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Girardin L, Stokes C, Thet MS, Oo AY, Balabani S, Díaz-Zuccarini V. Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch. Cardiovasc Eng Technol 2024; 15:290-304. [PMID: 38438692 DOI: 10.1007/s13239-024-00713-6] [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: 04/05/2023] [Accepted: 01/02/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Compliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations. MATERIALS AND METHODS A post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow MRI data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed. RESULTS Increased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively. CONCLUSION This study suggests that by minimising graft length and matching its compliance to the native aorta whilst aligning with surgical requirements, the risk of LV hypertrophy may be reduced. This provides evidence that compliance-matching grafts may enhance patient outcomes.
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Affiliation(s)
- Louis Girardin
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Catriona Stokes
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Myat Soe Thet
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK.
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Shahbad R, Pipinos M, Jadidi M, Desyatova A, Gamache J, MacTaggart J, Kamenskiy A. Structural and Mechanical Properties of Human Superficial Femoral and Popliteal Arteries. Ann Biomed Eng 2024; 52:794-815. [PMID: 38321357 DOI: 10.1007/s10439-023-03435-3] [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: 10/02/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024]
Abstract
The femoropopliteal artery (FPA) is the main artery in the lower limb. It supplies blood to the leg muscles and undergoes complex deformations during limb flexion. Atherosclerotic disease of the FPA (peripheral arterial disease, PAD) is a major public health burden, and despite advances in surgical and interventional therapies, the clinical outcomes of PAD repairs continue to be suboptimal, particularly in challenging calcified lesions and biomechanically active locations. A better understanding of human FPA mechanical and structural characteristics in relation to age, risk factors, and the severity of vascular disease can help develop more effective and longer-lasting treatments through computational modeling and device optimization. This review aims to summarize recent research on the main biomechanical and structural properties of human superficial femoral and popliteal arteries that comprise the FPA and describe their anatomy, composition, and mechanical behavior under different conditions.
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Affiliation(s)
- Ramin Shahbad
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Margarita Pipinos
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Majid Jadidi
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Anastasia Desyatova
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Jennifer Gamache
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA.
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Osswald A, Tsagakis K, Demircioglu E, Weymann A, Zubarevich A, Ruhparwar A, Karmonik C. Hostile Hemodynamics in Distal Stent Graft-Induced New Entry Prior to Aortic Rupture: A Comparison of Transient versus Steady-State CFD Simulations. Thorac Cardiovasc Surg 2024; 72:134-141. [PMID: 37506731 DOI: 10.1055/s-0043-1771357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND Computational fluid dynamics (CFD) simulations model blood flow in aortic pathologies. The aim of our study was to understand the local hemodynamic environment at the site of rupture in distal stent graft-induced new entry (dSINE) after frozen elephant trunk with a clinically time efficient steady-flow simulation versus transient simulations. METHODS Steady-state simulations were performed for dSINE, prior and after its development and prior to aortic rupture. To account for potential turbulences due geometric changes at the dSINE location, Reynolds-averaged Navier-Stokes equations with the realizable k-ε model for turbulences were applied. Transient simulations were performed for comparison. Hemodynamic parameters were assessed at various locations of the aorta. RESULTS Post-dSINE, jet-like flow due to luminal narrowing was observed which increased prior to rupture and resulted in focal neighbored regions of high and low wall shear stress (WSS). Prior to rupture, aortic diameter at the rupture site increased lowering WSS at the entire aortic circumference. Concurrently, WSS and turbulence increased locally above the entry tear at the inner aortic curvature. Turbulent kinetic energy and WSS elevation in the downstream aorta demonstrated enhanced stress on the native aorta. Results of steady-state simulations were in good qualitative agreement with transient simulations. CONCLUSION Steady-flow CFD simulations feasible at clinical time scales prior to aortic rupture reveal a hostile hemodynamic environment at the dSINE rupture site in agreement with lengthy transient simulations. Consequently, our developed approach may be of value in treatment planning where a fast assessment of the local hemodynamic environment is essential.
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Affiliation(s)
- Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Ender Demircioglu
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Christof Karmonik
- MRI Core, Translational Imaging Center, Houston Methodist Research Institute, Houston, Texas, United States
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de Azevedo FS, Almeida GDC, Alvares de Azevedo B, Ibanez Aguilar IF, Azevedo BN, Teixeira PS, Camargo GC, Correia MG, Nieckele AO, Oliveira GMM. Stress Load and Ascending Aortic Aneurysms: An Observational, Longitudinal, Single-Center Study Using Computational Fluid Dynamics. Bioengineering (Basel) 2024; 11:204. [PMID: 38534478 DOI: 10.3390/bioengineering11030204] [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: 12/27/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Ascending aortic aneurysm (AAoA) is a silent disease with high mortality; however, the factors associated with a worse prognosis are not completely understood. The objective of this observational, longitudinal, single-center study was to identify the hemodynamic patterns and their influence on AAoA growth using computational fluid dynamics (CFD), focusing on the effects of geometrical variations on aortic hemodynamics. Personalized anatomic models were obtained from angiotomography scans of 30 patients in two different years (with intervals of one to three years between them), of which 16 (53%) showed aneurysm growth (defined as an increase in the ascending aorta volume by 5% or more). Numerically determined velocity and pressure fields were compared with the outcome of aneurysm growth. Through a statistical analysis, hemodynamic characteristics were found to be associated with aneurysm growth: average and maximum high pressure (superior to 100 Pa); average and maximum high wall shear stress (superior to 7 Pa) combined with high pressure (>100 Pa); and stress load over time (maximum pressure multiplied by the time interval between the exams). This study provides insights into a worse prognosis of this serious disease and may collaborate for the expansion of knowledge about mechanobiology in the progression of AAoA.
