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Tsubata H, Nakanishi N, Itatani K, Takigami M, Matsubara Y, Ogo T, Fukuda T, Matsuda H, Matoba S. Pulmonary artery blood flow dynamics in chronic thromboembolic pulmonary hypertension. Sci Rep 2023; 13:6490. [PMID: 37081116 PMCID: PMC10119089 DOI: 10.1038/s41598-023-33727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension is caused by incomplete resolution and organization of thrombi. Blood flow dynamics are involved in thrombus formation; however, only a few studies have reported on pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension. Furthermore, the effects of treatment interventions on pulmonary artery blood flow dynamics are not fully understood. The aim of the study was to evaluate pulmonary artery blood flow dynamics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy and balloon pulmonary angioplasty, using computational fluid dynamics. We analyzed patient-specific pulmonary artery models of 10 patients with chronic thromboembolic pulmonary hypertension and three controls using computational fluid dynamics. In patients with chronic thromboembolic pulmonary hypertension, flow velocity and wall shear stress in the pulmonary arteries were significantly decreased, and the oscillatory shear index and blood stagnation volume were significantly increased than in controls. Pulmonary endarterectomy induced redistribution of pulmonary blood flow and improved blood flow dynamics in the pulmonary artery. Balloon pulmonary angioplasty improved pulmonary blood flow disturbance, decreased blood flow stagnation, and increased wall shear stress, leading to vasodilatation of the distal portion of the pulmonary artery following balloon pulmonary angioplasty treatment.
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Affiliation(s)
- Hideo Tsubata
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ward, Kyoto, 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ward, Kyoto, 602-8566, Japan.
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masao Takigami
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ward, Kyoto, 602-8566, Japan
| | - Yuki Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ward, Kyoto, 602-8566, Japan
| | - Takeshi Ogo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Vascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ward, Kyoto, 602-8566, Japan
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Chaudhuri K, Pletzer A, Waqanivavalagi SWFR, Milsom P, Smith NP. Personalized surgical planning for coronary bypass graft configurations using patient-specific computational modeling to avoid flow competition in arterial grafts. Front Cardiovasc Med 2023; 10:1095678. [PMID: 36815022 PMCID: PMC9940318 DOI: 10.3389/fcvm.2023.1095678] [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: 11/11/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives Flow competition between coronary artery bypass grafts (CABG) and native coronary arteries is a significant problem affecting arterial graft patency. The objectives of this study were to compare the predictive hemodynamic flow resulting from various total arterial grafting configurations and to evaluate whether the use of computational fluid dynamics (CFD) models capable of predicting flow can assist surgeons to make better decisions for individual patients by avoiding poorly functioning grafts. Methods Sixteen cardiac surgeons declared their preferred CABG configuration using bilateral internal mammary and radial arteries for each of 5 patients who had differing degrees of severe triple vessel coronary disease. Surgeons selected both a preferred 'aortic' strategy, with at least one graft arising from the ascending aorta, and a preferred "anaortic" strategy which could be performed as a "no-aortic touch" operation. CT coronary angiograms of the 5 patients were coupled to CFD models using a novel flow solver "COMCAB." Twelve different CABG configurations were compared for each patient of which 4 were "aortic" and 8 were "anaortic." Surgeons then selected their preferred grafting configurations after being shown predictive hemodynamic metrics including functional assessment of stenoses (instantaneous wave-free ratio; fractional flow reserve), transit time flowmetry graft parameters (mean graft flow; pulsatility index) and myocardial perfusion. Results A total of 87.5% (7/8) of "anaortic" configurations compared to 25% (1/4) of "aortic" configurations led to unsatisfactory grafts in at least 1 of the 5 patients (P = 0.038). The use of the computational models led to a significant decrease in the selection of unsatisfactory grafting configurations when surgeons employed "anaortic" (21.25% (17/80) vs. 1.25% (1/80), P < 0.001) but not "aortic" techniques (5% (4/80) vs. 0% (0/80), P = 0.64). Similarly, there was an increase in the selection of ideal configurations for "anaortic" (6.25% (5/80) vs. 28.75% (23/80), P < 0.001) but not "aortic" techniques (65% (52/80) vs. 61.25% (49/80), P = 0.74). Furthermore, surgeons who planned to use more than one unique "anaortic" configuration across all 5 patients increased (12.5% (2/16) vs. 87.5% (14/16), P<0.001). Conclusions "COMCAB" is a promising tool to improve personalized surgical planning particularly for CABG configurations involving composite or sequential grafts which are used more frequently in anaortic operations.
