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Hemodynamic Modeling of Surgically Repaired Coarctation of the Aorta
Laura J Olivieri1, Diane A de Zélicourt, Christopher M Haggerty
1Division of Cardiology, Children s National Medical Center, Washington, DC.
Insights
Surgically repaired coarctation of the aorta can lead to late morbidity. This study found that the Gothic arch shape uniquely alters blood flow, potentially explaining higher risks in patients with this remodeling pattern.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Medical Imaging
Background:
- Late morbidity after coarctation of the aorta repair includes cardiovascular and cerebrovascular disease.
- Arch remodeling patterns (Gothic, Crenel, Romanesque) are linked to late morbidity, with Gothic arches showing higher incidence.
Purpose of the Study:
- To evaluate blood flow in native and repaired aortic arches.
- To correlate hemodynamic indices with late morbidity incidence.
Main Methods:
- 3D reconstructions from MR images of remodeled aortic arches.
- Computational fluid dynamics (CFD) analysis of blood flow.
- Extraction of wall shear stress (WSS), pressure, and velocity data.
Main Results:
- Maximum WSS was in the mid-transverse arch for Crenel, Romanesque, and Native arches.
- Peak WSS was located in the isthmus of the Gothic model.
- Flow patterns in the descending aorta varied among models.
Conclusions:
- The location of peak WSS differs significantly among arch remodeling patterns.
- The Gothic arch's unique WSS location and descending aorta flow disorganization may be clinically relevant.
- Varied WSS patterns from abnormal arch remodeling may influence clinical vascular dysfunction.
Abstract:
PURPOSE: Late morbidity of surgically repaired coarctation of the aorta includes early cardiovascular and cerebrovascular disease, shortened life expectancy, abnormal vasomodulator response, hypertension and exercise-induced hypertension in the absence of recurrent coarctation. Observational studies have linked patterns of arch remodeling (Gothic, Crenel, and Romanesque) to late morbidity, with Gothic arches having the highest incidence. We evaluated flow in native and surgically repaired aortic arches to correlate respective hemodynamic indices with incidence of late morbidity. METHODS: Three dimensional reconstructions of each remodeled arch were created from an anatomic stack of magnetic resonance (MR) images. A structured mesh core with a boundary layer was generated. Computational fluid dynamic (CFD) analysis was performed assuming peak flow conditions with a uniform velocity profile and unsteady turbulent flow. Wall shear stress (WSS), pressure and velocity data were extracted. RESULTS: The region of maximum WSS was located in the mid-transverse arch for the Crenel, Romanesque and Native arches. Peak WSS was located in the isthmus of the Gothic model. Variations in descending aorta flow patterns were also observed among the models. CONCLUSION: The location of peak WSS is a primary difference among the models tested, and may have clinical relevance. Specifically, the Gothic arch had a unique location of peak WSS with flow disorganization in the descending aorta. Our results suggest that varied patterns and locations of WSS resulting from abnormal arch remodeling may exhibit a primary effect on clinical vascular dysfunction.
