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Computational Modelling of Cerebral Blood Flow Rate at Different Stages of Moyamoya Disease in Adults and Children. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010077. [PMID: 36671650 PMCID: PMC9854682 DOI: 10.3390/bioengineering10010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Moyamoya disease is a cerebrovascular disorder which causes a decrease in the cerebral blood flow rate. In this study, a lumped parameter model describing the pressures and flow rates in the heart chambers, circulatory system, and cerebral circulation with the main arteries in the circle of Willis, pial circulation, cerebral capillaries, and veins was used to simulate Moyamoya disease with and without coarctation of the aorta in adults and children. Cerebral blood flow rates were 724 mL/min and 1072 mL/min in the healthy adult and child cardiovascular system models. The cerebral blood flow rates in the adult and child cardiovascular system models simulating Moyamoya disease were 676 mL/min and 1007 mL/min in stage 1, 627 mL/min and 892 mL/min in stage 2, 571 mL/min and 831 in stage 3, and 444 and 537 mL/min in stage 4. The cerebral blood flow rates were 926 mL/min and 1421 mL/min in the adult and child cardiovascular system models simulating coarctation of the aorta. Furthermore, the cerebral blood flow rates in the adult and child cardiovascular system model simulating Moyamoya disease with coarctation of the aorta were 867 mL/min and 1341 mL/min in stage 1, 806 mL/min and 1197 mL/min in stage 2, 735 mL/min and 1121 in stage 3, and 576 and 741 mL/min in stage 4. The numerical model utilised in this study can simulate the advancing stages of Moyamoya disease and evaluate the associated risks with Moyamoya disease.
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Homsi M, El Khoury M, Hmedeh C, Arabi M, El Rassi I, Bulbul Z, Sawaya F, Bitar F, Haddad F. Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 39:66-72. [PMID: 34916158 DOI: 10.1016/j.carrev.2021.10.010] [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: 06/15/2021] [Revised: 10/10/2021] [Accepted: 10/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND/PURPOSE CoA remains one of the most common congenital heart diseases and is associated with significant morbidity and mortality and if untreated. We aim to evaluate the safety, feasibility, and outcomes of endovascular stenting of Coarctation of the aorta (CoA) in a developing country with limited resources and compare it to available benchmarks. MATERIALS/METHODS A retrospectively review of all patients who underwent endovascular stent repair of aortic coarctation at our tertiary center since 2009 was done. RESULTS 18 patients were identified, sixteen had native CoA, while two had recurrent CoA. mean age at the time of procedure was 21.2 ± 9.8 years (range 10-45 years), and 12(66%) patients were males. The mean follow-up duration was 4 ± 2.8 years. Post stenting, the average ascending-to-descending aorta systolic gradient decreased by 42.9 ± 20.4 mmHg (p < 0.001). After the intervention, 13(72.2%) patients achieved normal BP while 5(27.8%) had residual hypertension. Fourteen patients received bare-metal stents, and four had covered stents. Attempted stent implantation was successful in all patients. Our procedural success rate was 94%. On follow-up, no dissections or aneurysmal changes were detected, four patients underwent re-expansion of the stent, one patient with suboptimal stenting result required surgery 6 months after stenting, and two patients had minor post-operative complications. CONCLUSIONS Endovascular stenting for de-novo or recurrent CoA in children and adults at a tertiary center in a developing country is feasible and safe with outcomes comparable to developed countries. A multidisciplinary team approach is paramount in achieving good results and low complication rates in limited-resource settings.
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Affiliation(s)
- Mouafak Homsi
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Maya El Khoury
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Caroline Hmedeh
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Mariam Arabi
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Issam El Rassi
- American University of Beirut Medical Center, Department of surgery, Children Heart Center, Lebanon
| | - Ziad Bulbul
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fadi Sawaya
- American University of Beirut Medical Center, Department of Medicine, Lebanon
| | - Fadi Bitar
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fady Haddad
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon.
