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Zhang X, Chen J, Qiu C, He Y, Wang B, Zhang H, Wu Z, Chen D. Validation of classification system for isolated superior mesenteric artery dissections using image-based computational flow analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108364. [PMID: 39146760 DOI: 10.1016/j.cmpb.2024.108364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND OBJECTIVE The isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially fatal vascular disorder. Classifications for ISMAD were previously proposed based on morphometric features. However, the classification systems were not standardized and verified yet. This study conducted computational flow analysis to validate the latest classification system of ISMAD and aid clinical decision-making based on hemodynamic parameters. METHODS 62 patients with ISMAD were included and classified into different types according to false lumen structures (five types, Type I-V) and true lumen patency (two types, Type P and Type S) according to Qiu classification system. Computational fluid dynamics and three-dimensional structural analyses were conducted on the basis of computed tomography angiography datasets. Quantitative and qualitative functional analyses were performed via parameters of interest including volume flow of each minute, pressure drop, pressure gradient, the derivative parameters of wall shear stress such as time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and the relative residence time (RRT). Statistical analyses were conducted among different ISMAD types. RESULTS TAWSS, OSI and RRT showed significant difference among different types when classified using false lumen structures. In detail, Type IV showed significantly higher TAWSS than other types (p = 0.007). OSI was obviously higher in Type II (p = 0.015). Type IV also presented the lowest RRT (p = 0.005). The pressure drop, pressure gradient, OSI and RRT showed higher value in Type S than that in Type P, demonstrating a statistical significance with p values of 0.017, 0.041, 0.001 and 0.012, respectively. While Type P had larger volume flow than Type S (p = 0.041). CONCLUSIONS The notable differences in hemodynamic features among different types demonstrated the feasibility of Qiu classification system. The evaluation based on hemodynamic simulation might also provide insights into risk identification and guide therapeutic decisions for ISMAD.
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Affiliation(s)
- Xuehuan Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jiale Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
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Mei J, Yuan Y, Yan H, Zhao X, Xue T, Su H, Jia Z. Factors associated with false lumen changes in patients with superior mesenteric artery dissection. Vasc Med 2024; 29:274-285. [PMID: 38334057 DOI: 10.1177/1358863x231220624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND False lumen changes (FLCs) are the main reference for the prognosis judgment and treatment plan selection for type IIa superior mesenteric artery dissection (SMAD). METHODS For this retrospective study, 55 patients with symptomatic type IIa SMAD were included. Computational fluid dynamics (CFD) analysis was used to explore the hemodynamic basis of FLCs. Correlation and multiple linear regression analyses were performed to identify clinical, morphological and hemodynamic factors associated with FLCs. RESULTS The FLCs of patients with successful conservative treatment (n = 29) are significantly higher than those with failed conservative treatment (n = 26) (58.5 ± 21.1% vs 10.9 ± 17.4%, p < 0.0001). Positive correlations were seen between FLCs and the morphological parameters false lumen length (FLL)/dissection entrance length (DEL) and FLL. In terms of hemodynamic parameters, negative correlations were seen between FLCs and time-averaged wall shear stress (TAWSS), vorticity, and high areas of TAWSS and vorticity, whereas positive correlations were seen between FLCs and oscillatory shear index (OSI), relative residence time (RRT), and high areas of OSI and RRT. Multiple linear regression analysis identified symptom duration (odds ratio [OR], 0.93; 95% CI, 0.91-0.96; p < 0.0001), FLL/DEL (OR, 1.30; 95% CI, 1.01-1.67; p = 0.044), and high RRT area (OR, 2.03; 95% CI, 1.48-2.78; p < 0.0001) as predictors of FLCs. CONCLUSION The clinical predictor symptom duration, morphological factor FLL/DEL, and the hemodynamic factor high RRT area can serve as predictors of FLCs in patients with symptomatic type IIa SMAD.
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Affiliation(s)
- Junhao Mei
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yuan Yuan
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Yan
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huaian's City, Huai'an, China
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
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Zhang X, Wang D, Zhang X, Liang S, Wu Z, Wen Z, Ventikos Y, Xiong J, Chen D. A CT-based predictive model for stent-induced vessel damage: application to type B aortic dissection. Eur Radiol 2023; 33:8682-8692. [PMID: 37368110 DOI: 10.1007/s00330-023-09773-z] [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: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The distal stent-induced new entry (distal SINE) is a life-threatening device-related complication after thoracic endovascular aortic repair (TEVAR). However, risk factors for distal SINE are not fully determined, and prediction models are lacking. This study aimed to establish a predictive model for distal SINE based on the preoperative dataset. METHODS Two hundred and six patients with Stanford type B aortic dissection (TBAD) that experienced TEVAR were involved in this study. Among them, thirty patients developed distal SINE. Pre-TEVAR morphological parameters were measured based on the CT-reconstructed configurations. Virtual post-TEVAR morphological and mechanical parameters were computed via the virtual stenting algorithm (VSA). Two predictive models (PM-1 and PM-2) were developed and presented as nomograms to help risk evaluation of distal SINE. The performance of the proposed predictive models was evaluated and internal validation was conducted. RESULTS Machine-selected variables for PM-1 included key pre-TEVAR parameters, and those for PM-2 included key virtual post-TEVAR parameters. Both models showed good calibration in both development and validation subsamples, while PM-2 outperformed PM-1. The discrimination of PM-2 was better than PM-1 in the development subsample, with an optimism-corrected area under the curve (AUC) of 0.95 and 0.77, respectively. Application of PM-2 in the validation subsample presented good discrimination with an AUC of 0.9727. The decision curve demonstrated that PM-2 was clinically useful. CONCLUSION This study proposed a predictive model for distal SINE incorporating the CT-based VSA. This predictive model could efficiently predict the risk of distal SINE and thus might contribute to personalized intervention planning. CLINICAL RELEVANCE STATEMENT This study established a predictive model to evaluate the risk of distal SINE based on the pre-stenting CT dataset and planned device information. With an accurate VSA tool, the predictive model could help to improve the safety of the endovascular repair procedure. KEY POINTS • Clinically useful prediction models for distal stent-induced new entry are still lacking, and the safety of the stent implantation is hard to guarantee. • Our proposed predictive tool based on a virtual stenting algorithm supports different stenting planning rehearsals and real-time risk evaluation, guiding clinicians to optimize the presurgical plan when necessary. • The established prediction model provides accurate risk evaluation for vessel damage, improving the safety of the intervention procedure.
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Affiliation(s)
- Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Dianpeng Wang
- School of Mathematics, Beijing Institute of Technology, Beijing, China
| | - Xuyang Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ziheng Wu
- Department of Vascular Surgery, First Affiliated Hospital of Medical College, Zhejiang University, Zhejiang, China
| | - Zipeng Wen
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Yiannis Ventikos
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Department of Mechanical Engineering, University College London, London, UK
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China.
- Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
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Che Y, Zhao J, Zhang X, Luo M, Cao X, Zheng L, Shu C. Hemodynamics of different configurations of the left subclavian artery parallel stent graft for thoracic endovascular aortic repair. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107741. [PMID: 37544164 DOI: 10.1016/j.cmpb.2023.107741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Parallel (chimney and periscope) graft technique is an effective approach for left subclavian artery (LSA) reconstruction in patients treated by thoracic endovascular aortic repair (TEVAR) for the inadequate landing zone. However, certain stent graft (SG) configurations may promote thrombosis and reduce distal blood flow, increasing risks of cerebral infarction and reintervention. METHODS In this paper, we first attempt to systematically evaluate the hemodynamic performances of different parallel graft techniques as potential determinants of complication risks. Based on the patient-specific 3D aortic geometry undergoing parallel graft technique, fifteen models in total for five kinds of LSA branched SG configurations (Forward, Backward, Extended, Elliptical and Periscopic) were designed virtually, and the hemodynamic discrepancies between them were analyzed by computational fluid dynamics. RESULTS Results show that flow rate of patients undergoing periscope technique reduces by half compared with chimney technique, suggesting that periscope SG may cause more serious flow obstruction to LSA, leading to stroke. For chimney stent structure, the extension length 0has little influence on energy loss and other parameters. Conversely, hemodynamic differences between the retrograde curvature and the antegrade curvature are significant (time average WSS: 47.07%), so the retrograde curvature might prompt SG displacement. Furthermore, the flatter chimney SG induces more aggressive hemodynamic forces, among which the difference of the maximum WSS between the flatter SG and nearly round SG reaches 65.56%, leading to the greater risk of vascular wall damage. CONCLUSIONS Results obtained might provide suggestions for physicians to formulate appropriate parallel graft technique schemes in TEVAR.
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Affiliation(s)
- Yue Che
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Jiawei Zhao
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, China
| | - Xuelan Zhang
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China; School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 10083, China.
| | - Mingyao Luo
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, China; Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming 650102, China.
| | - Xiran Cao
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Liancun Zheng
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Chang Shu
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, China; Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha 410011, China.
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Tang QH, Chen J, Long Z, Wang YL, Su XA, Qiu JY, Lin QN, Zhang JF, Qin X. Factors affecting distal false lumen enlargement after thoracic endovascular aortic repair for type B aortic dissection. Heliyon 2023; 9:e17248. [PMID: 37383200 PMCID: PMC10293708 DOI: 10.1016/j.heliyon.2023.e17248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Objective To investigate the factors influencing distal false lumen enlargement after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Materials and methods Data were collected on patients with type B aortic dissection who underwent TEVAR from January 2008 to August 2022. Patients were divided into a distal aortic segmental enlargement (DSAE) group and a non-DSAE group based on whether the distal false lumen was dilated more than 5 mm on computed tomographic angiography (CTA) images. To analyze the independent influences on distal false lumen dilatation after TEVAR, the variables with a P value < 0.05 during univariate analysis were included in the binary logistic regression analysis model. Results A total of 335 patients were included in this study, with 85 in the DSAE group and 250 in the non-DSAE group. The mean age was 52.40 ± 11.34 years, 289 (86.27%) were male patients, and the median follow-up time was 6.41 (11.99-29.99) months. There were significant differences in Marfan syndrome, chronic obstructive pulmonary disease (COPD), and follow-up time between the two groups. In terms of morphology, there were statistically significant differences in the number of tears, the size of the primary tear, and the length of dissection between the two groups. Binary logistic regression analysis indicated that Marfan syndrome, COPD, and the primary tear size were associated with distal false lumen dilatation. Conclusions Marfan syndrome, COPD, and the primary tear size influence distal aortic segmental enlargement after TEVAR in type B aortic dissection patients.
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Zhu Y, Xu XY, Rosendahl U, Pepper J, Mirsadraee S. Advanced risk prediction for aortic dissection patients using imaging-based computational flow analysis. Clin Radiol 2023; 78:e155-e165. [PMID: 36610929 DOI: 10.1016/j.crad.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Patients with either a repaired or medically managed aortic dissection have varying degrees of risk of developing late complications. High-risk patients would benefit from earlier intervention to improve their long-term survival. Currently serial imaging is used for risk stratification, which is not always reliable. On the other hand, understanding aortic haemodynamics within a dissection is essential to fully evaluate the disease and predict how it may progress. In recent decades, computational fluid dynamics (CFD) has been extensively applied to simulate complex haemodynamics within aortic diseases, and more recently, four-dimensional (4D)-flow magnetic resonance imaging (MRI) techniques have been developed for in vivo haemodynamic measurement. This paper presents a comprehensive review on the application of image-based CFD simulations and 4D-flow MRI analysis for risk prediction in aortic dissection. The key steps involved in patient-specific CFD analyses are demonstrated. Finally, we propose a workflow incorporating computational modelling for personalised assessment to aid in risk stratification and treatment decision-making.
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Affiliation(s)
- Y Zhu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - X Y Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - U Rosendahl
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - J Pepper
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - S Mirsadraee
- National Heart and Lung Institute, Imperial College London, London, UK; Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK.
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7
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Li F, Zhu Y, Song H, Zhang H, Chen L, Guo W. Analysis of Postoperative Remodeling Characteristics after Modular Inner Branched Stent-Graft Treatment of Aortic Arch Pathologies Using Computational Fluid Dynamics. Bioengineering (Basel) 2023; 10:bioengineering10020164. [PMID: 36829658 PMCID: PMC9952632 DOI: 10.3390/bioengineering10020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The modular inner branched stent-graft (MIBSG), a novel interventional therapy, has demonstrated good effects in the endovascular treatment of aortic arch pathologies, especially those involving the supra-aortic branches. Nevertheless, the long-term efficacy of the MIBSG and in-depth quantitative evaluation of postoperative outcomes remain to be examined. Moreover, the regularity of postoperative vascular remodeling induced by MIBSG implantation has yet to be explored. To address these questions, we constructed four models (normal, preoperative, 1 week postoperative, and 6 months postoperative) based on a single patient case to perform computational fluid dynamics simulations. The morphological and hemodynamic characteristics, including the velocity profile, flow rate distribution, and hemodynamic parameter distribution (wall shear stress and its derivative parameters), were investigated. After MIBSG implantation, the morphology of the supra-aortic branches changed significantly, and the branch point moved forward to the proximal ascending aorta. Moreover, the curvature radius of the aortic arch axis continued to change. These changes in morphology altered the characteristics of the flow field and wall shear stress distribution. As a result, the local forces exerted on the vessel wall by the blood led to vessel remodeling. This study provides insight into the vascular remodeling process after MIBSG implantation, which occurs as a result of the interplay between vascular morphological characteristics and blood flow characteristics.
