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Cheng CP, Bondesson J, Hegde S, Acuero MT, El-Said HG. Impact of Stenting on PDA Length, Curvature, and Pulsatile Deformations Based on CT Assessment. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101134. [PMID: 39129905 PMCID: PMC11307392 DOI: 10.1016/j.jscai.2023.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/19/2023] [Accepted: 08/11/2023] [Indexed: 08/13/2024]
Abstract
Background We sought to investigate the impact of stenting on native patent ductus arteriosus (PDA) length, curvature, and pulsatile deformations in patients with ductal-dependent pulmonary circulations. Methods Patients with PDA stents who received contrast-enhanced 3-dimensional computed tomography with a view of the PDA, thoracic aorta, and pulmonary arteries were retrospectively included in this study. Geometric models of the prestented and poststented PDA were constructed from the computed tomography images, and PDA arclength, curvature, and pulsatile deformations were quantified. Results A total of 12 patients with cyanotic congenital heart disease were included, 10 of whom received 1 stent in the PDA and 2 received multiple overlapping stents. From prestenting to poststenting, the PDA shortened by 26 ± 18% (P = .004) and decreased in mean and peak curvature by 60 ± 21% and 68 ± 15%, respectively (both P < .001). Pulsatile deformations varied highly for the native PDA, stented PDA, and stents themselves. Conclusions The shortening and straightening of the PDA after stenting are significant and substantial, and their quantitative characterization will enable interventionalists to select stent lengths that span the entire PDA without encroaching on the aortic or pulmonary artery, which could cause hemodynamic interference, stent kink, and fatigue. Pulsatile PDA deformations can be used to design and evaluate devices tailored to congenital heart disease in neonates.
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Affiliation(s)
- Christopher P. Cheng
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California
| | - Johan Bondesson
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, California
| | - Sanjeet Hegde
- Division of Pediatric Cardiology, Rady Children’s Hospital, UC San Diego, San Diego, California
| | - Maria T. Acuero
- Division of Pediatric Cardiology, Rady Children’s Hospital, UC San Diego, San Diego, California
| | - Howaida G. El-Said
- Division of Pediatric Cardiology, Rady Children’s Hospital, UC San Diego, San Diego, California
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Suh GYK, Bondesson J, Zhu YD, Nilson MC, Roselli EE, Cheng CP. Ascending Aortic Endograft and Thoracic Aortic Deformation After Ascending Thoracic Endovascular Aortic Repair. J Endovasc Ther 2023:15266028231168351. [PMID: 37144300 DOI: 10.1177/15266028231168351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE We aim to quantify multiaxial cardiac pulsatility-induced deformation of the thoracic aorta after ascending thoracic endovascular aortic repair (TEVAR) as a part of the GORE ARISE Early Feasibility Study. MATERIALS AND METHODS Fifteen patients (7 females and 8 males, age 73±9 years) with ascending TEVAR underwent computed tomography angiography with retrospective cardiac gating. Geometric modeling of the thoracic aorta was performed; geometric features including axial length, effective diameter, and centerline, inner surface, and outer surface curvatures were quantified for systole and diastole; and pulsatile deformations were calculated for the ascending aorta, arch, and descending aorta. RESULTS From diastole to systole, the ascending endograft exhibited straightening of the centerline (0.224±0.039 to 0.217±0.039 cm-1, p<0.05) and outer surface (0.181±0.028 to 0.177±0.029 cm-1, p<0.05) curvatures. No significant changes were observed for inner surface curvature, diameter, or axial length in the ascending endograft. The aortic arch did not exhibit any significant deformation in axial length, diameter, or curvature. The descending aorta exhibited small but significant expansion of effective diameter from 2.59±0.46 to 2.63±0.44 cm (p<0.05). CONCLUSION Compared with the native ascending aorta (from prior literature), ascending TEVAR damps axial and bending pulsatile deformations of the ascending aorta similar to how descending TEVAR damps descending aortic deformations, while diametric deformations are damped to a greater extent. Downstream diametric and bending pulsatility of the native descending aorta was muted compared with that in patients without ascending TEVAR (from prior literature). Deformation data from this study can be used to evaluate the mechanical durability of ascending aortic devices and inform physicians about the downstream effects of ascending TEVAR to help predict remodeling and guide future interventional strategies. CLINICAL IMPACT This study quantified local deformations of both stented ascending and native descending aortas to reveal the biomechanical impact of ascending TEVAR on the entire thoracic aorta, and reported that the ascending TEVAR muted cardiac-induced deformation of the stented ascending aorta and native descending aorta. Understanding of in vivo deformations of the stented ascending aorta, aortic arch and descending aorta can inform physicians about the downstream effects of ascending TEVAR. Notable reduction of compliance may lead to cardiac remodeling and long-term systemic complications. This is the first report which included dedicated deformation data regarding ascending aortic endograft from clinical trial.
