aortic aneurysms. Acta Biomater 2016; 42:273-285. [PMID: 27345137 DOI: 10.1016/j.actbio.2016.06.028] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/11/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022]
Abstract
UNLABELLED Although hundreds of samples obtained from ascending thoracic aortic aneurysms (ATAA) of patients undergoing elective surgical repair have already been characterized biomechanically, their rupture properties were always derived from uniaxial tensile tests. Due to their bulge shape, ATAAs are stretched biaxially in vivo. In order to understand the biaxial rupture of ATAAs, our group developed a novel methodology based on bulge inflation and full-field optical measurements. The objective of the current paper is threefold. Firstly, we will review the failure properties (maximum stress, maximum stretch) obtained by bulge inflation testing on a cohort of 31 patients and compare them with failure properties obtained by uniaxial tension in a previously published study. Secondly, we will investigate the relationship between the failure properties and the age of patients, showing that patients below 55years of age display significantly higher strength. Thirdly, we will define a rupture risk based on the extensibility of the tissue and we will show that this rupture risk is strongly correlated with the physiological elastic modulus of the tissue independently of the age, ATAA diameter or the aortic valve phenotype of the patient. STATEMENT OF SIGNIFICANCE Despite their medical importance, rupture properties of ascending thoracic aortic aneurysms (ATAA) subjected to biaxial tension were inexistent in the literature. In order to address this lack, our group developed a novel methodology based on bulge inflation and full-field optical measurements. Here we report rupture properties obtained with this methodology on 31 patients. It is shown for the first time that rupture occurs when the stretch applied to ATAAs reaches the maximum extensibility of the tissue and that this maximum extensibility correlates strongly with the elastic properties. The outcome is a better detection of at-risk individuals for elective surgical repair.
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23
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Wittek A, Grosland NM, Joldes GR, Magnotta V, Miller K. From Finite Element Meshes to Clouds of Points: A Review of Methods for Generation of Computational Biomechanics Models for Patient-Specific Applications. Ann Biomed Eng 2015; 44:3-15. [PMID: 26424475 DOI: 10.1007/s10439-015-1469-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
Abstract
It has been envisaged that advances in computing and engineering technologies could extend surgeons' ability to plan and carry out surgical interventions more accurately and with less trauma. The progress in this area depends crucially on the ability to create robustly and rapidly patient-specific biomechanical models. We focus on methods for generation of patient-specific computational grids used for solving partial differential equations governing the mechanics of the body organs. We review state-of-the-art in this area and provide suggestions for future research. To provide a complete picture of the field of patient-specific model generation, we also discuss methods for identifying and assigning patient-specific material properties of tissues and boundary conditions.
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Affiliation(s)
- Adam Wittek
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Crawley-Perth, Western Australia, Australia.
| | - Nicole M Grosland
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA.,Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, IA, USA.,Center for Computer Aided Design, The University of Iowa, Iowa City, IA, USA
| | - Grand Roman Joldes
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Crawley-Perth, Western Australia, Australia
| | - Vincent Magnotta
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
| | - Karol Miller
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Crawley-Perth, Western Australia, Australia.,Institute of Mechanics and Advanced Materials, Cardiff School of Engineering, Cardiff University, Wales, UK
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