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Affiliation(s)
- Fen Li
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- Institute of Applied Mechanics, Taiyuan University of Technology, Taiyuan 030024, China
| | - Yating Zhu
- First Medical Center of Chinese PLA General Hospital, Department of Vascular Surgery, Beijing 100853, China
| | - Hui Song
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- Institute of Applied Mechanics, Taiyuan University of Technology, Taiyuan 030024, China
| | - Hongpeng Zhang
- First Medical Center of Chinese PLA General Hospital, Department of Vascular Surgery, Beijing 100853, China
| | - Lingfeng Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- Correspondence: (L.C.); (W.G.)
| | - Wei Guo
- First Medical Center of Chinese PLA General Hospital, Department of Vascular Surgery, Beijing 100853, China
- Correspondence: (L.C.); (W.G.)
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8
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Lee GH, Heo W, Lee Y, Kim TH, Huh H, Song SW, Ha H. Fluid-structure interaction simulation of visceral perfusion and impact of different cannulation methods on aortic dissection. Sci Rep 2023; 13:1116. [PMID: 36670162 PMCID: PMC9860063 DOI: 10.1038/s41598-023-27855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Hemodynamics in aortic dissection (AD) is closely associated with the risk of aortic aneurysm, rupture, and malperfusion. Altered blood flow in patients with AD can lead to severe complications such as visceral malperfusion. In this study, we aimed to investigate the effect of cannulation flow on hemodynamics in AD using a fluid-structure interaction simulation. We developed a specific-idealized AD model that included an intimal tear in the descending thoracic aorta, a re-entry tear in the left iliac artery, and nine branches. Two different cannulation methods were tested: (1) axillary cannulation (AC) only through the brachiocephalic trunk and (2) combined axillary and femoral cannulation (AFC) through the brachiocephalic trunk and the right common iliac artery. AC was found to result in the development of a pressure difference between the true lumen and false lumen, owing to the difference in the flow rate through each lumen. This pressure difference collapsed the true lumen, disturbing blood flow to the celiac and superior mesenteric arteries. However, in AFC, the pressure levels between the two lumens were similar, and no collapse occurred. Moreover, the visceral flow was higher than that in AC. Lastly, the stiffness of the intimal flap affected the true lumen's collapse.
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Affiliation(s)
- Gyu-Han Lee
- Department of Interdisciplinary Program in Biohealth-Machinery Convergence Engineering, Kangwon National University, Chuncheon, Republic of Korea
| | - Woon Heo
- Vascular Access Center, Lifeline Clinic, Busan, Republic of Korea
| | - Youngjin Lee
- Department of Smart Health Science and Technology, Kangwon National University, 1 Gangwondaehak-Gil, Chuncheon, 24341, Republic of Korea
| | - Tae-Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Hyungkyu Huh
- Daegu-Gyeongbuk Medical Innovation Foundation, Medical Device Development Center, Daegu, Republic of Korea
| | - Suk-Won Song
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
| | - Hojin Ha
- Department of Smart Health Science and Technology, Kangwon National University, 1 Gangwondaehak-Gil, Chuncheon, 24341, Republic of Korea.
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Capoccia M, Sherif MA, Nassef A, Shaw D, Walker P, Evans B, Kaul P, Elmahdy W. Aortic arch surgery for type B aortic dissection: How far should we go? The value of a hybrid approach. Clin Case Rep 2023; 11:e6742. [PMID: 36619481 PMCID: PMC9810843 DOI: 10.1002/ccr3.6742] [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: 08/30/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023] Open
Abstract
Traditionally, the management of type B aortic dissection has been the domain of the vascular surgeons. Timing and type of intervention still generate debate. We sought to review our early experience with the treatment of this condition based on a hybrid approach following an aortic multi-disciplinary team meeting involving close cooperation between cardiac surgeons, vascular surgeons, interventional radiologists, vascular anesthetists, and cardiac anesthetists. Four patients (age 41-56 years; 3 males; 1 female) with type B aortic dissection underwent aortic arch surgery through a hybrid approach: one elective procedure consisting of ascending aorta and hemi-arch replacement with debranching followed by thoracic endovascular aortic repair (TEVAR); one redo procedure requiring aortic arch replacement with hybrid frozen elephant trunk; two acute presentations (aortic arch replacement and debranching followed by TEVAR; AVR with ascending aorta, arch, and proximal descending thoracic aorta replacement with conventional elephant trunk and debranching). Deep hypothermic circulatory arrest was required in three patients. Despite respiratory complications and slightly prolonged postoperative course, all patients survived without onset of stroke, paraplegia, malperfusion, endoleak, or need for re-exploration. Follow-up remains satisfactory. Different factors may affect outcome following complex aortic procedures. Nevertheless, close cooperation between cardiac surgeons, vascular surgeons, and interventional radiologists may reduce potential for complications and address aspects that may not be completely within the domain of individual specialists.
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Affiliation(s)
- Massimo Capoccia
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Mohamed Ashur Sherif
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Ahmed Nassef
- Vascular SurgeryLeeds Teaching Hospitals NHS TrustLeedsUK
| | - David Shaw
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Paul Walker
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Betsy Evans
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Pankaj Kaul
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Walid Elmahdy
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
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Liu D, Wang X, Zhao D, Sun Z, Biekan J, Wen Z, Xu L, Liu J. Influence of MRI-based boundary conditions on type B aortic dissection simulations in false lumen with or without abdominal aorta involvement. Front Physiol 2022; 13:977275. [PMID: 36160847 PMCID: PMC9490059 DOI: 10.3389/fphys.2022.977275] [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: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Most computational hemodynamic studies of aortic dissections rely on idealized or general boundary conditions. However, numerical simulations that ignore the characteristics of the abdominal branch arteries may not be conducive to accurately observing the hemodynamic changes below the branch arteries. In the present study, two men (M-I and M-II) with type B aortic dissection (TBAD) underwent arterial-phase computed tomography angiography and four-dimensional flow magnetic resonance imaging (MRI) before and after thoracic endovascular aortic repair (TEVAR). The finite element method was used to simulate the computational fluid dynamic parameters of TBAD [false lumen (FL) with or without visceral artery involvement] under MRI-specific and three idealized boundary conditions in one cardiac cycle. Compared to the results of zero pressure and outflow boundary conditions, the simulations with MRI boundary conditions were closer to the initial MRI data. The pressure difference between true lumen and FL after TEVAR under the other three boundary conditions was lower than that of the MRI-specific results. The results of the outflow boundary conditions could not characterize the effect of the increased wall pressure near the left renal artery caused by the impact of Tear-1, which raised concerns about the distal organ and limb perfused by FL. After TEVAR, the flow velocity and wall pressure in the FL and the distribution areas of high time average wall shear stress and oscillating shear index were reduced. The difference between the calculation results for different boundary conditions was lower in M-II, wherein FL did not involve the abdominal aorta branches than in M-I. The boundary conditions of the abdominal branch arteries from MRI data might be valuable in elucidating the hemodynamic changes of the descending aorta in TBAD patients before and after treatment, especially those with FL involving the branch arteries.