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Affiliation(s)
- Fabiula Schwartz de Azevedo
- Department of Cardiology, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Gabriela de Castro Almeida
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Bruno Alvares de Azevedo
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Ivan Fernney Ibanez Aguilar
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Bruno Nieckele Azevedo
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | | | - Gabriel Cordeiro Camargo
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Marcelo Goulart Correia
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Angela Ourivio Nieckele
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
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Gu Z, Ong CW, Mi Y, Seetharaman A, Ling RR, Ramanathan K, Leo HL. The Impact of Left Ventricular Assist Device Outflow Graft Positioning on Aortic Hemodynamics: Improving Flow Dynamics to Mitigate Aortic Insufficiency. Biomimetics (Basel) 2023; 8:465. [PMID: 37887596 PMCID: PMC10604423 DOI: 10.3390/biomimetics8060465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/27/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Heart failure is a global health concern with significant implications for healthcare systems. Left ventricular assist devices (LVADs) provide mechanical support for patients with severe heart failure. However, the placement of the LVAD outflow graft within the aorta has substantial implications for hemodynamics and can lead to aortic insufficiency during long-term support. This study employs computational fluid dynamics (CFD) simulations to investigate the impact of different LVAD outflow graft locations on aortic hemodynamics. The introduction of valve morphology within the aorta geometry allows for a more detailed analysis of hemodynamics at the aortic root. The results demonstrate that the formation of vortex rings and subsequent vortices during the high-velocity jet flow from the graft interacted with the aortic wall. Time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) indicate that modification of the outflow graft location changes mechanical states within the aortic wall and aortic valve. Among the studied geometric factors, both the height and inclination angle of the LVAD outflow graft are important in controlling retrograde flow to the aortic root, while the azimuthal angle primarily determines the rotational direction of blood flow in the aortic arch. Thus, precise positioning of the LVAD outflow graft emerges as a critical factor in optimizing patient outcomes by improving the hemodynamic environment.
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Affiliation(s)
- Zhuohan Gu
- Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore; (Z.G.); (A.S.)
| | - Chi Wei Ong
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Yongzhen Mi
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore 138632, Singapore;
| | - Ashwin Seetharaman
- Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore; (Z.G.); (A.S.)
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore (K.R.)
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore (K.R.)
- Cardiothoracic Intensive Care Unit, National University Heart Centre Singapore, National Univeristy Health System, Singapore 119228, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore; (Z.G.); (A.S.)
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Ong CW, Wee IJY, Toma M, Cui F, Xu XY, Richards AM, Leo HL, Choong AMTL. Haemodynamic changes in visceral hybrid repairs of type III and type V thoracoabdominal aortic aneurysms. Sci Rep 2023; 13:13760. [PMID: 37612440 PMCID: PMC10447573 DOI: 10.1038/s41598-023-40323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
The visceral hybrid procedure combining retrograde visceral bypass grafting and completion endovascular stent grafting is a feasible alternative to conventional open surgical or wholly endovascular repairs of thoracoabdominal aneurysms (TAAA). However, the wide variability in visceral hybrid configurations means that a priori prediction of surgical outcome based on haemodynamic flow profiles such as velocity pattern and wall shear stress post repair remain challenging. We sought to appraise the clinical relevance of computational fluid dynamics (CFD) analyses in the setting of visceral hybrid TAAA repairs. Two patients, one with a type III and the other with a type V TAAA, underwent successful elective and emergency visceral hybrid repairs, respectively. Flow patterns and haemodynamic parameters were analysed using reconstructed pre- and post-operative CT scans. Both type III and type V TAAAs showed highly disturbed flow patterns with varying helicity values preoperatively within their respective aneurysms. Low time-averaged wall shear stress (TAWSS) and high endothelial cell action potential (ECAP) and relative residence time (RRT) associated with thrombogenic susceptibility was observed in the posterior aspect of both TAAAs preoperatively. Despite differing bypass configurations in the elective and emergency repairs, both treatment options appear to improve haemodynamic performance compared to preoperative study. However, we observed reduced TAWSS in the right iliac artery (portending a theoretical risk of future graft and possibly limb thrombosis), after the elective type III visceral hybrid repair, but not the emergency type V repair. We surmise that this difference may be attributed to the higher neo-bifurcation of the aortic stent graft in the type III as compared to the type V repair. Our results demonstrate that CFD can be used in complicated visceral hybrid repair to yield potentially actionable predictive insights with implications on surveillance and enhanced post-operative management, even in patients with complicated geometrical bypass configurations.
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Affiliation(s)
- Chi Wei Ong
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Ian J Y Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Milan Toma
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, New York, USA
| | - Fangsen Cui
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, New Zealand, New Zealand
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Andrew M T L Choong
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.
- Asian Aortic & Vascular Centre, Singapore, Singapore.
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van de Velde L, Groot Jebbink E, Hagmeijer R, Versluis M, Reijnen MMPJ. Computational Fluid Dynamics for the Prediction of Endograft Thrombosis in the Superficial Femoral Artery. J Endovasc Ther 2023; 30:615-627. [DOI: https:/doi.org/10.1177/15266028221091890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Purpose: Contemporary diagnostic modalities, including contrast-enhanced computed tomography (CTA) and duplex ultrasound, have been insufficiently able to predict endograft thrombosis. This study introduces an implementation of image-based computational fluid dynamics (CFD), by exemplification with 4 patients treated with an endograft for occlusive disease of the superficial femoral artery (SFA). The potential of personalized CFD for predicting endograft thrombosis is investigated. Materials and Methods: Four patients treated with endografts for an occluded SFA were retrospectively included. CFD simulations, based on CTA and duplex ultrasound, were compared for patients with and without endograft thrombosis to investigate potential flow-related causes of endograft thrombosis. Time-averaged wall shear stress (TAWSS) was computed, which highlights areas of prolonged residence times of coagulation factors in the graft. Results: CFD simulations demonstrated normal TAWSS (>0.4 Pa) in the SFA for cases 1 and 2, but low levels of TAWSS (<0.4 Pa) in cases 3 and 4, respectively. Primary patency was achieved in cases 1 and 2 for over 2 year follow-up. Cases 3 and 4 were complicated by recurrent endograft thrombosis. Conclusion: The presence of a low TAWSS was associated with recurrent endograft thrombosis in subjects with otherwise normal anatomic and ultrasound assessment and a good distal run-off.
