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Mill J, Harrison J, Saiz-Vivo M, Albors C, Morales X, Olivares AL, Iriart X, Cochet H, Noailly J, Sermesant M, Camara O. The role of the pulmonary veins on left atrial flow patterns and thrombus formation. Sci Rep 2024; 14:5860. [PMID: 38467726 DOI: 10.1038/s41598-024-56658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Atrial fibrillation (AF) is the most common human arrhythmia, forming thrombi mostly in the left atrial appendage (LAA). However, the relation between LAA morphology, blood patterns and clot formation is not yet fully understood. Furthermore, the impact of anatomical structures like the pulmonary veins (PVs) have not been thoroughly studied due to data acquisition difficulties. In-silico studies with flow simulations provide a detailed analysis of blood flow patterns under different boundary conditions, but a limited number of cases have been reported in the literature. To address these gaps, we investigated the influence of PVs on LA blood flow patterns and thrombus formation risk through computational fluid dynamics simulations conducted on a sizeable cohort of 130 patients, establishing the largest cohort of patient-specific LA fluid simulations reported to date. The investigation encompassed an in-depth analysis of several parameters, including pulmonary vein orientation (e.g., angles) and configuration (e.g., number), LAA and LA volumes as well as their ratio, flow, and mass-less particles. Our findings highlight the total number of particles within the LAA as a key parameter for distinguishing between the thrombus and non-thrombus groups. Moreover, the angles between the different PVs play an important role to determine the flow going inside the LAA and consequently the risk of thrombus formation. The alignment between the LAA and the main direction of the left superior pulmonary vein, or the position of the right pulmonary vein when it exhibits greater inclination, had an impact to distinguish the control group vs. the thrombus group. These insights shed light on the intricate relationship between PV configuration, LAA morphology, and thrombus formation, underscoring the importance of comprehensive blood flow pattern analyses.
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Affiliation(s)
- Jordi Mill
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain.
| | - Josquin Harrison
- Inria, Université Côte d'Azur, Epione team, 06902, Sophia Antipolis, France
| | - Marta Saiz-Vivo
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Carlos Albors
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Xabier Morales
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Andy L Olivares
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Xavier Iriart
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm, 33600, Pessac, France
- Bordeaux University Hospital, 33600, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm, 33600, Pessac, France
- Bordeaux University Hospital, 33600, Bordeaux, France
| | - Jerome Noailly
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Maxime Sermesant
- Inria, Université Côte d'Azur, Epione team, 06902, Sophia Antipolis, France
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
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Valvez S, Oliveira-Santos M, Gonçalves L, Amaro AM, Piedade AP. Preprocedural Planning of Left Atrial Appendage Occlusion: A Review of the Use of Additive Manufacturing. 3D PRINTING AND ADDITIVE MANUFACTURING 2024; 11:333-346. [PMID: 38389681 PMCID: PMC10880654 DOI: 10.1089/3dp.2022.0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Stroke is a significant public health problem, with non-valvular atrial fibrillation (NVAF) being one of its main causes. This cardiovascular arrhythmia predisposes to the production of intracardiac thrombi, mostly formed in the left atrial appendage (LAA). When there are contraindications to treatment with oral anticoagulants, another therapeutic option to reduce the possibility of thrombus formation in the LAA is the implantation of an occlusion device by cardiac catheterization. The effectiveness of LAA occlusion is dependent on accurate preprocedural device sizing and proper device positioning at the LAA ostium, to ensure sufficient device anchoring and avoid peri-device leaks. Additive manufacturing, commonly known as three-dimensional printing (3DP), of LAA models is beginning to emerge in the scientific literature to address these challenges through procedural simulation. This review aims at clarifying the impact of 3DP on preprocedural planning of LAA occlusion, specifically in the training of cardiac surgeons and in the assessment of the perfect adjustment between the LAA and the biomedical implant.