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Affiliation(s)
- Ga-Young K Suh
- Department of Biomedical Engineering, California State University, Long Beach, Long Beach, CA, USA
- Department of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Johan Bondesson
- Department of Mechanics and Maritime Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Yufei D Zhu
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | | | - Eric E Roselli
- Aorta Center, Departments of Thoracic and Cardiovascular Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher P Cheng
- Department of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Peng T, Pu H, Qiu P, Yang H, Ju Z, Ma H, Zhang J, Chen K, Zhan Y, Sheng R, Wang Y, Zha B, Yang Y, Fang S, Lu X, Zhou J. A stable and quantitative method for dimensionality reduction of aortic centerline. Front Cardiovasc Med 2022; 9:940711. [PMID: 36119736 PMCID: PMC9473432 DOI: 10.3389/fcvm.2022.940711] [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: 05/10/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Aortic dissection (AD) is a fatal aortic disease with high mortality. Assessing the morphology of the aorta is critical for diagnostic and surgical decisions. Aortic centerline projection methods have been used to evaluate the morphology of the aorta. However, there is a big difference between the current model of primary plane projection (PPP) and the actual shape of individuals, which is not conducive to morphological statistical analysis. Finding a method to compress the three-dimensional information of the aorta into two dimensions is helpful to clinical decision-making. In this paper, the evaluation parameters, including contour length (CL), enclosure area, and the sum of absolute residuals (SAR), were introduced to objectively evaluate the optimal projection plane rather than artificial subjective judgment. Our results showed that the optimal projection plane could be objectively characterized by the three evaluation parameters. As the morphological criterion, SAR is optimal among the three parameters. Compared to the optimal projection plane selected by traditional PPP, our method has better AD discrimination in the analysis of aortic tortuosity, and is conducive to the clinical operation of AD. Thus, it has application prospects for the preprocessing techniques for the geometric morphology analysis of AD.
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Affiliation(s)
- Tao Peng
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Yang
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Ziyue Ju
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Hui Ma
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Juanlin Zhang
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Kexin Chen
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Yanqing Zhan
- The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rui Sheng
- Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Yi Wang
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Binshan Zha
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Yang
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shu Fang
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinhua Zhou
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
- 3D-Printing and Tissue Engineering Center, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China
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Suh GY, Bondesson J, Zhu YD, Lee JT, Dake MD, Cheng CP. Multiaxial pulsatile dynamics of the thoracic aorta and impact of thoracic endovascular repair. Eur J Radiol Open 2021; 8:100333. [PMID: 33748348 PMCID: PMC7957153 DOI: 10.1016/j.ejro.2021.100333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Altered motion of the thoracic aorta after thoracic endovascular aortic repair. Geometric analysis with cardiac-gated computed tomography and computer modeling. Decreased motion of the stented aorta and increased motion above the stented aorta. Longitudinal curvature and diametric deformation affected by presence of endograft.