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Affiliation(s)
- Krish Chaudhuri
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand,Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand,*Correspondence: Krish Chaudhuri ✉
| | | | - Steve W. F. R. Waqanivavalagi
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand,Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Paget Milsom
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Nicolas P. Smith
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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Patient-specific fluid–structure interaction simulation of the LAD-ITA bypass graft for moderate and severe stenosis: A doubt on the fractional flow reserve-based decision. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hohri Y, Numata S, Itatani K, Kanda K, Yamazaki S, Inoue T, Yaku H. Prediction for future occurrence of type A aortic dissection using computational fluid dynamics. Eur J Cardiothorac Surg 2021; 60:384-391. [PMID: 33619516 DOI: 10.1093/ejcts/ezab094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/26/2020] [Accepted: 01/22/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The actual underlying mechanisms of acute type A aortic dissection (AAAD) are not well understood. The present study aimed to elucidate the mechanism of AAAD using computational fluid dynamics (CFD) analysis. METHODS We performed CFD analysis using patient-specific computed tomography imaging in 3 healthy control cases and 3 patients with AAAD. From computed tomography images, we made a healthy control model or pre-dissection model for CFD analysis. Pulsatile cardiac flow during one cardiac cycle was simulated, and a three-dimensional flow streamline was visualized to evaluate flow velocity, wall shear stress and oscillatory shear index (OSI). RESULTS In healthy controls, the transvalvular aortic flow was parallel to the ascending aorta. There was no spotty high OSI area at the ascending aorta. In pre-dissection patients, accelerated transvalvular aortic flow was towards the posterolateral ascending aorta. The vortex flow was observed on the side of the lesser curvature in mid-systole and expanded throughout the entire ascending aorta during diastole. Systolic wall shear stress was high due to the accelerated aortic blood flow on the side of the greater curvature of the ascending aorta. On the side of the lesser curvature, high OSI areas were observed around the vortex flow. In all pre-dissection cases, a spotty high OSI area was in close proximity to the actual primary entry site of the future AAAD. CONCLUSIONS The pre-onset high OSI area with vortex flow is closely associated with the future primary entry site. Therefore, we can elucidate the mechanism of AAAD with CFD analysis.
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Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Kanda
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoya Inoue
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hohri Y, Itatani K, Yamazaki S, Yaku H. Computerized virtual surgery based on computational fluid dynamics simulation for planning coronary revascularization with aortic root replacement in adult congenital heart disease: a case report. Gen Thorac Cardiovasc Surg 2020; 69:722-726. [PMID: 33130943 PMCID: PMC7981308 DOI: 10.1007/s11748-020-01517-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
A 38-year-old woman presented with exertional dyspnea and chest compression. She had undergone repair of congenital supravalvular aortic stenosis at 8 years of age. Contrast-enhanced computed tomography showed re-stenosis in the ascending aorta, bilateral coronary arterial aneurysm, and a highly thickened left ventricular wall. Release of stenosis was necessary to avoid left ventricular functional deterioration; however, it could cause demand–supply mismatch in coronary flow due to substantial left ventricular hypertrophy. Sufficient statistical evidence was not available in this situation; therefore, computerized virtual surgery based on computational fluid dynamics (CFD) was performed to predict the postoperative hemodynamics. Consequently, root replacement with in situ Carrel patch coronary reconstruction was considered a better option than coronary artery graft bypass in the left-side coronary flow supply. The patient underwent root replacement with in situ Carrel patch coronary reconstruction as planned based on CFD without any complication and was discharged 15 days postoperatively.
