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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Haemodynamic impacts of myocardial bridge length: A congenital heart disease
Ashkan Javadzadegan1, Abouzar Moshfegh1, Maryam Mohammadi2
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia.
Insights
Longer myocardial bridges (MB) are linked to altered blood flow dynamics. Increased MB length reduces wall shear stress (WSS) and heightens blood residence time in the proximal coronary artery segment.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Medical Imaging
Background:
- Myocardial bridging (MB) is a congenital anomaly where a segment of coronary artery tunneled through heart muscle.
- Long and thick myocardial bridges are associated with adverse cardiovascular events, including myocardial infarction.
- Understanding the impact of MB length on coronary hemodynamics is crucial for risk stratification.
Purpose of the Study:
- To investigate how the length of myocardial bridging affects coronary hemodynamics.
- To analyze alterations in blood flow patterns, specifically wall shear stress (WSS) and blood residence time, in relation to MB length.
Main Methods:
- Utilized angiography and intravascular ultrasound in 10 patients with varying myocardial bridging lengths in the left anterior descending artery.
- Developed in silico computational fluid dynamics models based on patient-specific 3D reconstructions of the left anterior descending artery.
- Simulated transient blood flow to calculate WSS and residence time in proximal, bridge, and distal segments of the artery.
Main Results:
- Increasing myocardial bridging length correlated with decreasing WSS in the proximal segment and increasing WSS in the bridge segment.
- Patients with longer MBs (>23.92 mm) exhibited lower proximal WSS and higher residence time compared to those with shorter MBs.
- No significant difference in distal WSS was observed between patients with short and long myocardial bridges.
Conclusions:
- A direct relationship exists between myocardial bridging length and hemodynamic alterations in the proximal coronary artery segment.
- Increased MB length is associated with reduced WSS and prolonged blood residence time, potentially contributing to cardiovascular risk.
- These findings highlight the hemodynamic significance of myocardial bridging length.
Objectives:
There is an association between long and thick myocardial bridging (MB), haemodynamic perturbations and increased risk of myocardial infarction. This study aims to investigate the alteration in coronary haemodynamics with increasing the length of MB.
Methods:
Angiography and intravascular ultrasound were performed in 10 patients with varying length of MB in the left anterior descending (LAD) artery. In silico models of MB were developed based on the reconstructed three-dimensional model of the LAD. The entire LAD was divided into 3 segments, proximal (pre-bridge), bridge and distal (post-bridge). Transient computational fluid dynamics simulations were performed to derive distribution of blood residence time and wall shear stress (WSS) over entire vessel including proximal, bridge and distal segments.
Results:
With increasing the length of MB, a decreasing trend was observed in the WSS over proximal segment whereas an increasing trend was found in the WSS over bridge segment. When patients were divided into 2 groups based on the average length of MB in the whole cohort (Lave = 23.92 mm), patients with bridges longer than Lave had smaller WSS and higher residence time in the proximal segment compared to those with bridges shorter than Lave (0.59 ± 0.31 vs 0.21 ± 0.14 Pa and 0.0021 ± 0.0015 vs 0.0045 ± 0.0021 s). In contrast, patients with bridges longer than Lave had greater WSS in the bridge segment compared to those with bridges shorter than Lave (1.37 ± 1.66 vs 2.53 ± 3.14 Pa). No significant difference was found in the distal WSS of patients with short and long bridges.
Conclusion:
Our findings revealed a direct relationship between the length of MB and haemodynamic perturbations in the proximal segment such that the increased length of MB is associated with decreased WSS and increased residence time.
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