Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-30T00:43:48.025Z Has data issue: false hasContentIssue false
  • English
  • Français

Computational fluid dynamics simulations as a complementary study for transcatheter endovascular stent implantation for re-coarctation of the aorta associated with minimal pressure drop: an aneurysmal ductal ampulla with aortic isthmus narrowing

Published online by Cambridge University Press:  14 June 2019

Martin Guillot ,
Robert Ascuitto ,
Nancy Ross-Ascuitto ,
Kiran Mallula  and
Ernest Siwik
Martin Guillot
Affiliation:
ccDepartment of Mechanical Engineering, University of New Orleans, New Orleans, LA, USA
Robert Ascuitto*
Affiliation:
Pediatric and Adult Congenital Cardiology (LLC), New Orleans, LA, USA
Nancy Ross-Ascuitto
Affiliation:
Pediatric and Adult Congenital Cardiology (LLC), New Orleans, LA, USA
Kiran Mallula
Affiliation:
Division of Pediatric Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
Ernest Siwik
Affiliation:
Division of Pediatric Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
*
Author for correspondence: Robert Ascuitto, PhD, MD, Pediatric and Adult Congenital Cardiology (LLC), 27 Killdeer Street, New Orleans, LA, USA. E-mail: nrossascuitto@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Transcatheter stent implantation has been employed to treat re-coarctation of the aorta in adolescents and young adults. The aim of this work is to use computational fluid dynamics to characterise haemodynamics associated with re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing, which created minimal pressure drop, and to incorporate computational fluid dynamics’s findings into decision-making concerning catheter-directed treatment.

Methods:

Computational fluid dynamics permits numerically solving the Navier–Stokes equations governing pulsatile flow in the aorta, based on patient-specific data. We determined flow-velocity fields, wall shear stresses, oscillatory shear indices, and particle stream traces, which cannot be ascertained from catheterisation data or magnetic resonance imaging.

Results:

Computational fluid dynamics showed that, as flow entered the isthmus, it separated from the aortic wall, and created vortices leading to re-circulating low-velocity flow that induced low and multidirectional wall shear stress, which could sustain platelet-mediated thrombus formation in the ampulla. In contrast, as flow exited the isthmus, it created a jet leading to high-velocity flow that induced high and unidirectional wall shear stress, which could eventually undermine the wall of the descending aorta.

Summary:

We used computational fluid dynamics to study re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing. Despite minimal pressure drop, computational fluid dynamics identified flow patterns that would place the patient at risk for: thromboembolic events, rupture of the ampulla, and impaired descending aortic wall integrity. Thus, catheter-directed stenting was undertaken and proved successful. Computational fluid dynamics yielded important information, not only about the case presented, but about the complementary role it can serve in the management of patients with complex aortic arch obstruction.