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Affiliation(s)
- Dongting Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xuan Wang
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Dongliang Zhao
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA, Australia
- *Correspondence: Jiayi Liu, ; Zhonghua Sun,
| | | | - Zhaoying Wen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jiayi Liu, ; Zhonghua Sun,
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Zhang X, Chen D, Wu M, Dong H, Wan Z, Jia H, Liang S, Shao J, Zheng J, Xu S, Xiong J, Guo W. Functional Evaluation of Embedded Modular Single-Branched Stent Graft: Application to Type B Aortic Dissection With Aberrant Right Subclavian Artery. Front Cardiovasc Med 2022; 9:869505. [PMID: 35586645 PMCID: PMC9108238 DOI: 10.3389/fcvm.2022.869505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endovascular repair of type B aortic dissection (TBAD) with aberrant right subclavian artery (ARSA) is challenging due to anatomical complexity. The embedded modular single-branched stent graft (EMSBSG) could solve this problem. However, the hemodynamic efficacy of this innovative technique has not been fully assessed. This study aimed to propose morphometric and functional indicators to quantify the outcomes of EMSBSG in treating TBAD with ARSA. Material and Methods A patient who had TBAD with ARSA underwent EMSBSG implantation was admitted. Computational fluid dynamics (CFD) and three-dimensional structural analyses were conducted based on CTA datasets before the operation (Pre-1) and at 4 and 25 days after EMSBSG implantation (Post-1 and Post-2). Quantitative and qualitative functional analyses were conducted via pressure-, velocity- and wall shear stress (WSS) -based parameters, such as the luminal pressure difference (LPD), total energy loss, and flow distribution ratio. By precisely registering the aortas at the three time points, parameter variations in the EMSBSG region were also computed to investigate the prognostic improvement after EMSBSG implantation. Results The first balance point of LPD distally shifted to the abdominal aorta in Post-1 by a distance of 20.172 cm, and shifted out of the dissected region in Post-2, indicating positive pressure recovery post EMSBSG. The flow distribution ratios of all aortic arch branches increased after EMSBSG implantation. A positive normal deformation index in the EMSBSG region confirmed true lumen expansion; dominant ARN (area ratio of negative value) of pressure and WSS-based parameters indicated an improved prognosis from Post-1 to Post-2. Conclusions The short-term results of EMSBSG in treating TBAD with ARSA proved to be promising, especially in EMSBSG region. Comprehensive evaluation could provide new insight into the therapy of TBAD with ARSA. Thus, it might guide the further management of complex aortic arch lesions.
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12
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Li Z, Xu H, Armour CH, Guo Y, Xiong J, Xu X, Chen D. The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator. Front Bioeng Biotechnol 2022; 10:831903. [PMID: 35433660 PMCID: PMC9009393 DOI: 10.3389/fbioe.2022.831903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management.
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Affiliation(s)
- Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, China
| | - Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Chlöe Harriet Armour
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Yuze Guo
- School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Jiang Xiong, ; Xiaoyun Xu,
| | - Xiaoyun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
- *Correspondence: Jiang Xiong, ; Xiaoyun Xu,
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, China
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13
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Liang S, Jia H, Dong H, Li Z, Zhou G, Zhang X, Chen D, Xiong J. Hemodynamic Study of Stanford Type B Aortic Dissection Based on Ex Vivo Porcine Aorta Models. J Endovasc Ther 2022; 30:441-448. [PMID: 35249398 DOI: 10.1177/15266028221081089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In this study, we aimed to evaluate hemodynamic influence of the dissected aortic system via various ex vivo type B aortic dissection (AD) models. Methods: Twenty-four raw porcine aortas were harvested and randomly divided into 4 groups to create various aortic models. Model A was the control group, while models B to D indicated the AD group, where models B and C presented a proximal primary entry with the false lumen (FL) lengths of 15 and 20 cm, respectively, and model D presented a 20 cm FL with a proximal primary entry and a distal reentry. All the aortic models were connected to a mock circulation loop to attain the realistic flow and pressure status. The flow distribution rate (FDR) of the aortic branches was calculated. Doppler ultrasound was applied to visualize the AD structure and to attain the velocity of flow in both the true and false lumens. Several sections of the AD were stained with hematoxylin and eosin for histologic evaluation after the experiment. Results: This study demonstrated that higher pressures were found for the AD group compared with the control group. The mean systolic pressures at the inlet of models A to D were 113.34±0.81, 120.58±0.52, 117.76±0.82, and 115.87±0.42 mm Hg, respectively. The FDRs of the celiac artery in models A to D were 8.65%, 8.32%±0.15%, 7.87%±0.13%, and 8.03%±0.21%, respectively. By ultrasound visualization, the velocity of the flow at the entry to the FL in the AD group ranged in 10 to 92 cm/s. The dissection flap presented pulsatile movement, especially in the models B and C which contained 1 primary entry without distal reentries. Histological examinations indicated that AD was located between the intimal and medial layers. Conclusions: Our ex vivo models demonstrated that the configuration of the dissected aorta influenced the pressure distribution. Moreover, the dissection flap affected the FDR of the aortic branches that possibly inducing malperfusion syndrome.