Purpose The thoracic aorta is a highly mobile organ whose dynamics are altered by thoracic endovascular aorta repair (TEVAR). The aim of this study was to quantify cardiac pulsatility-induced multi-axial deformation of the thoracic aorta before and after descending aortic TEVAR. Methods Eleven TEVAR patients (8 males and 3 females, age 57–89) underwent retrospective cardiac-gated CT angiography before and after TEVAR. 3D geometric models of the thoracic aorta were constructed, and lumen centerlines, inner and outer surface curves, and cross-sections were extracted to measure aortic arclength, centerline, inner surface, and outer surface longitudinal curvatures, as well as cross-sectional effective diameter and eccentricity for the ascending and stented aortic portions. Results From pre- to post-TEVAR, arclength deformation was increased at the ascending aorta from 5.9 ± 3.1 % to 8.8 ± 4.4 % (P < 0.05), and decreased at the stented aorta from 7.5 ± 5.1 % to 2.7 ± 2.5 % (P < 0.05). Longitudinal curvature and diametric deformations were reduced at the stented aorta. Centerline curvature, inner surface curvature, and cross-sectional eccentricity deformations were increased at the distal ascending aorta. Conclusions Deformations were reduced in the stented thoracic aorta after TEVAR, but increased in the ascending aorta near the aortic arch, possibly as a compensatory mechanism to maintain overall thoracic compliance in the presence of reduced deformation in the stiffened stented aorta.
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Affiliation(s)
- Ga-Young Suh
- Department of Biomedical Engineering, California State University, Long Beach: 1250 Bellflower Blvd, Long Beach, CA, 90840, USA.,Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Johan Bondesson
- Division of Dynamics, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden
| | - Yufei D Zhu
- Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Jason T Lee
- Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Christopher P Cheng
- Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
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Bondesson J, Suh GY, Lundh T, Dake MD, Lee JT, Cheng CP. Quantification of true lumen helical morphology and chirality in type B aortic dissections. Am J Physiol Heart Circ Physiol 2020; 320:H901-H911. [PMID: 33382638 DOI: 10.1152/ajpheart.00778.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chirality is a fundamental property in many biological systems. Motivated by previous observations of helical aortic blood flow, aortic tissue fibers, and propagation of aortic dissections, we introduce methods to characterize helical morphology of aortic dissections. After validation on computer-generated phantoms, the methods were applied to patients with type B dissection. For this cohort, there was a distinct bimodal distribution of helical propagation of the dissection with either achiral or exclusively right-handed chirality, with no intermediate cases or left-handed cases. This clear grouping indicates that dissection propagation favors these two modes, which is potentially due to the right-handedness of helical aortic blood flow and cell orientation. The characterization of dissection chirality and quantification of helical morphology advances our understanding of dissection pathology and lays a foundation for applications in clinical research and treatment practice. For example, the chirality and magnitude of helical metrics of dissections may indicate risk of dissection progression, help define treatment and surveillance strategies, and enable development of novel devices that account for various helical morphologies.NEW & NOTEWORTHY A novel definition of helical propagation of type B aortic dissections reveals a distinct bimodality, with the true lumen being either achiral (nonhelical) or exclusively right-handed. This right-handed chirality is consistent with anatomic and physiological phenomena such as right-handed twist during left ventricle contraction, helical blood flow, and tissue fiber direction. The helical character of aortic dissections may be useful for pathology research, diagnostics, treatment selection, therapeutic durability prediction, and aortic device design.
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Affiliation(s)
- Johan Bondesson
- Division of Dynamics, Chalmers University of Technology, Gothenburg, Sweden
| | - Ga-Young Suh
- Department of Biomedical Engineering, California State University, Long Beach, California.,Division of Vascular Surgery, Stanford University, Stanford, California
| | - Torbjörn Lundh
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Michael D Dake
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University, Stanford, California
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Frohlich MM, Suh GY, Bondesson J, Leineweber M, Lee JT, Dake MD, Cheng CP. Thoracic aortic geometry correlates with endograft bird-beaking severity. J Vasc Surg 2020; 72:1196-1205. [DOI: 10.1016/j.jvs.2019.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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Bondesson J, Suh GY, Lundh T, Lee JT, Dake MD, Cheng CP. Automated Quantification of Diseased Thoracic Aortic Longitudinal Centerline and Surface Curvatures. J Biomech Eng 2020; 142:041007. [PMID: 31633168 DOI: 10.1115/1.4045271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 07/25/2024]
Abstract
Precise description of vascular morphometry is crucial to support medical device manufacturers and clinicians for improving device development and interventional outcomes. A compact and intuitive method is presented to automatically characterize the surface geometry of tubular anatomic structures and quantify surface curvatures starting from generic stereolithographic (STL) surfaces. The method was validated with software phantoms and used to quantify the longitudinal surface curvatures of 37 human thoracic aortas with aneurysm or dissection. The quantification of surface curvatures showed good agreement with analytic solutions from the software phantoms, and demonstrated better agreement as compared to estimation methods using only centerline geometry and cross-sectional radii. For the human thoracic aortas, longitudinal inner surface curvature was significantly higher than centerline curvature (0.33 ± 0.06 versus 0.16 ± 0.02 cm-1 for mean; 1.38 ± 0.48 versus 0.45 ± 0.11 cm-1 for peak; both p < 0.001). These findings show the importance of quantifying surface curvatures in order to better describe the geometry and biomechanical behavior of the thoracic aorta, which can assist in treatment planning and supplying device manufactures with more precise boundary conditions for mechanical evaluation.
