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Multi-modality image-based computational analysis of haemodynamics in aortic dissection.

Desmond Dillon-Murphy1, Alia Noorani1, David Nordsletten1

  • 1Department of Biomedical Engineering, King's College London, London, SE1 7EH, UK.

Biomechanics and Modeling in Mechanobiology
|September 30, 2015
PubMed
Summary

Aortic dissection alters blood flow dynamics, increasing pressure and wall stress, particularly in the true lumen. Computational models reveal dissection significantly increases left ventricular workload and impacts outcomes based on tear configurations.

Keywords:
Aortic dissectionCFDCardiac work loadIntimal tearsMulti-scale modelling

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Area of Science:

  • Cardiovascular Science
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Aortic dissection involves a tear in the aorta, creating true and false lumens separated by an intimal flap.
  • Stable type B aortic dissections present a debate regarding the optimal timing for surgical intervention.
  • Understanding aortic dissection hemodynamics is crucial for predicting patient outcomes.

Purpose of the Study:

  • To investigate the complex hemodynamics within aortic dissections using medical imaging and computational fluid dynamics (CFD).
  • To analyze the impact of morphometric variations, such as septum removal and connecting tear numbers, on aortic blood flow.
  • To compare hemodynamics in dissected aortas with a simulated healthy aorta.

Main Methods:

  • Creation of patient-specific CFD models of acute Stanford type B aortic dissection.
  • Utilized 2D and 4D Phase-Contrast Magnetic Resonance Imaging (PC-MRI) for patient-specific flow data and model validation.
  • Incorporated zero-dimensional Windkessel models for distal vasculature and a lumped-parameter heart model.

Main Results:

  • Identified localized increases in velocity, pressure, and wall shear stress in the narrow true lumen and near entry tears.
  • Demonstrated a significant increase in left ventricular stroke work (estimated 14%) due to aortic dissection.
  • Showed that the absence of secondary connecting tears led to substantial hemodynamic changes, including increased true lumen flow and decreased peak pressure.

Conclusions:

  • Computational modeling provides valuable insights into the intricate hemodynamics of aortic dissection.
  • Hemodynamic alterations in dissection significantly affect cardiac workload and may influence long-term outcomes.
  • The number and configuration of connecting tears play a critical role in modifying flow patterns and pressures within the dissected aorta.