Coronary three vessel disease: hydrodynamic simulations including the time-dependence of the microvascular resistances

Harmouche, Majid; Anselmi, Amédéo; Maasrani, Mahmoud; Mariano, Chiara; Verhoye, Jean‐Philippe; Drochon, Agnès

doi:10.12989/aba.2014.1.4.279

Cited by 2 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The right graft (case (1G)) allows to get a pressure level equivalent to aortic pressure in RCA (P ao (1G) ≈ P w (1G) ≈ P 2 (1G)), but it also modifies the pressures on the left side, due to possible reversed flow in the collateral network. A modification of the aortic pressure itself can also be noticed for Patients 15,18,19,20,21,22. In the case (2G), pressure drops in LAD (P ao − P 1 ) and in LCx (P ao − P 3 ) are about a few mmHg, and correspond to the pressure drop in the internal mammary artery grafts. As discussed in Section 3.2, it appears that the pressure distal to the RCA thrombosis, P w , is not significantly improved by the left grafts.…”

Section: Pressuresmentioning

confidence: 83%

See 1 more Smart Citation

Impact of Revascularization on the Distal to Proximal Pressure Ratio in Case of Multiple Coronary Stenoses

Anselmi¹,

Verhoye²,

Drochon³

2021

JBiSE

Self Cite

View full text Add to dashboard Cite

Objective: In order to take a decision about the revascularization approach to be adopted, it is of fundamental importance to determine whether coronary artery stenoses induce ischemia or not. An index, named (Fractional Flow Reserve), based on pressure measurements has been proposed to this aim and is usually interpreted in terms of flows. The objective of this work is to compute simultaneously pressures and flow rates in the coronary network of patients with three-vessel disease, in order to study more precisely the relationship between these two quantities. Approach: 22 patients have been included in the study. Some pressure and flow rate measurements were collected during by-pass surgery. These clinical data allow determining parameters for a patient's specific model, based on the electric/hydraulic analogy. Collateral pathways are included in the model, as well as the severity of the disease and the impact of revascularization. Main Results: For patients with stenoses on LAD, LCx, LMCA and occlusion of the RCA, the flow rate delivered to the right territory is of course a function of the aortic pressure, the left stenoses severity, and the pressure distal to the thrombosis. But it mainly depends on the capillary and collateral resistances, and on the proportion between them. Abnormal microvascular hemodynamics, may be present in patients with non-hemodynamic significant lesions as assessed by the pressure ratio. Complete revascularization with the 3 grafts is demonstrated to be fully justified. The direction of collateral flows may be reversed, depending on the pressure gradient. In any case, they remain low and become negligible when the 3 grafts are operating. Significance: Surgical decision based only on pressure measurements may miss some real hemodynamic problems due to the considered stenosis. This risk is even greater in case of serial stenoses.

show abstract

Section: Pressuresmentioning

confidence: 83%

“…During systole, some collapse of the coronary vessels occurs, due to the ventricular contraction, and the micro-vascular resistances are increased [18]. A mathematical formulation (Equation ( 13)) has been proposed in Harmouche et al [19] to describe this variation:…”

Section: Variations Of the Capillary Resistances With Timementioning

confidence: 99%