Application of Patient-Specific Computational Fluid Dynamics in Anomalous Aortic Origin of Coronary Artery: A...

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Computational Science

Background:

• Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect.
• AAOCA can cause ischemia due to fixed and dynamic stenotic elements.
• Invasive coronary angiography is the current standard for hemodynamic assessment but has limitations.

Purpose of the Study:

• To systematically review the application of computational fluid dynamics (CFD) in analyzing hemodynamics in AAOCA.
• To evaluate patient-specific modeling, boundary conditions, and flow characteristics in existing CFD studies.
• To identify limitations and future directions for CFD in AAOCA research.

Main Methods:

• Systematic literature search using AAOCA and CFD keywords up to February 2023.
• Analysis of 19 publications encompassing 370 patients.
• Categorization of studies based on dedicated vs. general-purpose CFD models.

Main Results:

• A surge in CFD studies for AAOCA, predominantly using dedicated models (12 publications).
• Dedicated CFD models showed limitations in representing dynamic stenosis.
• General-purpose CFD models exhibited variability; fluid-solid interaction models show potential.
• Current CFD approaches inadequately replicate AAOCA pathophysiology under stress.

Conclusions:

• CFD holds promise as a noninvasive tool for AAOCA hemodynamic analysis.
• Existing CFD models require significant improvement for accurate simulation of dynamic stenotic elements.
• Novel CFD approaches are necessary to fully capture the pathophysiological changes in AAOCA.