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Affiliation(s)
- Johan Bondesson
- Division of Dynamics,Chalmers University of Technology, Hörsalsvägen 7A,Gothenburg 412 96, Sweden
| | - Ga-Young Suh
- Division of Vascular Surgery,Stanford University, 300 Pasteur Dr.,Always Building M121,Stanford, CA 94305
| | - Torbjörn Lundh
- Mathematical Sciences,Chalmers University of Technology and University of Gothenburg, Chalmers tvärgata 3,Gothenburg 412 58, Sweden
| | - Jason T Lee
- Division of Vascular Surgery,Stanford University, 300 Pasteur Dr.,Always Building M121,Stanford, CA 94305
| | - Michael D Dake
- Department of Cardiothoracic Surgery,Stanford University, Falk Building, 870 Quarry Road,Palo Alto, CA 94304
| | - Christopher P Cheng
- Division of Vascular Surgery,Stanford University, 300 Pasteur Dr.,Always Building M121,Stanford, CA 94305
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Suh GY, Ullery BW, Lee JT, Dake MD, Fleischmann D, Cheng C. Cardiopulmonary-induced deformations of the thoracic aorta following thoracic endovascular aortic repair. Vascular 2018; 27:181-189. [DOI: 10.1177/1708538118811204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Thoracic endovascular aortic repair has become a preferred treatment strategy for thoracic aortic aneurysms and dissections. Yet, it is not well understood if the performance of endografts is affected by physiologic strain due to cyclic aortic motion during cardiac pulsation and respiration. We aim to quantify cardiac- and respiratory-induced changes of the postthoracic endovascular aortic repair thoracic aorta and endograft geometries. Methods Fifteen thoracic endovascular aortic repair patients (66 ± 10 years) underwent cardiac-resolved computed tomography angiographies during inspiratory/expiratory breath holds. The computed tomography angiography images were utilized to build models of the aorta, and lumen centerlines and cross-sections were extracted. Arclength and curvature were computed from the lumen centerline. Effective diameter was computed from cross-sections of the thoracic aorta. Deformation was computed from the mid-diastole to end-systole (cardiac deformation) and expiration to inspiration (respiratory deformation). Results Cardiac pulsation induced significant changes in arclength, mean curvature, maximum curvature change, and effective diameter of the ascending aorta, as well as effective diameter of the stented aortic segment. Respiration, however, induced significant change in mean curvature and effective diameter of the ascending aorta only. Cardiac-induced arclength change of the ascending aorta was significantly greater than respiratory-induced arclength change. Conclusions Deformations are present across the thoracic aorta due to cardiopulmonary influences after thoracic endovascular aortic repair. The geometric deformations are greatest in the ascending aorta and decline at the stented thoracic aorta. Additional investigation is warranted to correlate aortic deformation to endograft performance.
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Affiliation(s)
- Ga-Young Suh
- Stanford University School of Medicine, Vascular Surgery, Stanford, USA
| | | | - Jason T. Lee
- Stanford University School of Medicine, Vascular Surgery, Stanford, USA
| | - Michael D. Dake
- Stanford University School of Medicine, Cardiothoracic Surgery, Stanford, USA
| | - Dominik Fleischmann
- Stanford University School of Medicine, Radiology, Stanford, USAGS and BWU contributed equally to this work
| | - Christopher Cheng
- Stanford University School of Medicine, Vascular Surgery, Stanford, USA
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