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Affiliation(s)
- Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Heyue Jia
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Huiwu Dong
- Department of Ultrasound Diagnosis, Chinese PLA General Hospital, Beijing, China
| | - Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Guojing Zhou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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14
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Lyu T, Yang G, Zhao X, Shu H, Luo L, Chen D, Xiong J, Yang J, Li S, Coatrieux JL, Chen Y. Dissected aorta segmentation using convolutional neural networks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106417. [PMID: 34587564 DOI: 10.1016/j.cmpb.2021.106417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Aortic dissection is a severe cardiovascular pathology in which an injury of the intimal layer of the aorta allows blood flowing into the aortic wall, forcing the wall layers apart. Such situation presents a high mortality rate and requires an in-depth understanding of the 3-D morphology of the dissected aorta to plan the right treatment. An accurate automatic segmentation algorithm is therefore needed. METHOD In this paper, we propose a deep-learning-based algorithm to segment dissected aorta on computed tomography angiography (CTA) images. The algorithm consists of two steps. Firstly, a 3-D convolutional neural network (CNN) is applied to divide the 3-D volume into two anatomical portions. Secondly, two 2-D CNNs based on pyramid scene parsing network (PSPnet) segment each specific portion separately. An edge extraction branch was added to the 2-D model to get higher segmentation accuracy on intimal flap area. RESULTS The experiments conducted and the comparisons made show that the proposed solution performs well with an average dice index over 92%. The combination of 3-D and 2-D models improves the aorta segmentation accuracy compared to 3-D only models and the segmentation robustness compared to 2-D only models. The edge extraction branch improves the DICE index near aorta boundaries from 73.41% to 81.39%. CONCLUSIONS The proposed algorithm has satisfying performance for capturing the aorta structure while avoiding false positives on the intimal flaps.
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Affiliation(s)
- Tianling Lyu
- Laboratory of Imaging Science and Technology, Southeast University, Nanjing, China
| | - Guanyu Yang
- Laboratory of Imaging Science and Technology, Southeast University, Nanjing, China
| | - Xingran Zhao
- Laboratory of Imaging Science and Technology, Southeast University, Nanjing, China
| | - Huazhong Shu
- Laboratory of Imaging Science and Technology, Southeast University, Nanjing, China
| | - Limin Luo
- Laboratory of Imaging Science and Technology, Southeast University, Nanjing, China
| | - Duanduan Chen
- Department of Biomedical Engineering, Beijing Institute of Technology, Beijing, China
| | | | - Jian Yang
- School of Optoelectronics, Beijing Institute of Technology, Beijing, China
| | - Shuo Li
- Digital Imaging Group of London, London, Canada
| | | | - Yang Chen
- Laboratory of Imaging Science and Technology, Southeast University, Nanjing, China; School of Cyber Science and Engineering, Southeast University, Nanjing, China; Key Laboratory of Computer Network and Information Integration (Southeast University), Ministry of Education, Nanjing, China.
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15
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Saitta S, Guo B, Pirola S, Menichini C, Guo D, Shan Y, Dong Z, Xu XY, Fu W. Qualitative and Quantitative Assessments of Blood Flow on Tears in Type B Aortic Dissection With Different Morphologies. Front Bioeng Biotechnol 2021; 9:742985. [PMID: 34692660 PMCID: PMC8531216 DOI: 10.3389/fbioe.2021.742985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/21/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: The interactions between aortic morphology and hemodynamics play a key role in determining type B aortic dissection (TBAD) progression and remodeling. The study aimed to provide qualitative and quantitative hemodynamic assessment in four different TBAD morphologies based on 4D flow MRI analysis. Materials and Methods: Four patients with different TBAD morphologies underwent CT and 4D flow MRI scans. Qualitative blood flow evaluation was performed by visualizing velocity streamlines and flow directionality near the tears. Quantitative analysis included flow rate, velocity and reverse flow index (RFI) measurements. Statistical analysis was performed to evaluate hemodynamic differences between the true lumen (TL) and false lumen (FL) of patients. Results: Qualitative analysis revealed blood flow splitting near the primary entry tears (PETs), often causing the formation of vortices in the FL. All patients exhibited clear hemodynamic differences between TL and FL, with the TL generally showing higher velocities and flow rates, and lower RFIs. Average velocity magnitude measurements were significantly different for Patient 1 (t = 5.61, p = 0.001), Patient 2 (t = 3.09, p = 0.02) and Patient 4 (t = 2.81, p = 0.03). At follow-up, Patient three suffered from left renal ischemia because of FL collapse. This patient presented a complex morphology with two FLs and marked flow differences between TL and FLs. In Patient 4, left renal artery malperfusion was observed at the 32-months follow-up, due to FL thrombosis growing after PET repair. Conclusion: The study demonstrates the clinical feasibility of using 4D flow MRI in the context of TBAD. Detailed patient-specific hemodynamics assessment before treatment may provide useful insights to better understand this pathology in the future.
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Affiliation(s)
- Simone Saitta
- Department of Chemical Engineering, Imperial College London, London, United Kingdom.,Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Claudia Menichini
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Yan Shan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
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16
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Chen D, Liang S, Li Z, Mei Y, Dong H, Ma Y, Zhao J, Xu S, Zheng J, Xiong J. A Mock Circulation Loop for In Vitro Hemodynamic Evaluation of Aorta: Application in Aortic Dissection. J Endovasc Ther 2021; 29:132-142. [PMID: 34342237 DOI: 10.1177/15266028211034863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Aortic dissection (AD) is a catastrophic disease with complex hemodynamic conditions, however, understandings regarding its perfusion characteristics were not sufficient. In this study, a mock circulation loop (MCL) that integrated the Windkessel element and patient-specific silicone aortic phantoms was proposed to reproduce the aortic flow environment in vitro. MATERIALS AND METHODS Patient-specific normal and dissected aortic phantoms with 12 branching vessels were established and embedded into this MCL. Velocities for aortic branches based on 20 healthy volunteers were regarded as the standardized data for flow division. By altering boundary conditions, the proposed MCL could mimic normal resting and left-sided heart failure (LHF) conditions. Flow rates and pressure status of the aortic branches could be quantified by separate sensors. RESULTS In normal resting condition, the simulated heart rate and systemic flow rate were 60 bpm and 4.85 L/minute, respectively. For the LHF condition, the systolic and diastolic blood pressures were 75.94±0.77 mmHg and 57.65±0.35 mmHg, respectively. By tuning the vascular compliance and peripheral resistance, the flow distribution ratio (FDR) of each aortic branch was validated by the standardized data in the normal aortic phantom (mean difference 2.4%±1.70%). By comparing between the normal and dissected aortic models under resting condition, our results indicated that the AD model presented higher systolic (117.82±0.60 vs 108.75±2.26 mmHg) and diastolic (72.38±0.58 vs 70.46±2.33 mmHg) pressures, the time-average velocity in the true lumen (TL; 36.95 cm/s) was higher than that in the false lumen (FL; 22.95 cm/s), and the blood transport direction between the TL and FL varied in different re-entries. CONCLUSIONS The proposed MCL could be applied as a research tool for in vitro hemodynamic analysis of the aorta diseases under various physical conditions.