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Affiliation(s)
- Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rob Hagmeijer
- Engineering Fluid Dynamics, University of Twente, Enschede, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michel M. P. J. Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Xiao M, Wu J, Chen D, Wang C, Wu Y, Sun T, Chen J. Ascending Aortic Volume: A Feasible Indicator for Ascending Aortic Aneurysm Elective Surgery? Acta Biomater 2023:S1742-7061(23)00353-7. [PMID: 37356784 DOI: 10.1016/j.actbio.2023.06.026] [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: 03/01/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
Diameter-based criterion have been widely adopted for preventive surgery of ascending thoracic aortic aneurysm (ATAA). However, recent and growing evidence has shown that diameter-based methods may not be sufficient for identifying patients who are at risk of an ATAA. In this study, fluid-structure interaction (FSI) analysis was performed on one-hundred ATAA geometries reconstructed from clinical data to examine the relationship between hemodynamic conditions, ascending aortic volume (AAV), ascending aortic curvature, and aortic ratios measured from the reconstructed 3D models. The simulated hemodynamic and biomechanical parameters were compared among different groups of ATAA geometries classified based on AAV. The ATAAs with enlarged AAV showed significantly compromised hemodynamic conditions and higher mechanical wall stress. The maximum oscillatory shear index (OSI), particle residence time (PRT) and wall stress (WS) were significantly higher in enlarged ATAAs compared with controls (0.498 [0.497, 0.499] vs 0.499 [0.498, 0.499], p = 0.002, 312.847 [207.445, 519.391] vs 996.047 [640.644, 1573.140], p < 0.001, 769.680 [668.745, 879.795] vs 1072.000 [873.060, 1280.000] kPa, p < 0.001, respectively). Values were reported as median with interquartile range (IQR). AAV was also found to be more strongly correlated with these parameters compared to maximum diameter. The correlation coefficient between AAV and average WS was as high as 0.92 (p < 0.004), suggesting that AAV might be a feasible risk identifier for ATAAs. STATEMENT OF SIGNIFICANCE: Ascending thoracic aortic aneurysm is associated with the risk of dissection or rupture, creating life-threatening conditions. Current surgical intervention guidelines are purely diameter based. Recently, many studies proposed to incorporate other morphological parameters into the current clinical guidelines to better prevent severe adverse aortic events like rupture or dissection. The purpose of this study is to gain a better understanding of the relationship between morphological parameters and hemodynamic parameters in ascending aortic aneurysms using fluid-solid-interaction analysis on patient-specific geometries. Our results suggest that ascending aortic volume may be a better indicator for surgical intervention as it shows a stronger association with pathogenic hemodynamic conditions.
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Affiliation(s)
- Meng Xiao
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000.; Department of Electrical and Computer Engineering, University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada, T6G 2R3..
| | - Jinlin Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Duanduan Chen
- Department of Biomedical Engineering, Beijing Institute of Technology, No. 5, South Street, Zhongguancun, Beijing, China..
| | - Chenghu Wang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Yanfen Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Tucheng Sun
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Jie Chen
- Department of Electrical and Computer Engineering, University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada, T6G 2R3..
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Moretti S, Tauro F, Orrico M, Mangialardi N, Facci AL. Comparative Analysis of Patient-Specific Aortic Dissections through Computational Fluid Dynamics Suggests Increased Likelihood of Degeneration in Partially Thrombosed False Lumen. Bioengineering (Basel) 2023; 10:bioengineering10030316. [PMID: 36978707 PMCID: PMC10045026 DOI: 10.3390/bioengineering10030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Aortic dissection is a life-threatening vascular disease associated with high rates of morbidity and mortality, especially in medically underserved communities. Understanding patients’ blood flow patterns is pivotal for informing evidence-based treatment as they greatly influence the disease outcome. The present study investigates the flow patterns in the false lumen of three aorta dissections (fully perfused, partially thrombosed, and fully thrombosed) in the chronic phase, and compares them to a healthy aorta. Three-dimensional geometries of aortic true and false lumens (TLs and FLs) are reconstructed through an ad hoc developed and minimally supervised image analysis procedure. Computational fluid dynamics (CFD) is performed through a finite volume unsteady Reynolds-averaged Navier–Stokes approach assuming rigid wall aortas, Newtonian and homogeneous fluid, and incompressible flow. In addition to flow kinematics, we focus on time-averaged wall shear stress and oscillatory shear index that are recognized risk factors for aneurysmal degeneration. Our analysis shows that partially thrombosed dissection is the most prone to false lumen degeneration. In all dissections, the arteries connected to the false lumen are generally poorly perfused. Further, both true and false lumens present higher turbulence levels than the healthy aorta, and critical stagnation points. Mesh sensitivity and a thorough comparison against literature data together support the reliability of the CFD methodology. Image-based CFD simulations are efficient tools to assess the possibility of aortic dissection to lead to aneurysmal degeneration, and provide new knowledge on the hemodynamic characteristics of dissected versus healthy aortas. Similar analyses should be routinely included in patient-specific hemodynamics investigations, to plan and design tailored therapeutic strategies, and to timely assess their effectiveness.
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Affiliation(s)
- Simona Moretti
- DEIM Department of Economics, Engineering, Society and Business Administration, University of Tuscia, Largo dell’Università, 01100 Viterbo, Italy
| | - Flavia Tauro
- DIBAF Department for Innovation in Biological, Agro-Food and Forest Systems, University of Tuscia, Via San Camillo de Lellis, 01100 Viterbo, Italy
- Correspondence: ; Tel.: +39-0761-357355
| | - Matteo Orrico
- Vascular and Endovascular Surgery Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00149 Roma, Italy
| | - Nicola Mangialardi
- Vascular and Endovascular Surgery Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00149 Roma, Italy
| | - Andrea Luigi Facci
- DEIM Department of Economics, Engineering, Society and Business Administration, University of Tuscia, Largo dell’Università, 01100 Viterbo, Italy
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Lim E, Shi Y, Leo HL, Al Abed A. Editorial: Data assimilation in cardiovascular medicine: Merging experimental measurements with physics-based computational models. Front Physiol 2023; 14:1153861. [PMID: 36846318 PMCID: PMC9948236 DOI: 10.3389/fphys.2023.1153861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Affiliation(s)
- E. Lim
- University of Malaya, Kuala Lumpur, Malaysia,*Correspondence: E. Lim,
| | - Y. Shi
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - H. L. Leo
- National University of Singapore, Singapore, Singapore
| | - A. Al Abed
- University of New South Wales, Kensington, NSW, Australia
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11
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Yevtushenko P, Goubergrits L, Franke B, Kuehne T, Schafstedde M. Modelling blood flow in patients with heart valve disease using deep learning: A computationally efficient method to expand diagnostic capabilities in clinical routine. Front Cardiovasc Med 2023; 10:1136935. [PMID: 36937926 PMCID: PMC10020717 DOI: 10.3389/fcvm.2023.1136935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction The computational modelling of blood flow is known to provide vital hemodynamic parameters for diagnosis and treatment-support for patients with valvular heart disease. However, most diagnosis/treatment-support solutions based on flow modelling proposed utilize time- and resource-intensive computational fluid dynamics (CFD) and are therefore difficult to implement into clinical practice. In contrast, deep learning (DL) algorithms provide results quickly with little need for computational power. Thus, modelling blood flow with DL instead of CFD may substantially enhances the usability of flow modelling-based diagnosis/treatment support in clinical routine. In this study, we propose a DL-based approach to compute pressure and wall-shear-stress (WSS) in the aorta and aortic valve of patients with aortic stenosis (AS). Methods A total of 103 individual surface models of the aorta and aortic valve were constructed from computed tomography data of AS patients. Based on these surface models, a total of 267 patient-specific, steady-state CFD simulations of aortic flow under various flow rates were performed. Using this simulation data, an artificial neural network (ANN) was trained to compute spatially resolved pressure and WSS using a centerline-based representation. An unseen test subset of 23 cases was used to compare both methods. Results ANN and CFD-based computations agreed well with a median relative difference between both methods of 6.0% for pressure and 4.9% for wall-shear-stress. Demonstrating the ability of DL to compute clinically relevant hemodynamic parameters for AS patients, this work presents a possible solution to facilitate the introduction of modelling-based treatment support into clinical practice.
