Ascending thoracic aorta aneurysm repair induces positive hemodynamic outcomes in a patient with unchanged bicuspid aortic valve

Condemi, Francesca; Campisi, Salvatore; Viallon, Magalie; Croisille, Pierre; Jean-François, Fuzelier,; Avril, Stéphane

doi:10.1016/j.jbiomech.2018.09.022

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…Ten studies provided 4D flow data on ARR for patients with BAV aortopathy (47,(51)(52)(53)(54)(55)(56)(57)(58)(59). The majority (nine) of these studies used a valve-sparing technique (47,(52)(53)(54)(55)(56)(57)(58)(59), with two using a mechanical prosthesis (47,51) and two comparing valve-sparing and valved ARR (47,52). All ARR studies reported data on the flow pattern or helicity in the aortic arch, with four also reporting WSS, and four reporting PV values.…”

Section: Resultsmentioning

confidence: 99%

Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

Cave

Panayiotou

Bissell

2021

Front. Cardiovasc. Med.

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Bicuspid aortic valve (BAV) disease presents a unique management challenge both pre- and post-operatively. 4D flow MRI offers multiple tools for the assessment of the thoracic aorta in aortic valve disease. In particular, its assessment of flow patterns and wall shear stress have led to new understandings around the mechanisms of aneurysm development in BAV disease. Novel parameters have now been developed that have the potential to predict pathological aortic dilatation and may help to risk stratify BAV patients in future. This systematic review analyses the current 4D flow MRI literature after aortic valve and/or ascending aortic replacement in bicuspid aortic valve disease. 4D flow MRI has also identified distinct challenges posed by this cohort at the time of valve replacement compared to standard management of tri-leaflet disorders, and may help tailor the type and timing of replacement. Eccentric pathological flow patterns seen after bioprosthetic valve implantation, but not with mechanical prostheses, might be an important future consideration in intervention planning. 4D flow MRI also has promising potential in supporting the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.

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Section: Resultsmentioning

confidence: 99%

Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

Cave

Panayiotou

Bissell

2021

Front. Cardiovasc. Med.

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“…Studies using a rigid wall often focus on geometric effects using patient-specific parameters without the additional computational expense and required material properties needed for FSI. For example, studies using rigid walls revealed that patients with bicuspid aortic valve (BAV) have complex blood flow patterns that cause higher and uneven wall shear stresses, increasing the potential for TAA formation (Youssefi et al, 2017;Condemi et al, 2018;Edlin et al, 2019). Mendez et al (2018) simulated blood flow in BAV TAAs using both rigid walls and FSI, finding non-significant differences in helical flow, but significantly lower estimated pressure in CFD simulations.…”

Section: Thoracic Aortic Aneurysmsmentioning

confidence: 99%

Computational Hemodynamic Modeling of Arterial Aneurysms: A Mini-Review

et al. 2020

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Arterial aneurysms are pathological dilations of blood vessels, which can be of clinical concern due to thrombosis, dissection, or rupture. Aneurysms can form throughout the arterial system, including intracranial, thoracic, abdominal, visceral, peripheral, or coronary arteries. Currently, aneurysm diameter and expansion rates are the most commonly used metrics to assess rupture risk. Surgical or endovascular interventions are clinical treatment options, but are invasive and associated with risk for the patient. For aneurysms in locations where thrombosis is the primary concern, diameter is also used to determine the level of therapeutic anticoagulation, a treatment that increases the possibility of internal bleeding. Since simple diameter is often insufficient to reliably determine rupture and thrombosis risk, computational hemodynamic simulations are being developed to help assess when an intervention is warranted. Created from subjectspecific data, computational models have the potential to be used to predict growth, dissection, rupture, and thrombus-formation risk based on hemodynamic parameters, including wall shear stress, oscillatory shear index, residence time, and anomalous blood flow patterns. Generally, endothelial damage and flow stagnation within aneurysms can lead to coagulation, inflammation, and the release of proteases, which alter extracellular matrix composition, increasing risk of rupture. In this review, we highlight recent work that investigates aneurysm geometry, model parameter assumptions, and other specific considerations that influence computational aneurysm simulations. By highlighting modeling validation and verification approaches, we hope to inspire future computational efforts aimed at improving our understanding of aneurysm pathology and treatment risk stratification.

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“…Youssefi et al used computational fluid-only biomechanical models to investigate the impact of inflow velocity profiles on hemodynamics of the thoracic aorta [ 29 ]. Condemi et al performed patient-specific computational fluid dynamics analysis to obtain the effect of hemodynamics on the ascending thoracic aortic aneurysm risk of rupture [ 30 ] and also investigated the hemodynamic alterations for a patient who was treated by only ascending aorta replacement preserving the BAV [ 31 ]. Underhill et al constructed image-based computational models by integrating plaque morphology, components, and mechanical stress/strain conditions to assess the vulnerability of human atherosclerotic carotid plaques [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Patient-Specific CT-Based Fluid-Structure-Interaction Aorta Model to Quantify Mechanical Conditions for the Investigation of Ascending Aortic Dilation in TOF Patients

Zuo

et al. 2020

Computational and Mathematical Methods in Medicine

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Background. Some adult patients with Tetralogy of Fallot (TOF) were found to simultaneously develop ascending aortic dilation. Severe aortic dilation would lead to several aortic diseases, including aortic aneurysm and dissection, which seriously affect patients’ living quality and even cause patients’ death. Current practice guidelines of aortic-dilation-related diseases mainly focus on aortic diameter, which has been found not always a good indicator. Therefore, it may be clinically useful to identify some other factors that can potentially better predict aortic response to dilation. Methods. 20 TOF patients scheduled for TOF repair surgery were recruited in this study and were divided into dilated and nondilated groups according to the Z scores of ascending aorta diameters. Patient-specific aortic CT images, pressure, and flow rates were used in the construction of computational biomechanical models. Results. Simulation results demonstrated a good coincidence between numerical mean flow rate at inlet and the one obtained from color Doppler ultrasonography, which implied that computational models were able to simulate the movement of the aorta and blood inside accurately. Our results indicated that aortic stress can effectively differentiate patients of the dilated group from the ones of the nondilated group. Mean ascending aortic stress-P1 (maximal principal stress) from the dilated group was 54% higher than that from the nondilated group (97.97 kPa vs. 63.47 kPa, p value = 0.044) under systolic pressure. Velocity magnitude in the aorta and aortic wall displacement of the dilated group were also greater than those of the nondilated group with p value < 0.1. Conclusion. Computational modeling and ascending aortic biomechanical factors may be used as a potential tool to identify and analyze aortic response to dilation. Large-scale clinical studies are needed to validate these preliminary findings.

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Ascending thoracic aorta aneurysm repair induces positive hemodynamic outcomes in a patient with unchanged bicuspid aortic valve

Cited by 17 publications

References 19 publications

Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

Computational Hemodynamic Modeling of Arterial Aneurysms: A Mini-Review

Patient-Specific CT-Based Fluid-Structure-Interaction Aorta Model to Quantify Mechanical Conditions for the Investigation of Ascending Aortic Dilation in TOF Patients

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