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Affiliation(s)
- Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Huiwu Dong
- Department of Ultrasound Diagnosis, Chinese PLA General Hospital, Beijing, China
| | - Yihao Ma
- The High School Affiliated to Renmin University of China, China
| | - Jing Zhao
- Department of Scientific Research Management, Medical Services Division, Chinese PLA General Hospital, Beijing, China
| | - Shangdong Xu
- Center of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Vascular Diseases, Capital Medical University Beijing Aortic Disease Center, Beijing, China
| | - Jun Zheng
- Center of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Vascular Diseases, Capital Medical University Beijing Aortic Disease Center, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.,Department of Vascular and Endovascular Surgery, Hainan Hospital, Chinese PLA General Hospital, Hainan, China
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17
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Zhu Y, Mirsadraee S, Asimakopoulos G, Gambaro A, Rosendahl U, Pepper J, Xu XY. Association of hemodynamic factors and progressive aortic dilatation following type A aortic dissection surgical repair. Sci Rep 2021; 11:11521. [PMID: 34075164 PMCID: PMC8169847 DOI: 10.1038/s41598-021-91079-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022] Open
Abstract
Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. However, a subset of these patients develops aortic rupture due to further dilatation of the residual dissected aorta. There is currently no reliable means to predict the risk of dilatation following TAAD repair. In this study, we performed a comprehensive morphological and hemodynamic analysis for patients with and without progressive aortic dilatation following surgical replacement of the ascending aorta. Patient-specific models of repaired TAAD were reconstructed from post-surgery computed tomography images for detailed computational fluid dynamic analysis. Geometric and hemodynamic parameters were evaluated and compared between patients with stable aortic diameters (N = 9) and those with aortic dilatation (N = 8). Our results showed that the number of re-entry tears and true/false lumen pressure difference were significantly different between the two groups. Patients with progressive aortic dilatation had higher luminal pressure difference (6.7 [4.6, 10.9] vs. 0.9 [0.5, 2.3] mmHg; P = 0.001) and fewer re-entry tears (1.5 [1, 2.8] vs. 5 [3.3, 7.5]; P = 0.02) compared to patients with stable aortic diameters, suggesting that these factors may serve as potential predictors of aneurysmal dilatation following surgical repair of TAAD.
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Affiliation(s)
- Yu Zhu
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Saeed Mirsadraee
- Department of Radiology, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - George Asimakopoulos
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - Alessia Gambaro
- Department of Cardiology, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - Ulrich Rosendahl
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - John Pepper
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK.
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18
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Marlevi D, Sotelo JA, Grogan-Kaylor R, Ahmed Y, Uribe S, Patel HJ, Edelman ER, Nordsletten DA, Burris NS. False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth. J Cardiovasc Magn Reson 2021; 23:51. [PMID: 33980249 PMCID: PMC8117268 DOI: 10.1186/s12968-021-00741-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/16/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic type B aortic dissection (TBAD) is associated with poor long-term outcome, and accurate risk stratification tools remain lacking. Pressurization of the false lumen (FL) has been recognized as central in promoting aortic growth. Several surrogate imaging-based metrics have been proposed to assess FL hemodynamics; however, their relationship to enlarging aortic dimensions remains unclear. We investigated the association between aortic growth and three cardiovascular magnetic resonance (CMR)-derived metrics of FL pressurization: false lumen ejection fraction (FLEF), maximum systolic deceleration rate (MSDR), and FL relative pressure (FL ΔPmax). METHODS CMR/CMR angiography was performed in 12 patients with chronic dissection of the descending thoracoabdominal aorta, including contrast-enhanced CMR angiography and time-resolved three-dimensional phase-contrast CMR (4D Flow CMR). Aortic growth rate was calculated as the change in maximal aortic diameter between baseline and follow-up imaging studies over the time interval, with patients categorized as having either 'stable' (< 3 mm/year) or 'enlarging' (≥ 3 mm/year) growth. Three metrics relating to FL pressurization were defined as: (1) FLEF: the ratio between retrograde and antegrade flow at the TBAD entry tear, (2) MSDR: the absolute difference between maximum and minimum systolic acceleration in the proximal FL, and (3) FL ΔPmax: the difference in absolute pressure between aortic root and distal FL. RESULTS FLEF was higher in enlarging TBAD (49.0 ± 17.9% vs. 10.0 ± 11.9%, p = 0.002), whereas FL ΔPmax was lower (32.2 ± 10.8 vs. 57.2 ± 12.5 mmHg/m, p = 0.017). MSDR and conventional anatomic variables did not differ significantly between groups. FLEF showed positive (r = 0.78, p = 0.003) correlation with aortic growth rate whereas FL ΔPmax showed negative correlation (r = - 0.64, p = 0.026). FLEF and FL ΔPmax remained as independent predictors of aortic growth rate after adjusting for baseline aortic diameter. CONCLUSION Comparative analysis of three 4D flow CMR metrics of TBAD FL pressurization demonstrated that those that focusing on retrograde flow (FLEF) and relative pressure (FL ΔPmax) independently correlated with growth and differentiated patients with enlarging and stable descending aortic dissections. These results emphasize the highly variable nature of aortic hemodynamics in TBAD patients, and suggest that 4D Flow CMR derived metrics of FL pressurization may be useful to separate patients at highest and lowest risk for progressive aortic growth and complications.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Julio A Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- ANID-Millennium Science Initiative Program-Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Ross Grogan-Kaylor
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Yunus Ahmed
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- ANID-Millennium Science Initiative Program-Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David A Nordsletten
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nicholas S Burris
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Cardiovascular Center 5588, SPC-5030, Ann Arbor, MI, 48109-5030, USA.
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Li Z, Liang S, Xu H, Zhu M, Mei Y, Xiong J, Chen D. Flow analysis of aortic dissection: comparison of inflow boundary conditions for computational models based on 4D PCMRI and Doppler ultrasound. Comput Methods Biomech Biomed Engin 2021; 24:1251-1262. [PMID: 33522843 DOI: 10.1080/10255842.2021.1876036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Computational hemodynamics quantifying the flow environment is an important tool in understanding aortic dissection. In this study, various inflow boundaries were applied on a patient-specific model and compared to the individualized velocimetry. The results indicated that the computations generally overestimated the flow volume and underestimated the wall shear stress. By quantifying the accuracy of the simulation results, two inflow settings were suggested. One was individualized, the PCMRI-extracted 4D flow information, and the other was averaged by healthy data, the ultrasound-extracted averaged flow waveform with parabolic velocity profile. This study might contribute to improving the precise computation of aortic dissection hemodynamics.
