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Patient-specific hemodynamic assessment using experimental and computational approaches in anomalous aortic origin of
Thangam Natarajan1, Yasaman Farsiani2, Jayanthi Parthasarathy2
1Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga.
Insights
This study presents a novel hybrid framework combining experimental and computational modeling for assessing anomalous aortic origin of coronary artery (AAOCA) hemodynamics. The approach accurately evaluates patient-specific coronary anatomy and supports future investigations in larger cohorts.
Area of Science:
- Cardiovascular Imaging and Modeling
- Biomedical Engineering
- Computational Fluid Dynamics
Background:
- Anomalous aortic origin of coronary artery (AAOCA) is a congenital heart defect that can lead to sudden cardiac death.
- Noninvasive hemodynamic evaluation of AAOCA is crucial for risk stratification and treatment planning.
- Current methods for assessing AAOCA hemodynamics have limitations in patient-specific accuracy and invasiveness.
Purpose of the Study:
- To develop and validate a patient-specific, noninvasive framework for hemodynamic evaluation of AAOCA.
- To combine experimental (3D printing, flow loop) and computational (CFD) modeling for comprehensive analysis.
- To assess the feasibility of this hybrid approach across different surgical stages of AAOCA.
Main Methods:
- Generated patient-specific models from coronary CT angiography at preoperative, post-unroofing, and post-reimplantation stages.
- Utilized 3D-printed aortocoronary models with a pulsatile flow loop for experimental assessment.
- Performed computational fluid dynamics (CFD) simulations to evaluate fractional flow reserve (FFR) and flow velocities under stress.
Main Results:
- Clinical FFR measurements showed improvement from 0.77 post-unroofing to 0.99 post-reimplantation.
- Experimental and computational FFR values closely correlated with clinical data across all stages (ranging from 0.7 to 0.99).
- Improved coronary perfusion and pressure gradients were observed post-reimplantation, aligning with anatomical findings.
Conclusions:
- The hybrid experimental-computational framework provides accurate, patient-specific hemodynamic assessment of AAOCA.
- This approach enables cross-validation of results and offers mechanistic insights into ischemia.
- The study demonstrates the feasibility of this noninvasive method, supporting its use in clinical practice and future research.
Objective:
To develop and demonstrate the feasibility of a patient-specific framework combining experimental and computational modeling for noninvasive hemodynamic evaluation of anomalous aortic origin of coronary artery (AAOCA) anatomy derived from coronary computed tomography angiography.
Methods:
A patient with a left AAOCA who experienced aborted sudden cardiac death underwent an unroofing procedure and later required coronary reimplantation after recurrent aborted sudden cardiac death was studied. Patient-specific models were generated at 3 stages: preoperative, postunroofing, and postreimplantation. Experimental assessment used 3-dimensional-printed aortocoronary models integrated with a pulsatile flow loop, whereas computational simulations were performed using computational fluid dynamics. Fractional flow reserve (FFR) and flow velocities were evaluated at rest and under simulated stress and compared with clinical stress FFR obtained during cardiac catheterization.
Results:
Clinical cardiac catheterization-derived FFR under dobutamine stress was 0.77 postunroofing and 0.99 after reimplantation. Experimental testing demonstrated similar stress FFR of 0.7 in native left AAOCA (with short intramural course), 0.8 after unroofing (compression from the intercoronary pillar), and 0.9 postreimplantation. Computational FFR agreed with both experimental and clinical measurements: lowest values were 0.74 preoperatively, 0.8 post unroofing, and 0.87 post reimplantation. Flow patterns and pressure gradients corresponded with surgical and anatomical observations, showing improved coronary perfusion after reimplantation.
Conclusions:
This hybrid experimental-computational workflow enables patient-specific assessment of AAOCA hemodynamics across sequential surgical stages. The approach provides accurate evaluation of coronary anatomy, cross-validation of model results, and preliminary mechanistic insight into ischemia, supporting the feasibility of this hybrid approach for patient-specific hemodynamic evaluation and motivating future investigation in larger cohorts.
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