Computational Simulations for Aortic Coarctation: Representative Results From a Sampling of Patients
Computational Simulations for Aortic Coarctation: Representative Results From a Sampling of Patients
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DOI：
10.1115/1.4004996
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发表时间：
2011-09-01
影响因子：
1.7
通讯作者：
Taylor, Charles A.
中科院分区：
文献类型：
--
作者：
LaDisa, John F., Jr.;Figueroa, C. Alberto;Taylor, Charles A.
主动脉缩窄（CoA）的治疗可以缓解血压（BP）梯度（Delta），但长期发病率仍然存在，这可以通过血流动力学和生物力学指标的改变来解释。我们介绍了一种技术，以增加我们对这些指标的休息和非休息条件下CoA的理解，量化其对发病率的贡献，并评估治疗方案。根据1例正常和4例CoA患者（中度自体CoA：Delta 12 mmHg，重度自体CoA：Delta 25 mmHg，术后端对端和端对侧患者：Delta 0 mmHg）的成像和BP数据创建患者特异性计算流体动力学（CFD）模型。模拟包括血管变形、下游血管阻力和顺应性。量化指标包括循环应变、时均壁面剪应力（TAWSS）和振荡剪切指数（OSI）。模拟复制了静息BP和血流数据。正常患者模拟运动期间的BP与报告值匹配。中度天然CoA患者的收缩压和平均和峰值Δ BP出现最大的运动诱导增加（SBP：115至154 mmHg;平均和峰值Δ BP：31和73 mmHg）。对于自体CoA患者，循环应变在缩窄近端升高，但在治疗后整个主动脉降低。对于CoA患者，更大比例的血管暴露于低于正常的TAWSS或升高的OSI。在正常患者中，这些与动脉粥样硬化相关的指数的局部模式被CoA加重。这些结果首次将CFD应用于一系列CoA患者，并为该领域的未来进展提供了基础。[DOI：10.1115/1.4004996]
Treatments for coarctation of the aorta (CoA) can alleviate blood pressure (BP) gradients (Delta), but long-term morbidity still exists that can be explained by altered indices of hemodynamics and biomechanics. We introduce a technique to increase our understanding of these indices for CoA under resting and nonresting conditions, quantify their contribution to morbidity, and evaluate treatment options. Patient-specific computational fluid dynamics (CFD) models were created from imaging and BP data for one normal and four CoA patients (moderate native CoA: Delta 12 mmHg, severe native CoA: Delta 25 mmHg and postoperative end-to-end and end-to-side patients: Delta 0 mmHg). Simulations incorporated vessel deformation, downstream vascular resistance and compliance. Indices including cyclic strain, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) were quantified. Simulations replicated resting BP and blood flow data. BP during simulated exercise for the normal patient matched reported values. Greatest exercise-induced increases in systolic BP and mean and peak Delta BP occurred for the moderate native CoA patient (SBP: 115 to 154 mmHg; mean and peak Delta BP: 31 and 73 mmHg). Cyclic strain was elevated proximal to the coarctation for native CoA patients, but reduced throughout the aorta after treatment. A greater percentage of vessels was exposed to subnormal TAWSS or elevated OSI for CoA patients. Local patterns of these indices reported to correlate with atherosclerosis in normal patients were accentuated by CoA. These results apply CFD to a range of CoA patients for the first time and provide the foundation for future progress in this area. [DOI: 10.1115/1.4004996]