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Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Kanzaki T, Numata S, Yamazaki S, Ikemoto K, Hohri Y, Yaku H, Itatani K, Nakajma S, Takahashi A. Computational fluid dynamics of internal mammary artery-left anterior descending artery anastomoses. Interact Cardiovasc Thorac Surg 2020; 31:611-617. [PMID: 33137825 DOI: 10.1093/icvts/ivaa183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to elucidate the remodelling of the internal mammary artery (IMA)-left anterior descending artery anastomosis and compare 2 different anastomosis techniques (end-to-side versus side-to-side) using computational fluid dynamics. METHODS This study included 9 patients. Computed tomography (CT) angiography was performed immediately after coronary artery bypass grafting (CABG) and at 3-6 months later. The computational fluid dynamics models were made using the CT data. The pulsatile 3-dimensional blood flow was achieved with the finite volume method to evaluate the postoperative morphological and haemodynamic changes at the anastomosis in each patient. Flow velocity distribution, wall shear stress (WSS) and its fluctuation oscillatory shear index were measured. RESULTS No early or mid-term graft occlusion was observed in the study series. In the side-to-side anastomosis, pouch formation at the distal end of IMA caused a vortex flow with low WSS immediately after CABG. However, at 3-6 months after surgery, this pouch disappeared. As a result, the laminar straight flow with uniform WSS distribution was achieved inside the anastomosis. In the end-to-side anastomosis, the anastomosis shape was remodelled, resulting in a laminar flow pattern with uniform WSS distribution. A patchy high oscillatory shear index was detected at the IMA wall on the top of anastomosis in either anastomosis techniques immediately after the surgery, but it disappeared at 3-6 months after surgery. CONCLUSIONS Regardless of the anastomosis technique used, a successful remodelling of the IMA-left anterior descending artery anastomosis shape was achieved a few months after surgery, resulting in a straightforward flow streamline, with uniform WSS distribution and minimal oscillatory shear index.
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Affiliation(s)
- Tomohito Kanzaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koki Ikemoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shunsuke Nakajma
- Department of Cardiology, Sakurakai Takahashi Hospital, Hyogo, Japan
| | - Akihiko Takahashi
- Department of Cardiology, Sakurakai Takahashi Hospital, Hyogo, Japan
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Yoshida S, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kainuma S, Kawamura T, Kawamura A, Nakatani S, Sawa Y. Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous‐flow left ventricular‐assist device support. Artif Organs 2020; 44:883-891. [DOI: 10.1111/aor.13671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | - Koichi Toda
- Cardiovascular Surgery Osaka University Suita Japan
| | | | | | - Hiroki Hata
- Cardiovascular Surgery Osaka University Suita Japan
| | | | | | | | - Ai Kawamura
- Cardiovascular Surgery Osaka University Suita Japan
| | | | - Yoshiki Sawa
- Cardiovascular Surgery Osaka University Suita Japan
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Katsimpoulas M, Morticelli L, Gontika I, Kouvaka A, Mallis P, Dipresa D, Böer U, Soudah B, Haverich A, Michalopoulos E, Korossis S. Biocompatibility and Immunogenicity of Decellularized Allogeneic Aorta in the Orthotopic Rat Model. Tissue Eng Part A 2019; 25:399-415. [PMID: 30582419 DOI: 10.1089/ten.tea.2018.0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The generation of a small-caliber arterial graft, utilizing a large vessel of a small animal, such as the aorta of the rat or rabbit, for clinical use in the peripheral arterial tree, can widen the options for arterial prostheses. This in vivo study demonstrated the ability of the decellularization protocol that was used to produce a noncytotoxic acellular small-caliber arterial graft, with sufficient biomechanical and biological integrity to withstand the demanding flow and pressure environment of the rat aorta. This work also demonstrated the superiority of the decellularized homograft over its intact counterpart, in terms of lower immunogenicity.
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Affiliation(s)
- Michalis Katsimpoulas
- 1 Centre of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- 2 Attikon Animal Hospital, Paiania, Greece
| | - Lucrezia Morticelli
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ioanna Gontika
- 4 Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Artemis Kouvaka
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Panagiotis Mallis
- 4 Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Daniele Dipresa
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ulrike Böer
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bisharah Soudah
- 5 Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- 6 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Sotirios Korossis
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- 6 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- 7 Cardiopulmonary Regenerative (CARE) Group, Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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Numata S, Itatani K, Kawajiri H, Yamazaki S, Kanda K, Yaku H. Computational fluid dynamics simulation of the right subclavian artery cannulation. J Thorac Cardiovasc Surg 2017; 154:480-487. [DOI: 10.1016/j.jtcvs.2017.02.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/19/2017] [Accepted: 02/14/2017] [Indexed: 12/16/2022]
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Reply. Ann Thorac Surg 2016; 103:363-364. [PMID: 28007246 DOI: 10.1016/j.athoracsur.2016.06.057] [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: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 11/22/2022]
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ZHAO XI, LIU YOUJUN, XIE JINSHENG, ZHAO ZHOU, QIAO AIKE. SURGICAL DECISION OF CORONARY ARTERY BYPASS GRAFTING FOR NORMAL LEFT ANTERIOR DESCENDING ARTERY (LAD) AND LAD WITH STENOSIS: SEQUENTIAL GRAFT OR NOT. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sequential graft was used frequently in clinical studies. In this study, the hemodynamic effect of one kind of sequential graft in two different conditions of the lesion was discussed and some recommendations on the surgical procedures were made. A patient-specific three-dimensional (3D) model of left anterior descending artery (LAD) was reconstructed. A moderate stenosis exist in the trunk of LAD between the first and the second diagonal branch (D1 and D2). Another 3D model without stenosis was also reconstructed based on the patient-specific model. Sequential graft and single graft were applied on these two 3D model. Thus four 3D models were built so that the hemodynamic effect of sequential graft can be discussed. The zero-dimensional (0D)/3D coupling method was used to perform the numerical simulation by coupling the 3D artery model with a 0D lumped parameter model of the cardiovascular system. The flow rates in the branches of LAD and the graft flow were calculated and illustrated in this paper. The wall shear stress (WSS) and oscillatory shear index (OSI) were also calculated and depicted. If the native LAD is stenosis, sequential graft should be applied for the short-term outcomes. Moreover, the long-term patency of the sequential graft applied on the stenosis LAD is good. The long-term patency of the single graft was bad. But the short-term outcomes are almost the same when LAD is not stenosis. If no stenosis exist in the native LAD, a graft with smaller diameter should be applied to improve the long-term patency.
