Patient-specific computational fluid dynamics-assessment of aortic hemodynamics in a spectrum of aortic valve pathologies
The complexity of aortic disease is not fully exposed by aortic dimensions alone, and morbidity or mortality can occur before intervention thresholds are met. Patient-specific computational fluid dynamics (CFD) were used to assess the effect of different aortic valve morphologies on velocity profile...
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| Vydáno v: | The Journal of thoracic and cardiovascular surgery Ročník 153; číslo 1; s. 8 - 20.e3 |
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| Hlavní autoři: | , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
01.01.2017
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| ISSN: | 1097-685X |
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| Abstract | The complexity of aortic disease is not fully exposed by aortic dimensions alone, and morbidity or mortality can occur before intervention thresholds are met. Patient-specific computational fluid dynamics (CFD) were used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress (WSS), and oscillatory shear index (OSI) in the thoracic aorta.
A total of 45 subjects were divided into 5 groups: volunteers, aortic regurgitation-tricuspid aortic valve (AR-TAV), aortic stenosis-tricuspid aortic valve (AS-TAV), aortic stenosis-bicuspid aortic valve right-left cusp fusion (BAV[RL]), and aortic stenosis-right-non cusp fusion (AS-BAV[RN]). Subjects underwent magnetic resonance angiography, with phase-contrast magnetic resonance imaging at the sino-tubular junction to define patient-specific inflow velocity profiles. Hemodynamic recordings were used alongside magnetic resonance imaging angiographic data to run patient-specific CFD.
The BAV groups had larger mid-ascending aorta diameters (P < .05). Ascending aorta flow was more eccentric in BAV (flow asymmetry = 78.9% ± 6.5% for AS-BAV(RN), compared with 4.7% ± 2.1% for volunteers, P < .05). Helicity was greater in AS-BAV(RL) (P < .05). Mean WSS was elevated in AS groups, greatest in AS-BAV(RN) (37.1 ± 4.0 dyn/cm
, compared with 9.8 ± 5.4 for volunteers, P < .05). The greater curvature of the ascending aorta experienced highest WSS and lowest OSI in AS patients, most significant in AS-BAV(RN) (P < .05).
BAV displays eccentric flow with high helicity. The presence of AS, particularly in BAV-RN, led to greater WSS and lower OSI in the greater curvature of the ascending aorta. Patient-specific CFD provides noninvasive functional assessment of the thoracic aorta, and may enable development of a personalized approach to diagnosis and management of aortic disease beyond traditional guidelines. |
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| AbstractList | OBJECTIVESThe complexity of aortic disease is not fully exposed by aortic dimensions alone, and morbidity or mortality can occur before intervention thresholds are met. Patient-specific computational fluid dynamics (CFD) were used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress (WSS), and oscillatory shear index (OSI) in the thoracic aorta.METHODSA total of 45 subjects were divided into 5 groups: volunteers, aortic regurgitation-tricuspid aortic valve (AR-TAV), aortic stenosis-tricuspid aortic valve (AS-TAV), aortic stenosis-bicuspid aortic valve right-left cusp fusion (BAV[RL]), and aortic stenosis-right-non cusp fusion (AS-BAV[RN]). Subjects underwent magnetic resonance angiography, with phase-contrast magnetic resonance imaging at the sino-tubular junction to define patient-specific inflow velocity profiles. Hemodynamic recordings were used alongside magnetic resonance imaging angiographic data to run patient-specific CFD.RESULTSThe BAV groups had larger mid-ascending aorta diameters (P < .05). Ascending aorta flow was more eccentric in BAV (flow asymmetry = 78.9% ± 6.5% for AS-BAV(RN), compared with 4.7% ± 2.1% for volunteers, P < .05). Helicity was greater in AS-BAV(RL) (P < .05). Mean WSS was elevated in AS groups, greatest in AS-BAV(RN) (37.1 ± 4.0 dyn/cm2, compared with 9.8 ± 5.4 for volunteers, P < .05). The greater curvature of the ascending aorta experienced highest WSS and lowest OSI in AS patients, most significant in AS-BAV(RN) (P < .05).CONCLUSIONSBAV displays eccentric flow with high helicity. The presence of AS, particularly in BAV-RN, led to greater WSS and lower OSI in the greater curvature of the ascending aorta. Patient-specific CFD provides noninvasive functional assessment of the thoracic aorta, and may enable