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Rodríguez-Aparicio S, Ferrera C, Millán-Núñez MV, García García J, Dueñas-Pamplona J. Influence of the flow split ratio on the position of the main atrial vortex: Implications for stasis on the left atrial appendage. Comput Biol Med 2024; 178:108772. [PMID: 38917532 DOI: 10.1016/j.compbiomed.2024.108772] [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] [Received: 02/22/2024] [Revised: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Despite the recent advances in computational fluid dynamics (CFD) techniques applied to blood flow within the left atrium (LA), the relationship between atrial geometry, flow patterns, and blood stasis within the left atrial appendage (LAA) remains unclear. A better understanding of this relationship would have important clinical implications, as thrombi originating in the LAA are a common cause of stroke in patients with atrial fibrillation (AF). AIM To identify the most representative atrial flow patterns on a patient-specific basis and study their influence on LAA blood stasis by varying the flow split ratio and some common atrial modeling assumptions. METHODS Three recent techniques were applied to nine patient-specific computational fluid dynamics (CFD) models of patients with AF: a kinematic atrial model to isolate the influence of wall motion because of AF, projection on a universal LAA coordinate system, and quantification of stagnant blood volume (SBV). RESULTS We identified three different atrial flow patterns based on the position of the center of the main circulatory flow. The results also illustrate how atrial flow patterns are highly affected by the flow split ratio, increasing the SBV within the LAA. As the flow split ratio is determined by the patient's lying position, the results suggest that the most frequent position adopted while sleeping may have implications for the medium- and long-term risks of stroke.
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Affiliation(s)
- Sergio Rodríguez-Aparicio
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, Avda. Elvas s/n, Badajoz 06006, Spain
| | - Conrado Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, Avda. Elvas s/n, Badajoz 06006, Spain; Instituto de Computación Científica Avanzada (ICCAEX), Avda. Elvas s/n, Badajoz 06006, Spain
| | | | - Javier García García
- Departamento de Ingeniería Energética, Universidad Politécnica de Madrid, Avda. de Ramiro de Maeztu 7, Madrid 28040, Spain
| | - Jorge Dueñas-Pamplona
- Departamento de Ingeniería Energética, Universidad Politécnica de Madrid, Avda. de Ramiro de Maeztu 7, Madrid 28040, Spain.
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Depes D, Mennander A, Vehniäinen R, Paavonen T, Kholová I. Human Pulmonary Vein Myocardial Sleeve Autonomic Neural Density and Cardiovascular Mortality. J Histochem Cytochem 2022; 70:627-642. [PMID: 36154512 PMCID: PMC9527475 DOI: 10.1369/00221554221129899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Myocardial sleeves around pulmonary veins (PVs) are highly innervated structures with heterogeneous morphological and electrophysiological characteristics. Autonomic nerve dysfunction in the myocardium may be associated with an increased risk of cardiovascular morbidity and mortality. This article studied autonomic neural remodeling in myocardial sleeves around PVs and atrial-PV ostia with immunohistochemical and morphometric methods with clinicopathological correlations. PVs were collected from 37 and atrial-PV ostia from 17 human autopsy hearts. Immunohistochemical analysis was performed using antibodies against tyrosine hydroxylase (TH), choline acetyltransferase (CHAT), and growth-associated protein 43 (GAP43). In the PV cohort, subjects with immediate cardiovascular cause of death had significantly decreased sympathetic nerve density in fibro-fatty tissue vs those with non-cardiovascular cause of death (1624.53 vs 2522.05 µm2/mm2, p=0.038). In the atrial-PV ostia cohort, parasympathetic nerve density in myocardial sleeves was significantly increased in subjects with underlying cardiovascular cause of death (19.48 µm2/mm2) than subjects with underlying non-cardiovascular cause of death with no parasympathetic nerves detected (p=0.034). Neural growth regionally varied in sympathetic nerves and was present in most of the parasympathetic nerves. Heterogeneous autonomic nerve distribution and growth around PVs and atrial-PV ostia might play a role in cardiovascular morbidity and mortality. No association in nerve density was found with atrial fibrillation.
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Affiliation(s)
- Denis Depes
- Department of Pathology, Fimlab Laboratories,
Tampere, Finland
- Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
| | - Ari Mennander
- Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
- Division of Cardiothoracic Surgery, Tampere
University Heart Hospital, Tampere, Finland
| | - Rauha Vehniäinen
- Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
| | - Timo Paavonen
- Department of Pathology, Fimlab Laboratories,
Tampere, Finland
- Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories,
Tampere, Finland
- Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
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Bonczar M, Piątek-Koziej K, Wolska J, Tomala O, Stitou EA, Pękala J, Pękala P, Walocha J, Hołda M, Koziej M. Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis. Clin Anat 2022; 35:906-926. [PMID: 35460116 DOI: 10.1002/ca.23896] [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: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Joanna Wolska
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - El-Ayachi Stitou
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Dudkiewicz D, Słodowska K, Jasińska KA, Dobrzynski H, Hołda MK. The clinical anatomy of the left atrial structures used as landmarks in ablation of arrhythmogenic substrates and cardiac invasive procedures. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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