Keywords

Re-coarctationstentcomputational fluid dynamicsthrombosis
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 6 , June 2019 , pp. 768 - 776
Check for updates
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jenkins, NP, Ward, C. Coarctation of the aorta: natural history and outcome after surgical repair treatment. QJM 1999; 92: 365–371.CrossRefGoogle Scholar
Dodge-Khatami, A, Backer, CL, Mavroudis, C. Risk factors for coarctation and results of reoperation: a 40-year review. J Card Surg 2000; 15: 369–377.CrossRefGoogle ScholarPubMed
Kappetein, AP, Zwinderman, AH, Bogers, AJJC, Rohmer, J, Huymans, HA. More than thirty years of coarctation repair: an unexpected high relapse rate. J Thorac Cardiovasc Surg 1994; 107: 87–95.Google ScholarPubMed
Forbes, TJ, Gowda, ST. Intravascular stent therapy for coarctation of the aorta. Methodist Debakey Cardiovasc J 2014; 10: 82–87.CrossRefGoogle ScholarPubMed
Vergales, JE, Gangemi, JJ, Rhueban, KS, Lim, DS. Coarctation of the aorta-The current state of surgical and transcatheter therapies. Curr Cardiol Rev 2013; 9: 211–219.CrossRefGoogle ScholarPubMed
Bandon Bravo Bruinsma, GJ, Leicher, FG, Haalebos, MMP. Ruptured aneurysm of a ductus arteriosus diverticulum in an adult. Neth Heart J 2001; 9: 85–86.Google Scholar
Rayz, VL, Boussel, L, Ge, L, et al. Flow residence time and regions of intraluminal thrombus deposition in intracranial aneurysms. Ann Biomed Eng 2010; 38: 3058–3069.CrossRefGoogle ScholarPubMed
Bluestein, D, Dumont, K, DeBeule, M, et al. Intraluminal thrombus and risk of rupture in patient specific abdominal aortic aneurysm-FSI modeling. Comput Methods Biomech Biomed Eng 2009; 12: 73–81.CrossRefGoogle Scholar
Morris, PD, Narracott, A, von Tengg-Kobligk, H, et al. Computational fluid dynamics modeling in cardiovascular medicine. Heart 2016; 102: 18–28.CrossRefGoogle Scholar
Davis, PF. Hemodynamic shear stress and the endothelium in cardiovascular pathology. Nat Clin Pract Cardiovasc Med 2009; 6: 16–26.CrossRefGoogle Scholar
Ascuitto, RJ, Kydon, DW, Ross-Ascuitto, NT. Pressure loss from flow energy dissipation: relevance to Fontan-type modifications. Pediatr Cardiol 2001; 22: 110, 2001.CrossRefGoogle ScholarPubMed
Celestin, C, Guillot, M, Ross-Ascuitto, N, Ascuitto, R. Computational fluid dynamics characterization of blood flow in central aorta to pulmonary artery connections: importance of shunt angulation as a determinant of shear stress-induced thrombosis. Pediatr Cardiol 2014; 35: 600–615.Google Scholar
Shadden, SC, Hendabadi, S. Potential fluid mechanic pathways of platelet activation. Biomech Model Mechanobiol 2013; 12: 467–474.CrossRefGoogle ScholarPubMed
Andrade, LCF, Petronilio, JA, de A. Maneschy, CE, de A. Cruz, DO. The Carreau-Yasuda fluids: a skin friction equation for turbulent flow in pipes and Kolmogorov dissipative scales. J Braz Soc Mech Sci Eng 2007; 29: 162–167.CrossRefGoogle Scholar
Ascuitto, R, Ross-Ascuitto, N, Guillot, M, Celestin, C. Computational fluid dynamics characterization of pulsatile flow in central and Sano shunts connected to the pulmonary arteries: importance of graft angulation on shear stress-induced, platelet-mediated thrombosis. Interact CardioVasc Thorac Surg 2017; 25: 414–421.CrossRefGoogle ScholarPubMed
Alastruey, J, Xiao, N, Fok, H, Schaeffter, T, Figueroa, CA. On the impact of modeling assumptions in multi-scale, subject-specific models of aortic haemodynamics. J R Soc Interface 2016; 13: 1–17.CrossRefGoogle Scholar
Nerem, RM. Vascular fluid dynamics, the arterial wall, and atherosclerosis. J Biomech Eng 1992; 114: 274–282.CrossRefGoogle Scholar
Keshavarz-Motamed, Z, Garcia, J, Gaillard, E, et al. Effects of coarctation of the aorta and bicuspid aortic valve on flow dynamics and turbulence in the aorta using particle image velocimetry. Exp Fluids 2014; 55: 1696–1712.CrossRefGoogle Scholar
Soulis, JV, Lampri, OP, Fytanidis, DK, Giannoglou, GD. Relative residence time and oscillatory shear index of non-Newtonian flow models in aorta. IEEE 10th International Workshop on Biomedical Engineering, Kos, Greece; 2011: 5–7.CrossRefGoogle Scholar
Segre, G, Silberberg, A. Radial particle displacements in Poiseuille flow of suspensions. Nature 1961; 189: 209–210.CrossRefGoogle Scholar
Segre, G, Silberberg, A. Behavior of macroscopic rigid spheres in Poiseuille flow II: experimental results and interpretation. J Fluid Mech 1962; 14: 136–157.CrossRefGoogle Scholar
Mountrakis, L, Lorenz, E, Hoekstra, G. Where do platelets go? A simulation study of fully resolved blood flow through aneurysmal vessels. Interface Focus 2013; 3: 20120089.CrossRefGoogle Scholar
Haller, SJ, Crawford, JD, Courchaine, KM, et al. Intraluminal thrombus is associated with early rupture of abdominal aortic aneurysm. J Vasc Surg 2018; 67: 1051–1058.CrossRefGoogle ScholarPubMed
Piechota-Polanczyk, A, Jozkowicz, A, Nowak, W, et al. The abdominal aortic aneurysm and intraluminal thrombus: current concepts of development and treatment. Front Cardiovasc Med 2015; 2: 1–29.CrossRefGoogle ScholarPubMed
Dolan, JM, Kolega, J, Meng, H. High wall shear stress and spatial gradients in vascular pathology: a review. Ann Biomed Eng 2013; 41: 1411–1427.CrossRefGoogle ScholarPubMed
Theodore, S, Varma, PK, Neema, PK, Neelakandhan, KS. Late aneurysm formation with destruction of the left lung after subclavian flap angioplasty for coarctation of aorta. J Thorac Cardiovasc Surg 2005; 129: 468–469.CrossRefGoogle ScholarPubMed
Jin, S, Oshinski, J, Giddens, DP. Effects of wall motion and compliance on flow patterns in the ascending aorta. J Biomech Eng 2003; 125: 347–354.CrossRefGoogle ScholarPubMed
Lantz, J, Renner, J, Karlsson, M. Wall shear stress in a subject specific human aorta-influence of fluid-structure interaction. Int J Appl Mech 2011; 9: 4–20.Google Scholar
Keshavarz-Motamed, Z, Garcia, J, Kadem, L. Fluid dynamics of coarctation of the aorta and effect of bicuspid aortic valve. PLoS ONE 2013; 8: e72394.CrossRefGoogle ScholarPubMed
Bauer, M, Pasic, M, Mayer, R, et al. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve. Ann Thorac Surg 2002; 74: 58–62.CrossRefGoogle ScholarPubMed
Siamo, M, Ferreira, JM, Tomas, AC, Fragata, J, Ramos, HM. Aorta ascending aneurysm analysis using CFD models towards possible anomalies. Fluids 2017; 2: 1–15.Google Scholar