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Affiliation(s)
- Sara Valvez
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
| | | | - Lino Gonçalves
- CBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana M. Amaro
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
| | - Ana P. Piedade
- Department of Mechanical Engineering, CEMMPRE, ARISE, University of Coimbra, Coimbra, Portugal
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Mill J, Montoliu H, Moustafa AH, Olivares AL, Albors C, Aguado AM, Medina E, Ceresa M, Freixa X, Arzamendi D, Cochet H, Camara O. Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions. Int J Bioprint 2022; 9:640. [PMID: 36636130 PMCID: PMC9830994 DOI: 10.18063/ijb.v9i1.640] [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: 05/04/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022] Open
Abstract
Advanced visual computing solutions and three-dimensional (3D) printing are moving from engineering to clinical pipelines for training, planning, and guidance of complex interventions. 3D imaging and rendering, virtual reality (VR), and in-silico simulations, as well as 3D printing technologies provide complementary information to better understand the structure and function of the organs, thereby improving and personalizing clinical decisions. In this study, we evaluated several advanced visual computing solutions, such as web-based 3D imaging visualization, VR, and computational fluid simulations, together with 3D printing, for the planning of the left atrial appendage occluder (LAAO) device implantations. Six cardiologists tested different technologies in pre-operative data of five patients to identify the usability, limitations, and requirements for the clinical translation of each technology through a qualitative questionnaire. The obtained results demonstrate the potential impact of advanced visual computing solutions and 3D printing to improve the planning of LAAO interventions as well as the need for their integration into a single workflow to be used in a clinical environment.
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Affiliation(s)
- Jordi Mill
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Helena Montoliu
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Abdel H. Moustafa
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, 08025, Spain
| | - Andy L. Olivares
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Carlos Albors
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Ainhoa M. Aguado
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Elodie Medina
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Mario Ceresa
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain
| | - Xavier Freixa
- Department of Cardiology, Hospital Clinic de Barcelona, 08036, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, 08025, Spain
| | - Hubert Cochet
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm 1045, Pessac, France
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018 Spain,Corresponding author: Oscar Camara ()
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Celi S, Vignali E, Capellini K, Gasparotti E. On the Role and Effects of Uncertainties in Cardiovascular in silico Analyses. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:748908. [PMID: 35047960 PMCID: PMC8757785 DOI: 10.3389/fmedt.2021.748908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
The assessment of cardiovascular hemodynamics with computational techniques is establishing its fundamental contribution within the world of modern clinics. Great research interest was focused on the aortic vessel. The study of aortic flow, pressure, and stresses is at the basis of the understanding of complex pathologies such as aneurysms. Nevertheless, the computational approaches are still affected by sources of errors and uncertainties. These phenomena occur at different levels of the computational analysis, and they also strongly depend on the type of approach adopted. With the current study, the effect of error sources was characterized for an aortic case. In particular, the geometry of a patient-specific aorta structure was segmented at different phases of a cardiac cycle to be adopted in a computational analysis. Different levels of surface smoothing were imposed to define their influence on the numerical results. After this, three different simulation methods were imposed on the same geometry: a rigid wall computational fluid dynamics (CFD), a moving-wall CFD based on radial basis functions (RBF) CFD, and a fluid-structure interaction (FSI) simulation. The differences of the implemented methods were defined in terms of wall shear stress (WSS) analysis. In particular, for all the cases reported, the systolic WSS and the time-averaged WSS (TAWSS) were defined.
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Affiliation(s)
- Simona Celi
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Emanuele Vignali
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Katia Capellini
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Emanuele Gasparotti
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
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Celi S, Gasparotti E, Capellini K, Vignali E, Fanni BM, Ali LA, Cantinotti M, Murzi M, Berti S, Santoro G, Positano V. 3D Printing in Modern Cardiology. Curr Pharm Des 2021; 27:1918-1930. [PMID: 32568014 DOI: 10.2174/1381612826666200622132440] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND 3D printing represents an emerging technology in the field of cardiovascular medicine. 3D printing can help to perform a better analysis of complex anatomies to optimize intervention planning. METHODS A systematic review was performed to illustrate the 3D printing technology and to describe the workflow to obtain 3D printed models from patient-specific images. Examples from our laboratory of the benefit of 3D printing in planning interventions were also reported. RESULTS 3D printing technique is reliable when applied to high-quality 3D image data (CTA, CMR, 3D echography), but it still needs the involvement of expert operators for image segmentation and mesh refinement. 3D printed models could be useful in interventional planning, although prospective studies with comprehensive and clinically meaningful endpoints are required to demonstrate the clinical utility. CONCLUSION 3D printing can be used to improve anatomy understanding and surgical planning.