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Affiliation(s)
- Pavlo Yevtushenko
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Benedikt Franke
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marie Schafstedde
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- *Correspondence: Marie Schafstedde,
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Evaluation of mechanical properties and biocompatibility of three-layer PCL/PLLA small-diameter vascular graft with pore diameter gradient. Eur Polym J 2023. [DOI: 10.1016/j.eurpolymj.2023.111864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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13
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Chen H, Su T, Wang Q, Zheng Z, Li H, Li J. Comparison of thrombosis risk in an abdominal aortic dissection aneurysm with a double false lumen using computational fluid dynamic simulation method. Technol Health Care 2022; 31:1003-1015. [PMID: 36442166 DOI: 10.3233/thc-220481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND: Aneurysms are associated with a mortality rate of 81% or more in cases of rupture. OBJECTIVE: To analyse the haemodynamic indices and compare the thrombosis risk in a double false lumen abdominal aortic dissection aneurysm using computational fluid dynamics (CFD). METHODS: Computer tomography angiography (CTA) imaging data were collected from a patient with a double false lumen abdominal aortic dissection aneurysm, and three different lesion morphology aneurysm models were established, double false lumen abdominal aortic dissection aneurysm, single false lumen abdominal aortic dissection aneurysm and saccular abdominal aortic aneurysm, in order to analyse the flow velocity, time-averaged shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) of blood flow, and endothelial cell activation potential (ECAP). RESULTS: All three aneurysms were in a low-flow state within the body, and the low-flow velocity flow in the proximal vessel wall extended to the right common iliac artery; the vortex intensity was more intense in the abdominal aortic dissection aneurysm than in the saccular abdominal aortic aneurysm. The risk area for thrombosis was concentrated in the expansion part of the aneurysm and the false lumen. The RRT and ECAP maxima of the double false lumen abdominal aortic dissection aneurysm were much greater than those of the single false lumen dissection aneurysm and saccular aortic aneurysm. CONCLUSION: Low-velocity blood flow, high OSI, low TAWSS, high RRT, and high ECAP regions correlate with the risk of thrombosis. The double false lumen type of abdominal aortic dissection aneurysm had some specificity in this case. The risk of thrombosis in the patient was extremely high, and the largest risk zone was within the smaller false lumen, which could be because the smaller false lumen was connected to the true lumen by only one breach. The results of the study provide some guidance in the early screening and development of treatment plans.
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Affiliation(s)
- Hongbing Chen
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Tong Su
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Wang
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Zhe Zheng
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Hongwei Li
- Institute of Forensic Science, Chongqing Public Security Bureau, Chongqing, China
| | - Jianbo Li
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Chongqing, China
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Qu W, Li X, Huang H, Xie C, Song H. Mechanisms of the ascites volume differences between patients receiving a left or right hemi-liver graft liver transplantation: From biofluidic analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107196. [PMID: 36367484 DOI: 10.1016/j.cmpb.2022.107196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Post-transplant refractory ascites (RA) is common in patients receiving living donor liver transplantation (LDLT) using a left hemi-liver graft than in those using a right hemi-liver graft. However, there is currently no clear mechanism explaining the effect of grafts on ascites drainage. The purpose of this study is to analyze the values of blood flow parameters in the portal vein under different grafts using computational fluid dynamics (CFD) to interpret the relationship between portal pressure values with ascites drainage. METHODS In this work, ascites drainage was counted in 30 patients who underwent left-sided liver transplantation and 26 patients who underwent right-sided liver transplantation. The portal vein flow models of the transplanted liver under different flow rates were established based on computed tomography (CT) images and finite element theory. Ascites drainage and blood flow parameters were qualitatively compared. RESULTS The results show that the ascites drained from patients who received LDLT with a left hemi-liver is three times as that with a right hemi-liver. The simulation results show that the coefficient of the pressure-velocity curve of the left-liver is 1.7 times of the right-liver under the same hydrodynamic conditions, which qualitatively agrees with the clinical data. Moreover, the streamline of the transplanted left liver shows more vortexes compared with the right liver, which is a major reason for the left liver's higher pressure value. CONCLUSION This clinical phenomenon is reproduced and comprehensively explained by the hemodynamic parameters of the portal vein. This work establishes the relationship between portal pressure values and floating water drainage, and offers a new way for physicians to predict postoperative risks intuitively.
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Affiliation(s)
- Wei Qu
- Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; Tsinghua University, Beijing 100084, China
| | - Xiaofan Li
- University of Science and Technology Beijing, Beijing 100083, China
| | - Hao Huang
- Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Chiyu Xie
- University of Science and Technology Beijing, Beijing 100083, China
| | - Hongqing Song
- University of Science and Technology Beijing, Beijing 100083, China.
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Anfinogenova ND, Sinitsyn VE, Kozlov BN, Panfilov DS, Popov SV, Vrublevsky AV, Chernyavsky A, Bergen T, Khovrin VV, Ussov WY. Existing and Emerging Approaches to Risk Assessment in Patients with Ascending Thoracic Aortic Dilatation. J Imaging 2022; 8:jimaging8100280. [PMID: 36286374 PMCID: PMC9605541 DOI: 10.3390/jimaging8100280] [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: 08/28/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966–2022, Web of Science 1975–2022, Scopus 1975–2022, and RSCI 1994–2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young’s elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient’s genotypes and phenotypes in this heterogeneous pathology.
