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Enlarged Lumen Volume of Proximal Aortic Segment and Acute Type B Aortic Dissection: A Computer Fluid Dynamics Study
Yuan Peng1, Xuelan Zhang2, Jiehua Li1
1Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China.
Insights
Enlarged proximal aortic segment (PAS) volume and diameters are linked to acute type B aortic dissection (ATBAD). Increased PAS volume leads to more aggressive hemodynamics, potentially contributing to ATBAD development.
Area of Science:
- Cardiovascular Research
- Medical Imaging Analysis
- Hemodynamic Simulation
Background:
- Ascending aorta and proximal aortic arch diameters are associated with acute type B aortic dissection (ATBAD).
- The precise relationship between proximal aortic segment (PAS) morphology and ATBAD remains incompletely understood.
Purpose of the Study:
- To investigate morphological differences in the proximal aortic segment (PAS) between patients with ATBAD and controls.
- To perform hemodynamic simulations to elucidate the impact of PAS morphology on blood flow dynamics.
Main Methods:
- Retrospective analysis of PAS morphology in 163 ATBAD patients and 120 controls.
- Statistical analysis, including ridge regression, to identify significant morphological parameters.
- Development of idealized aortic models and hemodynamic simulations based on significant variables.
Main Results:
- Patients with ATBAD exhibited significantly larger PAS diameters and lumen volumes compared to controls (124,659.07 ± 34,089.27 mm³ vs 89,796.65 ± 30,334.40 mm³).
- PAS lumen volume positively correlated with PAS diameters.
- Increased PAS volume led to elevated fluid kinetic energy, wall shear stress, and oscillatory shear index distally to the left subclavian artery.
Conclusions:
- Enlarged PAS volume and diameters are positively correlated in ATBAD patients.
- The enlarged PAS volume contributes to more aggressive hemodynamic parameters, potentially predisposing individuals to ATBAD.
Background:
Recent study has revealed that enlarged diameters of the ascending aorta and proximal aortic arch enhance the probability of ATBAD. However, little is understood about the relation to ATBAD.
Objective:
This study explored the differences in proximal aortic segment (PAS) morphology in patients with acute type B aortic dissection (ATBAD), and performed hemodynamic simulations to provide proof of principle.
Materials And Methods:
The morphological characteristics of PAS in the ATBAD group (n = 163) and corresponding segment in the control group (n = 120) were retrospectively measured. The morphological parameters were analyzed using comprehensive statistical approaches. Ridge regression analysis was also performed to determine the association between independent variable and dependent variable. P < 0.01 was considered significant. Idealized aortic models were established based on variables of statistical significance, and hemodynamic simulations were performed to evaluate blood flow changes caused by morphology.
Results:
Diameters at landmarks of PAS were significantly larger in the ATBAD group. The lumen volume (VPAS) of PAS in the ATBAD group was significantly enlarged than that of the control group (124,659.07 ± 34,089.27 mm3 vs 89,796.65 ± 30,334.40 mm3; P < 0.001). Furthermore, the VPAS was positively correlated to diameters. As the VPAS increased, the fluid kinetic energy in PAS enhanced linearly, and time-averaged wall shear stress and oscillatory shear index at the distal area of the left subclavian artery increased significantly.
Conclusion:
In the ATBAD group, the enlarged VPAS and increased diameters of PAS are positively correlated. Meanwhile, the enlarged VPAS leads to more aggressive hemodynamic parameters at the distal area of the left subclavian artery, which may create a contributory condition for ATBAD.
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