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Caimi A, Pasquali M, Sturla F, Pluchinotta FR, Giugno L, Carminati M, Redaelli A, Votta E. Prediction of post-stenting biomechanics in coarcted aortas: A pilot finite element study. J Biomech 2020; 105:109796. [PMID: 32423542 DOI: 10.1016/j.jbiomech.2020.109796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/06/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
Endovascular stenting has recently become a standard treatment for native coarctation of the aorta (CoA) in children and young adults, given the efficacy in relieving vessel obstruction with a low incidence of adverse events. Yet, despite the short-term success of the technique, late hypertension remains an endemic risk. To assess the impact of the percutaneous procedure on the aortic wall biomechanics, we designed a novel finite element (FE) protocol for the simulation of endovascular stenting in three patient-specific CoA anatomies, developing a remeshing procedure that allows for coping with different CoA severities. Our FE protocol was able to yield numerical results on stent distortions and stresses, as well as on changes in aortic wall stresses and distensibility. These results were consistent with intraprocedural in-vivo evidences and with previous findings from the literature, and they suggest that our numerical approach could be used to understand the role of patient specific anatomical features (CoA severity and arch type) on the post-stenting aortic biomechanics. If soundly validated on a vast cohort of patients, our approach could support patient selection for the procedure.
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Affiliation(s)
- Alessandro Caimi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Matteo Pasquali
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesca R Pluchinotta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Luca Giugno
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Lee MGY, d'Udekem Y. The Development of Left Ventricular Hypertrophy in Patients With Left-Sided Obstructive Lesions: Are Genetics at Play? Heart Lung Circ 2017; 27:1-2. [PMID: 29198831 DOI: 10.1016/j.hlc.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Melissa G Y Lee
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic, Australia.
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Pamukcu O, Narin N. Left ventricular hypertrophy in children with previous repair of coarctation of the aorta. Int J Cardiol 2017; 239:4. [DOI: 10.1016/j.ijcard.2016.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/17/2016] [Indexed: 02/04/2023]
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Maschietto N, Semplicini L, Ceolotto G, Cattelan A, Poser Dvm H, Iacopetti I, Gerardi G, De Benedictis GM, Pilla T, Bernardini D, Aresu L, Rizzo S, Basso C, Semplicini A, Milanesi O. Aortic stenting in the growing sheep causes aortic endothelial dysfunction but not hypertension: Clinical implications for coarctation repair. CONGENIT HEART DIS 2016; 12:74-83. [PMID: 27600478 DOI: 10.1111/chd.12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Stent implantation is the treatment of choice for adolescents and adults with aortic coarctation (CoAo). Despite excellent short-term results, 20%-40% of the patients develop arterial hypertension later in life, which was attributed to inappropriate response of the aortic baroreceptors to increased stiffness of the ascending aorta (ASAO), either congenital or induced by CoAo repair. In particular, it has been hypothesized that stent itself may cause or sustain hypertension. Therefore, we aimed to study the hemodynamic and structural impact following stent implantation in the normal aorta of a growing animal. METHODS Eight female sheep completed the study and a stent was implanted in four. Every 3 mo we measured blood pressure of the anterior and posterior limbs and left ventricular function by echocardiography. Twelve months later invasive pressure was measured under baseline and simulated stress conditions. Expression of genes indicating oxidative stress (OS), endothelial dysfunction (ED) and stiffness, as well as pathological examination were performed in ascending (ASAO) and descending aorta (DSAO). RESULTS SOD1 and MMP9 gene expression were higher in ASAO of the stented animals, compared to DSAO and controls, while NOS3 was decreased. No differences were found in blood pressure and echocardiographic parameters. No histological differences were found in the aorta of the two groups of animals. CONCLUSIONS Stent does not affect central and peripheral hemodynamics, cardiac structure and function even in the long term. However, the finding of markers of OS and increased stiffness of ASAO, proximal to the stent, points to molecular mechanisms for increased cardiovascular risk of patients with stented CoAo.
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Affiliation(s)
- Nicola Maschietto
- Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Padova, Italy
| | | | | | | | - Helen Poser Dvm
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Gabriele Gerardi
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | | | - Tommaso Pilla
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Daniele Bernardini
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Luca Aresu
- Department of Comparative BioMedicine and Food Science, University of Padua, Padova, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | | | - Ornella Milanesi
- Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Padova, Italy
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Pizarro C. Keeping the fundamentals in mind. J Thorac Cardiovasc Surg 2015; 149:1101. [PMID: 25906718 DOI: 10.1016/j.jtcvs.2015.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
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