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Affiliation(s)
- Nina D. Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia
- Correspondence: ; Tel.: +7-9095390220
| | | | - Boris N. Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia
| | - Dmitry S. Panfilov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia
| | - Sergey V. Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia
| | - Alexander V. Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia
| | | | - Tatyana Bergen
- E. Meshalkin National Medical Research Center, Novosibirsk 630055, Russia
| | - Valery V. Khovrin
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
| | - Wladimir Yu. Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia
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Girfoglio M, Ballarin F, Infantino G, Nicoló F, Montalto A, Rozza G, Scrofani R, Comisso M, Musumeci F. Non-intrusive PODI-ROM for patient-specific aortic blood flow in presence of a LVAD device. Med Eng Phys 2022; 107:103849. [DOI: 10.1016/j.medengphy.2022.103849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 06/23/2022] [Accepted: 07/10/2022] [Indexed: 10/17/2022]
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17
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Gong J, Zhang Y, Zhang H, Li Q, Ren G, Lu W, Wang J. Evaluation of Blood Coagulation by Optical Vortex Tracking. SENSORS (BASEL, SWITZERLAND) 2022; 22:4793. [PMID: 35808290 PMCID: PMC9269077 DOI: 10.3390/s22134793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Blood coagulation is a complicated dynamic process that maintains the blood's fluid state and prevents uncontrollable bleeding. The real-time monitoring of coagulation dynamics is critical for blood transfusion guidance, emergency management of trauma-induced coagulopathy, perioperative bleeding, and targeted hemostatic therapy. Here, we utilize optical vortex dynamics to detect the blood coagulation dynamic process in a rapid and non-contact manner. To characterize the temporal changes in viscoelastic properties of blood during coagulation, we track the stochastic motion of optical vortices in the time-varying speckles reflected from 100 blood samples with varied coagulation profiles. The mean square displacement (MSD) of the vortices increases nonlinearly with time lag during blood coagulation reminiscent of the particles in viscoelastic fluids. The MSD curves with coagulation time are similar to the tracings of thromboelastography (TEG) during the blood coagulation. The retrieved coagulation parameters, such as reaction time and activated clotting time measured using the optical vortex method, exhibit a close correlation to those parameters acquired from TEG. These results demonstrate the feasibility of the optical vortex method for monitoring blood coagulation at the point of care. Our method is also applicable to measuring the viscoelasticity of complex fluids and turbid soft matters.
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Affiliation(s)
- Jiaxing Gong
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518000, China
| | - Yaowen Zhang
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
| | - Hui Zhang
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
| | - Qi Li
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518000, China
| | - Guangbin Ren
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
| | - Wenjian Lu
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
| | - Jing Wang
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; (J.G.); (Y.Z.); (H.Z.); (Q.L.); (G.R.); (W.L.)
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518000, China
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18
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Aghilinejad A, Wei H, Magee GA, Pahlevan NM. Model-Based Fluid-Structure Interaction Approach for Evaluation of Thoracic Endovascular Aortic Repair Endograft Length in Type B Aortic Dissection. Front Bioeng Biotechnol 2022; 10:825015. [PMID: 35813993 PMCID: PMC9259938 DOI: 10.3389/fbioe.2022.825015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is a commonly performed operation for patients with type B aortic dissection (TBAD). The goal of TEVAR is to cover the proximal entry tear between the true lumen (TL) and the false lumen (FL) with an endograft to induce FL thrombosis, allow for aortic healing, and decrease the risk of aortic aneurysm and rupture. While TEVAR has shown promising outcomes, it can also result in devastating complications including stroke, spinal cord ischemia resulting in paralysis, as well as long-term heart failure, so treatment remains controversial. Similarly, the biomechanical impact of aortic endograft implantation and the hemodynamic impact of endograft design parameters such as length are not well-understood. In this study, a fluid-structure interaction (FSI) computational fluid dynamics (CFD) approach was used based on the immersed boundary and Lattice–Boltzmann method to investigate the association between the endograft length and hemodynamic variables inside the TL and FL. The physiological accuracy of the model was evaluated by comparing simulation results with the true pressure waveform measurements taken during a live TEVAR operation for TBAD. The results demonstrate a non-linear trend towards increased FL flow reversal as the endograft length increases but also increased left ventricular pulsatile workload. These findings suggest a medium-length endograft may be optimal by achieving FL flow reversal and thus FL thrombosis, while minimizing the extra load on the left ventricle. These results also verify that a reduction in heart rate with medical therapy contributes favorably to FL flow reversal.
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Affiliation(s)
- Arian Aghilinejad
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Heng Wei
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Niema M. Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States
- Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Niema M. Pahlevan,
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He Y, Northrup H, Le H, Cheung AK, Berceli SA, Shiu YT. Medical Image-Based Computational Fluid Dynamics and Fluid-Structure Interaction Analysis in Vascular Diseases. Front Bioeng Biotechnol 2022; 10:855791. [PMID: 35573253 PMCID: PMC9091352 DOI: 10.3389/fbioe.2022.855791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 01/17/2023] Open
Abstract
Hemodynamic factors, induced by pulsatile blood flow, play a crucial role in vascular health and diseases, such as the initiation and progression of atherosclerosis. Computational fluid dynamics, finite element analysis, and fluid-structure interaction simulations have been widely used to quantify detailed hemodynamic forces based on vascular images commonly obtained from computed tomography angiography, magnetic resonance imaging, ultrasound, and optical coherence tomography. In this review, we focus on methods for obtaining accurate hemodynamic factors that regulate the structure and function of vascular endothelial and smooth muscle cells. We describe the multiple steps and recent advances in a typical patient-specific simulation pipeline, including medical imaging, image processing, spatial discretization to generate computational mesh, setting up boundary conditions and solver parameters, visualization and extraction of hemodynamic factors, and statistical analysis. These steps have not been standardized and thus have unavoidable uncertainties that should be thoroughly evaluated. We also discuss the recent development of combining patient-specific models with machine-learning methods to obtain hemodynamic factors faster and cheaper than conventional methods. These critical advances widen the use of biomechanical simulation tools in the research and potential personalized care of vascular diseases.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Hannah Northrup
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Yan Tin Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- *Correspondence: Yan Tin Shiu,
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van de Velde L, Groot Jebbink E, Hagmeijer R, Versluis M, Reijnen MMPJ. Computational Fluid Dynamics for the Prediction of Endograft Thrombosis in the Superficial Femoral Artery. J Endovasc Ther 2022:15266028221091890. [PMID: 35466777 DOI: 10.1177/15266028221091890] [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: 11/16/2022]
Abstract
PURPOSE Contemporary diagnostic modalities, including contrast-enhanced computed tomography (CTA) and duplex ultrasound, have been insufficiently able to predict endograft thrombosis. This study introduces an implementation of image-based computational fluid dynamics (CFD), by exemplification with 4 patients treated with an endograft for occlusive disease of the superficial femoral artery (SFA). The potential of personalized CFD for predicting endograft thrombosis is investigated. MATERIALS AND METHODS Four patients treated with endografts for an occluded SFA were retrospectively included. CFD simulations, based on CTA and duplex ultrasound, were compared for patients with and without endograft thrombosis to investigate potential flow-related causes of endograft thrombosis. Time-averaged wall shear stress (TAWSS) was computed, which highlights areas of prolonged residence times of coagulation factors in the graft. RESULTS CFD simulations demonstrated normal TAWSS (>0.4 Pa) in the SFA for cases 1 and 2, but low levels of TAWSS (<0.4 Pa) in cases 3 and 4, respectively. Primary patency was achieved in cases 1 and 2 for over 2 year follow-up. Cases 3 and 4 were complicated by recurrent endograft thrombosis. CONCLUSION The presence of a low TAWSS was associated with recurrent endograft thrombosis in subjects with otherwise normal anatomic and ultrasound assessment and a good distal run-off.
