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Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection
John F LaDisa1, Ronak J Dholakia, C Alberto Figueroa
1Department of Biomedical Engineering, Marquette University, Children’s Hospital and the Medical College of Wisconsin, 1515 West Wisconsin Avenue, Milwaukee, WI 53233, USA. john.ladisa@marquette.edu
Insights
Resection with end-to-end anastomosis for coarctation of the aorta alters wall shear stress (WSS) patterns in the descending thoracic aorta. These localized hemodynamic changes may influence atherosclerotic plaque formation in unique locations post-surgery.
Area of Science:
- Cardiovascular Science
- Biomedical Engineering
- Medical Imaging
Background:
- Atherosclerotic plaque in the descending thoracic aorta (dAo) is linked to altered wall shear stress (WSS).
- Resection with end-to-end anastomosis (RWEA) is standard for coarctation of the aorta (CoA) repair but may alter WSS, contributing to morbidity.
Purpose of the Study:
- To investigate the impact of RWEA for CoA on WSS indices within the dAo.
- To identify specific regions of altered hemodynamics post-CoA repair using computational fluid dynamics (CFD).
Main Methods:
- CFD models were developed using imaging and blood pressure data from control subjects and CoA patients treated with RWEA.
- Blood flow velocity, time-averaged WSS (TAWSS), and oscillatory shear index (OSI) were calculated.
- Longitudinal and circumferential WSS indices were quantified in the dAo, with visualization techniques employed.
Main Results:
- While overall dAo area exposed to subnormal TAWSS and OSI was similar, significant local differences were observed.
- Control subjects exhibited left-handed rotating TAWSS and OSI patterns.
- CoA patients showed elevated TAWSS near residual narrowings and elevated OSI distally, particularly on the left dAo wall.
Conclusions:
- Localized WSS alterations in the dAo of RWEA-treated CoA patients suggest unique plaque formation sites influenced by surgical repair.
- These identified hemodynamic regions can be visualized for tracking contributions to morbidity in longitudinal studies.
Background:
Atherosclerotic plaque in the descending thoracic aorta (dAo) is related to altered wall shear stress (WSS) for normal patients. Resection with end-to-end anastomosis (RWEA) is the gold standard for coarctation of the aorta (CoA) repair, but may lead to altered WSS indices that contribute to morbidity.
Methods:
Computational fluid dynamics (CFD) models were created from imaging and blood pressure data for control subjects and age- and gender-matched CoA patients treated by RWEA (four males, two females, 15 ± 8 years). CFD analysis incorporated downstream vascular resistance and compliance to generate blood flow velocity, time-averaged WSS (TAWSS), and oscillatory shear index (OSI) results. These indices were quantified longitudinally and circumferentially in the dAo, and several visualization methods were used to highlight regions of potential hemodynamic susceptibility.
Results:
The total dAo area exposed to subnormal TAWSS and OSI was similar between groups, but several statistically significant local differences were revealed. Control subjects experienced left-handed rotating patterns of TAWSS and OSI down the dAo. TAWSS was elevated in CoA patients near the site of residual narrowings and OSI was elevated distally, particularly along the left dAo wall. Differences in WSS indices between groups were negligible more than 5 dAo diameters distal to the aortic arch.
Conclusions:
Localized differences in WSS indices within the dAo of CoA patients treated by RWEA suggest that plaque may form in unique locations influenced by the surgical repair. These regions can be visualized in familiar and intuitive ways allowing clinicians to track their contribution to morbidity in longitudinal studies.