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Affiliation(s)
- Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Minjia Zhu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
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20
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Bonfanti M, Franzetti G, Homer-Vanniasinkam S, Díaz-Zuccarini V, Balabani S. A Combined In Vivo, In Vitro, In Silico Approach for Patient-Specific Haemodynamic Studies of Aortic Dissection. Ann Biomed Eng 2020; 48:2950-2964. [PMID: 32929558 PMCID: PMC7723947 DOI: 10.1007/s10439-020-02603-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/02/2020] [Indexed: 12/30/2022]
Abstract
The optimal treatment of Type-B aortic dissection (AD) is still a subject of debate, with up to 50% of the cases developing late-term complications requiring invasive intervention. A better understanding of the patient-specific haemodynamic features of AD can provide useful insights on disease progression and support clinical management. In this work, a novel in vitro and in silico framework to perform personalised studies of AD, informed by non-invasive clinical data, is presented. A Type-B AD was investigated in silico using computational fluid dynamics (CFD) and in vitro by means of a state-of-the-art mock circulatory loop and particle image velocimetry (PIV). Both models not only reproduced the anatomical features of the patient, but also imposed physiologically-accurate and personalised boundary conditions. Experimental flow rate and pressure waveforms, as well as detailed velocity fields acquired via PIV, are extensively compared against numerical predictions at different locations in the aorta, showing excellent agreement. This work demonstrates how experimental and numerical tools can be developed in synergy to accurately reproduce patient-specific AD blood flow. The combined platform presented herein constitutes a powerful tool for advanced haemodynamic studies for a range of vascular conditions, allowing not only the validation of CFD models, but also clinical decision support, surgical planning as well as medical device innovation.
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Affiliation(s)
- Mirko Bonfanti
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS UK
| | - Gaia Franzetti
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE UK
| | - Shervanthi Homer-Vanniasinkam
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS UK
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE UK
- Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - Vanessa Díaz-Zuccarini
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS UK
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE UK
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE UK
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21
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Speir AM. Commentary: Computed tomography-based hemodynamic index for aortic dissection: Ciceronian or say what? J Thorac Cardiovasc Surg 2020; 162:e180-e181. [PMID: 32305199 DOI: 10.1016/j.jtcvs.2020.02.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Alan M Speir
- Department of Cardiac Surgery, Inova and Vascular Institute, Falls Church, Va.
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22
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Xu H, Xiong J, Han X, Mei Y, Shi Y, Wang D, Zhang M, Chen D. Computed tomography-based hemodynamic index for aortic dissection. J Thorac Cardiovasc Surg 2020; 162:e165-e176. [PMID: 32217023 DOI: 10.1016/j.jtcvs.2020.02.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In this study we aimed to propose a new computed tomography-based hemodynamic indicator to quantify the functional significance of aortic dissection and predict post intervention luminal remodeling. METHODS Computational hemodynamics and 3D structural analyses were conducted in 51 patients with type B aortic dissection, at initial presentation and at approximately 1 month, 3 months, and 1 year post intervention. A functional index was proposed on the basis of luminal pressure difference. Statistical relationships between the proposed indicator and longitudinal luminal development were analyzed. RESULTS The computed luminal pressure difference (true lumen pressure minus false lumen pressure) varied overall from positive to negative along the aorta. The first balance position at which the pressure difference equals 0 was proposed as the functional indicator. A more distally located first balance position indicated better functional status. Implantation of stent graft distally shifted this balance position. Patients with the balance position shifted out of the dissected region (43%) presented the highest functional improvement after intervention; whereas those with the balance position shifted to the abdominal region (25%) showed unsatisfactory results. The magnitude of distal shifting of the first balance position at 3 months post intervention was statistically related to the subsequent true lumen expansion and false lumen reduction. CONCLUSIONS The first balance position of luminal pressure difference quantified the hemodynamic status of the dissected aorta. The magnitude of distal shifting of the balance position after intervention was associated with functional improvement and might be used predict longitudinal aortic remodeling.
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Affiliation(s)
- Huanming Xu
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiaofeng Han
- Department of Diagnostic and Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuqian Mei
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yue Shi
- Department of Engineering and Technology, Meiyin (Beijing) Medical Device Development Ltd, Beijing, China
| | - Dianpeng Wang
- Department of Probability and Statistics, School of Mathematics and Statistics, Beijing Institute of Technology, Beijing, China
| | - Mingchen Zhang
- Department of Mathematics, University of California Santa Barbara, Santa Barbara, Calif
| | - Duanduan Chen
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China.
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23
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Li X, Zhang W, Liu J, Gonzalez L, Liu D, Zhang L, Dardik A, Shu C. Contrast-Induced Kidney Nephropathy in Thoracic Endovascular Aortic Repair: A 2-Year Retrospective Study in 470 Patients. Angiology 2019; 71:242-248. [PMID: 31829038 DOI: 10.1177/0003319719893578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We identified changes in renal function in patients who underwent thoracic endovascular aortic repair (TEVAR) and the factors that may influence renal function. Information on 470 consecutive patients was collected. Kidney function and contrast volume were recorded. Unpaired t test, Spearman correlation, and logistic regression were used for statistical analysis. A Kaplan-Meier curve helped clarify our follow-up findings. Mean contrast volume was 90.5 ± 21.2 mL. The change in serum creatinine was significantly correlated with (1) preexisting renal pathology (P = .033) and (2) aortic dissection (AD) involving the renal arteries (P = .019). The change in serum urea nitrogen (ΔBUN) was only significantly correlated with AD involving the renal arteries (P = .0348). Contrast volume (P = .036, odds ratio = 1.010, 95% confidence interval: 1.001-1.019) was a risk factor for contrast-induced nephropathy (CIN) after TEVAR. Survival rates and renal failure rates among no CIN, CIN, and CIN-acute kidney injury groups at longest 27 months follow-up were significantly different. Creatinine and BUN were generally elevated post-TEVAR. Contrast-induced nephropathy post-TEVAR may correlate with renal comorbidities and renal artery involvement. Contrast volume is risk factor for CIN after TEVAR. More attention needs to be paid to patient renal function during follow-up.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Weichang Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Jia Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Luis Gonzalez
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Dingxiao Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Alan Dardik
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Chang Shu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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24
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Diaz-Zuccarini V, Bonfanti M, Franzetti G, Balabani S. Virtual TEVAR: Overcoming the Roadblocks of In-Silico Tools for Aortic Dissection Treatment. Theranostics 2019; 8:6384-6385. [PMID: 30613306 PMCID: PMC6299687 DOI: 10.7150/thno.30753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022] Open
Abstract
The use of in silico tools for the interventional planning of complex vascular conditions, such as Aortic Dissections has been often limited by high computational cost, involving long timescales for accurate results to be produced and low numbers of patients, precluding the use of statistical analyses to inform individual-level models. In the paper [Theranostics 2018; 8(20):5758-5771. doi:10.7150/thno.28944], Chen et al. proposed a novel algorithm to compute patient-specific 'virtual TEVAR' that will help clinicians to approach individual treatment and decision-making based on objective and quantifiable metrics and validated on a cohort of 66 patients in real time. This research will significantly impact the field and has the potential to transform the way clinical interventions will be approached in the future.