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Affiliation(s)
- Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rob Hagmeijer
- Engineering Fluid Dynamics, University of Twente, Enschede, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Chen Z, Zhao H, Zhao Y, Han J, Yang X, Throckmorton A, Wei Z, Ge S, He Y. Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics. Echocardiography 2022; 39:166-177. [PMID: 35026051 DOI: 10.1111/echo.15256] [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: 07/27/2021] [Revised: 10/04/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Reverse flow Retrograde flow (RF) of blood in the aortic isthmus can be observed in different types of fetal heart disease (FHD), including abnormalities in heart structure and function. This study sought to investigate the relationship between RF and blood flow parameters, and develop a computational fluid dynamics (CFD) model to understand the mechanisms underlying this observation. MATERIAL AND METHODS A total of 281 fetuses (gestational age [GA] 26.6±.3 weeks) with FHD and 2803 normal fetuses (GA: 26.1±.1 weeks) by fetal echocardiography collected from May 2016 to December 2018. Principal component analysis (PCA) was performed to find the relationship and the CFD model reconstructed from 3D/4D spatio-temporal image correlation (STIC) images to simulate hemodynamics. RESULTS There was a significant difference in the percentages of RF between the study (80/201 (39%)) and control (29/2803 (1%)) groups (p < 0.05). The RF occur when the aorta flow rate (left heart) is reduced to 60% by CFD stimulation. Pearson correlation analysis showed significant correlations between flow rate and wall shear stress(WSS) (r = .883, p = 0.047) variables at the AI. CONCLUSION Volumetric flow rate of AO or left heart was the main component of the cause of RF. The hemodynamics of the cardiovascular system have highly complex behavior hinge on the turbulent nature of circulating blood flow.
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Affiliation(s)
- Zhuo Chen
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhao
- School of Energy and Power Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Ying Zhao
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Yang
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Zhenglun Wei
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Shuping Ge
- Geisinger Heart and Vascular Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Yihua He
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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22
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Yevtushenko P, Goubergrits L, Gundelwein L, Setio A, Ramm H, Lamecker H, Heimann T, Meyer A, Kuehne T, Schafstedde M. Deep Learning Based Centerline-Aggregated Aortic Hemodynamics: An Efficient Alternative to Numerical Modelling of Hemodynamics. IEEE J Biomed Health Inform 2021; 26:1815-1825. [PMID: 34591773 DOI: 10.1109/jbhi.2021.3116764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Image-based patient-specific modelling of hemodynamics are gaining increased popularity as a diagnosis and outcome prediction solution for a variety of cardiovascular diseases. While their potential to improve diagnostic capabilities and thereby clinical outcome is widely recognized, these methods require considerable computational resources since they are mostly based on conventional numerical methods such as computational fluid dynamics (CFD). As an alternative to the numerical methods, we propose a machine learning (ML) based approach to calculate patient-specific hemodynamic parameters. Compared to CFD based methods, our approach holds the benefit of being able to calculate a patient-specific hemodynamic outcome instantly with little need for computational power. In this proof-of-concept study, we present a deep artificial neural network (ANN) capable of computing hemodynamics for patients with aortic coarctation in a centerline aggregated (i.e. locally averaged) form. Considering the complex relation between vessels shape and hemodynamics on the one hand and the limited availability of suitable clinical data on the other, a sufficient accuracy of the ANN may however not be achieved with available data only. Another key aspect of this study is therefore the successful augmentation of available clinical data. Using a statistical shape model, additional training data was generated which substantially increased the ANNs accuracy, showcasing the ability of ML based methods to perform in-silico modelling tasks previously requiring resource intensive CFD simulations.
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Abazari MA, Rafiei D, Soltani M, Alimohammadi M. The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study. Sci Rep 2021; 11:16058. [PMID: 34362955 PMCID: PMC8346572 DOI: 10.1038/s41598-021-95315-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022] Open
Abstract
Aortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.
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Affiliation(s)
- Mohammad Amin Abazari
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Deniz Rafiei
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - M Soltani
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
- Department of Electrical and Computer Engineering, Faculty of Engineering, School of Optometry and Vision Science, Faculty of Science, University of Waterloo, Waterloo, Canada.
- Advanced Bio Initiative Center, Multidisciplinary International Complex, K. N. Toosi University of Technology, Tehran, Iran.
- Centre for Biotechnology and Bioengineering (CBB), University of Waterloo, Waterloo, ON, Canada.
- Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mona Alimohammadi
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
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24
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Alnajar A. Commentary: Predicting False Lumen Enlargement Based on Fenestration Flow Velocity - to What Extent Should Computational Models be Incorporated? Semin Thorac Cardiovasc Surg 2021; 34:451-452. [PMID: 34116200 DOI: 10.1053/j.semtcvs.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery. University of Miami Miller School of Medicine, Miami, Florida.