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Affiliation(s)
- XI ZHAO
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, P. R. China
| | - YOUJUN LIU
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, P. R. China
| | - JINSHENG XIE
- Beijing An Zhen Hospital, Affiliated to Capital Medical University, No. 2 Anzhen Road Chaoyang District, Beijing 100029, P. R. China
| | - ZHOU ZHAO
- Peking University People’s Hospital, No. 11 Xizhimen South Street Xicheng District, Beijing 100044, P. R. China
| | - AIKE QIAO
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, P. R. China
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Numata S, Itatani K, Kanda K, Doi K, Yamazaki S, Morimoto K, Manabe K, Ikemoto K, Yaku H. Blood flow analysis of the aortic arch using computational fluid dynamics. Eur J Cardiothorac Surg 2016; 49:1578-85. [PMID: 26792932 DOI: 10.1093/ejcts/ezv459] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/19/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To obtain predictive information regarding aortic disease, we evaluated how blood flow inside the aortic arch was influenced by thoracic aortic aneurysms. In addition, to reveal the optimal intraoperative management in these cases, we examined blood flow during right subclavian arterial (rSCA) perfusion using computational fluid dynamics (CFD). METHODS Patient-specific models of the aortic arch were made with six different patterns based on the computed tomographic images. CFD models with finite volume methods were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow stream patterns, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated during one cardiac cycle. Furthermore, flow streamlines during rSCA perfusion were simulated under different perfusion flows. RESULTS Aortic dilatation caused vortical disturbed flow in a dilated space, resulting in turbulent flow not only inside the aneurysm but also in the proximal and/or distal normal aortic portion. In patients with a dilated thoracic aorta, there was a helical spiral flow with a circumferential vortex in systole. In patients with an arch aneurysm, turbulent flow inside the aneurysm caused a high OSI at the tip of the aneurysm. A high OSI was detected at the orifice of the supra-aortic branches, sinotubular junction, posterior lateral side of the ascending aorta and lesser curvature of the proximal descending aorta. rSCA perfusion revealed that the right common carotid artery was perfused by blood flow from rSCA throughout the cardiac cycle. With 75% of the flow from the rSCA, blood flow from the heart reached the left common carotid and subclavian artery only during a short period during the peak of systole. CONCLUSIONS A dilated aorta causes a turbulent flow pattern in the aortic arch. The high OSI site was similar to the favourite entry site for acute aortic dissection, indicating the causal relationship between mechanical stress and acute aortic dissection. rSCA cannulation might be cerebroprotective from ascending aortic plaque.
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Affiliation(s)
- Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Kanda
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuki Morimoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaichiro Manabe
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koki Ikemoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Katsimpoulas M, Morticelli L, Michalopoulos E, Gontika I, Stavropoulos-Giokas C, Kostakis A, Haverich A, Korossis S. Investigation of the Biomechanical Integrity of Decellularized Rat Abdominal Aorta. Transplant Proc 2015; 47:1228-33. [DOI: 10.1016/j.transproceed.2014.11.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/13/2014] [Indexed: 10/23/2022]
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14
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Impact of top end anastomosis design on patency and flow stability in coronary artery bypass grafting. Heart Vessels 2015; 31:643-8. [DOI: 10.1007/s00380-015-0680-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/06/2015] [Indexed: 11/25/2022]
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