development of a personalized approach to diagnosis and management of aortic disease beyond traditional guidelines. The complexity of aortic disease is not fully exposed by aortic dimensions alone, and morbidity or mortality can occur before intervention thresholds are met. Patient-specific computational fluid dynamics (CFD) were used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress (WSS), and oscillatory shear index (OSI) in the thoracic aorta. A total of 45 subjects were divided into 5 groups: volunteers, aortic regurgitation-tricuspid aortic valve (AR-TAV), aortic stenosis-tricuspid aortic valve (AS-TAV), aortic stenosis-bicuspid aortic valve right-left cusp fusion (BAV[RL]), and aortic stenosis-right-non cusp fusion (AS-BAV[RN]). Subjects underwent magnetic resonance angiography, with phase-contrast magnetic resonance imaging at the sino-tubular junction to define patient-specific inflow velocity profiles. Hemodynamic recordings were used alongside magnetic resonance imaging angiographic data to run patient-specific CFD. The BAV groups had larger mid-ascending aorta diameters (P < .05). Ascending aorta flow was more eccentric in BAV (flow asymmetry = 78.9% ± 6.5% for AS-BAV(RN), compared with 4.7% ± 2.1% for volunteers, P < .05). Helicity was greater in AS-BAV(RL) (P < .05). Mean WSS was elevated in AS groups, greatest in AS-BAV(RN) (37.1 ± 4.0 dyn/cm , compared with 9.8 ± 5.4 for volunteers, P < .05). The greater curvature of the ascending aorta experienced highest WSS and lowest OSI in AS patients, most significant in AS-BAV(RN) (P < .05). BAV displays eccentric flow with high helicity. The presence of AS, particularly in BAV-RN, led to greater WSS and lower OSI in the greater curvature of the ascending aorta. Patient-specific CFD provides noninvasive functional assessment of the thoracic aorta, and may enable development of a personalized approach to diagnosis and management of aortic disease beyond traditional guidelines. |
| Author | He, Taigang Youssefi, Pouya Bunce, Nick Jahangiri, Marjan Anderson, Lisa Sharma, Rajan Figueroa, C Alberto Gomez, Alberto |
| Author_xml | – sequence: 1 givenname: Pouya surname: Youssefi fullname: Youssefi, Pouya organization: Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, London, United Kingdom; Department of Biomedical Engineering, King's College London, London, United Kingdom – sequence: 2 givenname: Alberto surname: Gomez fullname: Gomez, Alberto organization: Department of Biomedical Engineering, King's College London, London, United Kingdom – sequence: 3 givenname: Taigang surname: He fullname: He, Taigang organization: Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, London, United Kingdom – sequence: 4 givenname: Lisa surname: Anderson fullname: Anderson, Lisa organization: Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, London, United Kingdom – sequence: 5 givenname: Nick surname: Bunce fullname: Bunce, Nick organization: Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, London, United Kingdom – sequence: 6 givenname: Rajan surname: Sharma fullname: Sharma, Rajan organization: Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, London, United Kingdom – sequence: 7 givenname: C Alberto surname: Figueroa fullname: Figueroa, C Alberto organization: Department of Biomedical Engineering, King's College London, London, United Kingdom; Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, Mich – sequence: 8 givenname: Marjan surname: Jahangiri fullname: Jahangiri, Marjan email: marjan.jahangiri@stgeorges.nhs.uk organization: Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, London, United Kingdom. Electronic address: marjan.jahangiri@stgeorges.nhs.uk |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27847162$$D View this record in MEDLINE/PubMed |
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| Keywords | aorta MRI bicuspid aortic valve wall shear stress |
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| SubjectTerms | Adult Aged Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - physiopathology Aortic Valve - physiopathology Aortic Valve Insufficiency - physiopathology Aortic Valve Stenosis - physiopathology Blood Flow Velocity - physiology Case-Control Studies Computational Biology Female Hemodynamics - physiology Humans Imaging, Three-Dimensional Magnetic Resonance Angiography Male Middle Aged |
| Title | Patient-specific computational fluid dynamics-assessment of aortic hemodynamics in a spectrum of aortic valve pathologies |
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