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25
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Thamsen B, Yevtushenko P, Gundelwein L, Setio AAA, Lamecker H, Kelm M, Schafstedde M, Heimann T, Kuehne T, Goubergrits L. Synthetic Database of Aortic Morphometry and Hemodynamics: Overcoming Medical Imaging Data Availability. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1438-1449. [PMID: 33544670 DOI: 10.1109/tmi.2021.3057496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Modeling of hemodynamics and artificial intelligence have great potential to support clinical diagnosis and decision making. While hemodynamics modeling is extremely time- and resource-consuming, machine learning (ML) typically requires large training data that are often unavailable. The aim of this study was to develop and evaluate a novel methodology generating a large database of synthetic cases with characteristics similar to clinical cohorts of patients with coarctation of the aorta (CoA), a congenital heart disease associated with abnormal hemodynamics. Synthetic data allows use of ML approaches to investigate aortic morphometric pathology and its influence on hemodynamics. Magnetic resonance imaging data (154 patients as well as of healthy subjects) of aortic shape and flow were used to statistically characterize the clinical cohort. The methodology generating the synthetic cohort combined statistical shape modeling of aortic morphometry and aorta inlet flow fields and numerical flow simulations. Hierarchical clustering and non-linear regression analysis were successfully used to investigate the relationship between morphometry and hemodynamics and to demonstrate credibility of the synthetic cohort by comparison with a clinical cohort. A database of 2652 synthetic cases with realistic shape and hemodynamic properties was generated. Three shape clusters and respective differences in hemodynamics were identified. The novel model predicts the CoA pressure gradient with a root mean square error of 4.6 mmHg. In conclusion, synthetic data for anatomy and hemodynamics is a suitable means to address the lack of large datasets and provide a powerful basis for ML to gain new insights into cardiovascular diseases.
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26
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HOU XIAOXI, OU CHUBIN, HANZAWA KAZUHIKO, DAI XILEI, QIAN YI. GUIDANCE ON AREA OF CREATED TEARS FOR AORTIC FENESTRATION TREATMENT BASED ON COMPUTATIONAL FLUID DYNAMICS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aortic fenestration (AF) uses puncture and a dilation balloon to create a tear in the intimal flap, which can directly relieve ischemia syndrome and reduce hypertension in the false lumen. The selection of a dilation balloon as well as the area of the created tear applied in reality depend on clinical experience, so we aim to provide a quantitative guidance and reference for doctors to better plan the treatment of aortic fenestration. In this study, the area of the created tear was virtually enlarged to at least 10 different values for four cases including one ideal case, and a computational fluid dynamic approach was applied to simulate blood flows in the aorta. The area ratio (AR) between the created tear and entry tear was introduced to express the enlargement of the created tear. The quantitative hemodynamic results indicate that the AR should be controlled to be larger than 7.0, but not too big to obtain the best treatment for acute aortic dissection (AD) case. Additionally, we assessed that AR might also be a risk factor for the prediction of dissection propagation.
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Affiliation(s)
- XIAOXI HOU
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia 75 Talavera Road, Macquarie Park NSW, 2113, Australia
| | - CHUBIN OU
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia 75 Talavera Road, Macquarie Park NSW, 2113, Australia
| | - KAZUHIKO HANZAWA
- Advanced Treatment and Prevention for Vascular Disease and Embolism, Niigata University, Graduate School of Medicine, 1-757, Asahimachi-dori, Niigata City, 951-8511, Japan
| | - XILEI DAI
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia 75 Talavera Road, Macquarie Park NSW, 2113, Australia
| | - YI QIAN
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia 75 Talavera Road, Macquarie Park NSW, 2113, Australia
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27
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Deng L, Qin H, Guan Z, Mu Q, Xia Q, Wang M, Huang WH, Gu K. Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:667. [PMID: 33987365 PMCID: PMC8106110 DOI: 10.21037/atm-21-605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of the present study was to use a numerical simulation based on computational fluid dynamics (CFD) to analyze the difference of different cannulation methods on hemodynamics characteristic in a type A aortic dissection (TAAD) model. Methods A finite-element analysis based on the CFD model of a TAAD patient was used, and axillary artery cannulation (AAC), innominate artery cannulation (IAC), and femoral artery cannulation (FAC) were analyzed under different situations, including a cardiac output (CO) of 2.5 L/min and cardiopulmonary bypass (CPB) of 2.5 L/min (partial CPB before cross-clamping aorta, defined as condition A), and a CO of 0 L/min and CPB of 5 L/min (aortic cross-clamping phase, defined as condition B). The insertion of an 8-mm cannula into the different models was simulated. Hemodynamic characteristics, including wall shear stress, wall stress, blood flow, and velocity were analyzed. Results In condition A, the total flow of branches of the aortic arch was 2,009.5 mL/min (AAC), 1,855.47 mL/min (IAC), and 1,648.03 mL/min (FAC). All cannulation methods improved left renal blood perfusion. However, in relation to blood flow in the right renal artery, FAC showed the highest blood flow (105 mL/min). The results in condition B were similar to those of condition A. The velocity, shear stress, and stress of entry tear via AAC and IAC decreased in condition B compared with condition A. The velocity, shear stress, stress of tear via AAC was lower than that of IAC. Conclusions Different cannulation modes have an effect on the hemodynamic characteristic of the tear, but this effect is related to different states of CPB. AAC was found to superior to IAC, especially in reducing velocity, stress, and shear stress of site of tear. However, IAC and AAC are more conductive to blood supply than FAC in branch vessels of the aortic arch without being affected by the CPB state.