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Affiliation(s)
- Simona Celi
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Katia Capellini
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Benigno M Fanni
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Lamia A Ali
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
| | | | - Michele Murzi
- Adult Cardiosurgery Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Sergio Berti
- Adult Interventional Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
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Maresch AC, Chacon MM, Markin NW. Left Atrial Appendage Occlusion Device Placement and the Integration of Echocardiography-Fluoroscopy Fusion Imaging. J Cardiothorac Vasc Anesth 2021; 36:8-11. [PMID: 34376345 DOI: 10.1053/j.jvca.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew C Maresch
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - M Megan Chacon
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
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Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding. ACTA ACUST UNITED AC 2021; 57:medicina57050444. [PMID: 34063719 PMCID: PMC8147783 DOI: 10.3390/medicina57050444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia with an estimated prevalence of 1% in the general population. It is associated with an increased risk of ischemic stroke, silent cerebral ischemia, and cognitive impairment. Due to the blood flow stasis and morphology, thrombus formation occurs mainly in the left atrial appendage (LAA), particularly in the setting of nonvalvular AF (NVAF). Previous studies have shown that >90% of emboli related to NVAF originate from the LAA, thus prevention of systemic cardioembolism is indicated. According to the current guidelines, anticoagulant therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), represents the standard of care in AF patients, in order to prevent ischemic stroke and peripheral embolization. Although these drugs are widely used and DOACs have shown, compared to VKAs, non-inferiority for stroke prevention with significantly fewer bleeding complications, some issues remain a matter of debate, including contraindications, side effects, and adherence. An increasing number of patients, indeed, because of high bleeding risk or after experiencing life-threatening bleedings, must take anticoagulants with extreme caution if not contraindicated. While surgical closure or exclusion of LAA has been historically used in patients with AF with contradictory results, in the recent years, a novel procedure has emerged to prevent the cardioembolic stroke in these patients: The percutaneous left atrial appendage occlusion (LAAO). Different devices have been developed in recent years, though not all of them are approved in Europe and some are still under clinical investigation. Currently available devices have shown a significant decrease in bleeding risk while maintaining efficacy in preventing thromboembolism. The procedure can be performed percutaneously through the femoral vein access, under general anesthesia. A transseptal puncture is required to access left atrium and is guided by transesophageal echocardiography (TEE). Evidence from the current literature indicates that percutaneous LAAO represents a safe alternative for those patients with contraindications for long-term oral anticoagulation. This review summarizes scientific evidences regarding LAAO for stroke prevention including clinical indications and an adequate patient selection.
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Zaccaria A, Danielli F, Gasparotti E, Fanni BM, Celi S, Pennati G, Petrini L. Left atrial appendage occlusion device: Development and validation of a finite element model. Med Eng Phys 2020; 82:104-118. [DOI: 10.1016/j.medengphy.2020.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/17/2020] [Accepted: 05/25/2020] [Indexed: 11/26/2022]
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Correlation between LAA Morphological Features and Computational Fluid Dynamics Analysis for Non-Valvular Atrial Fibrillation Patients. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10041448] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The left atrial appendage (LAA) is a complex cardiovascular structure which can yield to thrombi formation in patients with non-valvular atrial fibrillation (AF). The study of LAA fluid dynamics together with morphological features should be investigated in order to evaluate the possible connection of geometrical and hemodynamics indices with the stroke risk. To reach this goal, we conducted a morphological analysis of four different LAA shapes considering their variation during the cardiac cycle and computational fluid dynamics (CFD) simulations in AF conditions were carried out. The analysis of main geometrical LAA parameters showed a huger ostium and a reduced motility for the cauliflower and cactus shapes, as well as a lower velocity values from the CFD analysis. Such findings are in line with literature and highlight the importance of coupling dynamics imaging data with CFD calculations for providing information not available at clinical level.
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