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25
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Chen D, Wei J, Deng Y, Xu H, Li Z, Meng H, Han X, Wang Y, Wan J, Yan T, Xiong J, Tang X. Virtual stenting with simplex mesh and mechanical contact analysis for real-time planning of thoracic endovascular aortic repair. Theranostics 2018; 8:5758-5771. [PMID: 30555579 PMCID: PMC6276306 DOI: 10.7150/thno.28944] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/06/2018] [Indexed: 11/29/2022] Open
Abstract
In aortic endovascular repair, the prediction of stented vessel remodeling informs treatment plans and risk evaluation; however, there are no highly accurate and efficient methods to quantitatively simulate stented vessels. This study developed a fast virtual stenting algorithm to simulate stent-induced aortic remodeling to assist in real-time thoracic endovascular aortic repair planning. Methods: The virtual stenting algorithm was established based on simplex deformable mesh and mechanical contact analysis. The key parameters of the mechanical contact analysis were derived from mechanical tests on aortic tissue (n=40) and commonly used stent-grafts (n=6). Genetic algorithm was applied to select weighting parameters. Testing and validation of the algorithm were performed using pre- and post-treatment computed tomography angiography datasets of type-B aortic dissection cases (n=66). Results: The algorithm was efficient in simulating stent-induced aortic deformation (mean computing time on a single processor: 13.78±2.80s) and accurate at the morphological (curvature difference: 1.57±0.57%; cross-sectional area difference: 4.11±0.85%) and hemodynamic (similarity of wall shear stress-derived parameters: 90.16-90.94%) levels. Stent-induced wall deformation was higher (p<0.05) in distal stent-induced new entry cases than in successfully treated cases, and this deformation did not differ significantly among the different stent groups. Additionally, the high stent-induced wall deformation regions and the new-entry sites overlapped, indicating the usefulness of wall deformation to evaluate the risks of device-induced complications. Conclusion: The novel algorithm provided fast real-time and accurate predictions of stent-graft deployment with luminal deformation tracking, thereby potentially informing individualized stenting planning and improving endovascular aortic repair outcomes. Large, multicenter studies are warranted to extend the algorithm validation and determine stress-induced wall deformation cutoff values for the risk stratification of particular complications.
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26
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Bonfanti M, Balabani S, Alimohammadi M, Agu O, Homer-Vanniasinkam S, Díaz-Zuccarini V. A simplified method to account for wall motion in patient-specific blood flow simulations of aortic dissection: Comparison with fluid-structure interaction. Med Eng Phys 2018; 58:S1350-4533(18)30074-2. [PMID: 29759947 DOI: 10.1016/j.medengphy.2018.04.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
Aortic dissection (AD) is a complex and highly patient-specific vascular condition difficult to treat. Computational fluid dynamics (CFD) can aid the medical management of this pathology, yet its modelling and simulation are challenging. One aspect usually disregarded when modelling AD is the motion of the vessel wall, which has been shown to significantly impact simulation results. Fluid-structure interaction (FSI) methods are difficult to implement and are subject to assumptions regarding the mechanical properties of the vessel wall, which cannot be retrieved non-invasively. This paper presents a simplified 'moving-boundary method' (MBM) to account for the motion of the vessel wall in type-B AD CFD simulations, which can be tuned with non-invasive clinical images (e.g. 2D cine-MRI). The method is firstly validated against the 1D solution of flow through an elastic straight tube; it is then applied to a type-B AD case study and the results are compared to a state-of-the-art, full FSI simulation. Results show that the proposed method can capture the main effects due to the wall motion on the flow field: the average relative difference between flow and pressure waves obtained with the FSI and MBM simulations was less than 1.8% and 1.3%, respectively and the wall shear stress indices were found to have a similar distribution. Moreover, compared to FSI, MBM has the advantage to be less computationally expensive (requiring half of the time of an FSI simulation) and easier to implement, which are important requirements for clinical translation.
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Affiliation(s)
- Mirko Bonfanti
- Department of Mechanical Engineering, University College London, WC1E 7JE, UK.
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, WC1E 7JE, UK
| | - Mona Alimohammadi
- Department of Mechanical Engineering, University College London, WC1E 7JE, UK
| | | | - Shervanthi Homer-Vanniasinkam
- Department of Mechanical Engineering, University College London, WC1E 7JE, UK; Leeds Teaching Hospitals NHS Trust, LS1 3EX, UK; University of Warwick Medical School & University Hospitals Coventry and Warwickshire NHS Trust, CV4 7AL, UK
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27
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Xu H, Piccinelli M, Leshnower BG, Lefieux A, Taylor WR, Veneziani A. Coupled Morphological-Hemodynamic Computational Analysis of Type B Aortic Dissection: A Longitudinal Study. Ann Biomed Eng 2018; 46:927-939. [PMID: 29594688 DOI: 10.1007/s10439-018-2012-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Progressive false lumen aneurysmal degeneration in type B aortic dissection (TBAD) is a complex process with a multi-factorial etiology. Patient-specific computational fluid dynamics (CFD) simulations provide spatial and temporal hemodynamic quantities that facilitate understanding this disease progression. A longitudinal study was performed for a TBAD patient, who was diagnosed with the uncomplicated TBAD in 2006 and treated with optimal medical therapy but received surgery in 2010 due to late complication. Geometries of the aorta in 2006 and 2010 were reconstructed. With registration algorithms, we accurately quantified the evolution of the false lumen, while with CFD simulations we computed several hemodynamic indexes, including the wall shear stress (WSS), and the relative residence time (RRT). The numerical fluid model included large eddy simulation (LES) modeling for efficiently capturing the flow disturbances induced by the entry tears. In the absence of complete patient-specific data, the boundary conditions were based on a specific calibration method. Correlations between hemodynamics and the evolution field in time obtained by registration of the false lumen are discussed. Further testing of this methodology on a large cohort of patients may enable the use of CFD to predict whether patients, with originally uncomplicated TBAD, develop late complications.
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Affiliation(s)
- Huijuan Xu
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, USA. .,Department of Mathematics and Computer Science, Emory University, Atlanta, USA.
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, USA
| | | | - Adrien Lefieux
- Department of Mathematics and Computer Science, Emory University, Atlanta, USA.,Department of Cardiology, Emory University, Atlanta, USA
| | - W Robert Taylor
- Department of Cardiology, Emory University, Atlanta, USA.,Atlanta VA Medical Center, Atlanta, USA
| | - Alessandro Veneziani
- Department of Mathematics and Computer Science, Emory University, Atlanta, USA.,School of Advanced Studies IUSS, Pavia, Italy
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