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Affiliation(s)
- Li Deng
- Affiliated Gaozhou Hospital of Guangdong Medical University, Gaozhou, China.,Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Hao Qin
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Zhiyuan Guan
- Peking University Third Hospital, Beijing, China
| | - Qingchun Mu
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Qingping Xia
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Maosheng Wang
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Wen-Hua Huang
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Kaiyun Gu
- National Clinical Research Center for Child Health, The Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
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28
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Runte K, Brosien K, Schubert C, Nordmeyer J, Kramer P, Schubert S, Berger F, Hennemuth A, Kuehne T, Kelm M, Goubergrits L. Image-Based Computational Model Predicts Dobutamine-Induced Hemodynamic Changes in Patients With Aortic Coarctation. Circ Cardiovasc Imaging 2021; 14:e011523. [PMID: 33591212 DOI: 10.1161/circimaging.120.011523] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacological stress testing can help to uncover pathological hemodynamic conditions and is, therefore, used in the clinical routine to assess patients with structural heart diseases such as aortic coarctation with borderline indication for treatment. The aim of this study was to develop and test a reduced-order model predicting dobutamine stress induced pressure gradients across the coarctation. METHODS The reduced-order model was developed based on n=21 imaging data sets of patients with aortic coarctation and a meta-analysis of subjects undergoing dobutamine stress testing. Within an independent test cohort of n=21 patients with aortic coarctation, the results of the model were compared with dobutamine stress testing during catheterization. RESULTS In n=19 patients responding to dobutamine stress testing, pressure gradients across the coarctation during dobutamine stress increased from 15.7±5.1 to 33.6±10.3 mm Hg (paired t test, P<0.001). The model-predicted pressure gradients agreed with catheter measurements with a mean difference of -2.2 mm Hg and a limit of agreement of ±11.16 mm Hg according to Bland-Altman analysis. Significant equivalence between catheter-measured and simulated pressure gradients during stress was found within the study cohort (two 1-sided tests of equivalence with a noninferiority margin of 5.0 mm Hg, 33.6±10.33 versus 31.5±11.15 mm Hg, P=0.021). CONCLUSIONS The developed reduced-order model can instantly predict dobutamine-induced hemodynamic changes with accuracy equivalent to heart catheterization in patients with aortic coarctation. The method is easy to use, available as a web-based calculator, and provides a promising alternative to conventional stress testing in the clinical routine. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02591940.
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Affiliation(s)
- Kilian Runte
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Kay Brosien
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.)
| | - Charlotte Schubert
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (S.S.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (S.S., F.B., T.K.)
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (S.S., F.B., T.K.)
| | - Anja Hennemuth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Fraunhofer Institute for Medical Image Computing-MEVIS, Bremen, Germany (A.H.)
| | - Titus Kuehne
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (S.S., F.B., T.K.)
| | - Marcus Kelm
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,Berlin Institute of Health, Germany (M.K.)
| | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Einstein Center Digital Future, Berlin, Germany (L.G.)
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29
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Gutierrez MA. Computational Analysis of Fluid Dynamics in the Transcatheter Aortic Valve Replacement. Arq Bras Cardiol 2020; 115:688-689. [PMID: 33111870 PMCID: PMC8386972 DOI: 10.36660/abc.20201002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marco A Gutierrez
- Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
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30
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Roux E, Bougaran P, Dufourcq P, Couffinhal T. Fluid Shear Stress Sensing by the Endothelial Layer. Front Physiol 2020; 11:861. [PMID: 32848833 PMCID: PMC7396610 DOI: 10.3389/fphys.2020.00861] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/26/2020] [Indexed: 12/21/2022] Open
Abstract
Blood flow produces mechanical frictional forces, parallel to the blood flow exerted on the endothelial wall of the vessel, the so-called wall shear stress (WSS). WSS sensing is associated with several vascular pathologies, but it is first a physiological phenomenon. Endothelial cell sensitivity to WSS is involved in several developmental and physiological vascular processes such as angiogenesis and vascular morphogenesis, vascular remodeling, and vascular tone. Local conditions of blood flow determine the characteristics of WSS, i.e., intensity, direction, pulsatility, sensed by the endothelial cells that, through their effect of the vascular network, impact WSS. All these processes generate a local-global retroactive loop that determines the ability of the vascular system to ensure the perfusion of the tissues. In order to account for the physiological role of WSS, the so-called shear stress set point theory has been proposed, according to which WSS sensing acts locally on vessel remodeling so that WSS is maintained close to a set point value, with local and distant effects of vascular blood flow. The aim of this article is (1) to review the existing literature on WSS sensing involvement on the behavior of endothelial cells and its short-term (vasoreactivity) and long-term (vascular morphogenesis and remodeling) effects on vascular functioning in physiological condition; (2) to present the various hypotheses about WSS sensors and analyze the conceptual background of these representations, in particular the concept of tensional prestress or biotensegrity; and (3) to analyze the relevance, explanatory value, and limitations of the WSS set point theory, that should be viewed as dynamical, and not algorithmic, processes, acting in a self-organized way. We conclude that this dynamic set point theory and the biotensegrity concept provide a relevant explanatory framework to analyze the physiological mechanisms of WSS sensing and their possible shift toward pathological situations.
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Affiliation(s)
- Etienne Roux
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, University of Bordeaux, Bordeaux, France.,UMR 8560 IHPST - Institut d'Histoire et de Philosophie des Sciences et des Techniques, CNRS, Université Paris 1 Panthéon-Sorbonne, Paris, France
| | - Pauline Bougaran
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, University of Bordeaux, Bordeaux, France
| | - Pascale Dufourcq
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, University of Bordeaux, Bordeaux, France
| | - Thierry Couffinhal
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, University of Bordeaux, Bordeaux, France
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31
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Marrocco-Trischitta MM, Romarowski RM, Alaidroos M, Sturla F, Glauber M, Nano G. Computational Fluid Dynamics Modeling of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Ann Vasc Surg 2020; 69:413-417. [PMID: 32479874 DOI: 10.1016/j.avsg.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND To assess the endograft displacement forces (DF), which quantify the forces exerted by the pulsatile blood flow on the vessel wall and transmitted on the terminal fixation site of the endograft after its deployment in proximal landing zones (PLZs) of the bovine aortic arch variant. METHODS Thirty healthy aortic computed tomographic angiographies of subjects with bovine arch configuration (10 per type of arch, I-III) were selected for the purpose of the study. A 3-dimensional model of the aortic arch lumen was reconstructed. Computational fluid dynamics modeling was then used to compute DF magnitude and orientation (i.e., x, y, and z axes) in PLZs of each case. DF values were normalized to the corresponding aortic wall area to estimate equivalent surface traction (EST). RESULTS DF were highest in zone 0, consistently with the greater surface area. DF in zone 3 were much greater than in zone 2 because of a 3-fold greater upward component (z axis) (P < 0.001), being therefore mainly oriented orthogonally to the aortic blood flow and to the vessel longitudinal axis in that zone. EST progressively increased from zone 0 toward more distal PLZs, with EST in zone 3 being much greater than that in zone 2 (P < 0.001). The same pattern was observed after stratification by type of arch. CONCLUSIONS The bovine arch is associated with a consistent fluid dynamic pattern, which identifies in zone 3 an unfavorable biomechanical environment for endograft deployment.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Cardiovascular Department, Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Cardiovascular Department, Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy.
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Moad Alaidroos
- Cardiovascular Department, Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Cardiovascular Department, Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy; Department of Scienze Biomediche per la Salute, University of Milan, Milan, Italy
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