Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis. Congenit Heart Dis 2011;6(5):432-43
Date
08/02/2011Pubmed ID
21801315Pubmed Central ID
PMC3208403DOI
10.1111/j.1747-0803.2011.00553.xScopus ID
2-s2.0-80052835284 (requires institutional sign-in at Scopus site) 70 CitationsAbstract
BACKGROUND: Atherosclerotic plaque in the descending thoracic aorta (dAo) is related to altered wall shear stress (WSS) for normal patients. Resection with end-to-end anastomosis (RWEA) is the gold standard for coarctation of the aorta (CoA) repair, but may lead to altered WSS indices that contribute to morbidity.
METHODS: Computational fluid dynamics (CFD) models were created from imaging and blood pressure data for control subjects and age- and gender-matched CoA patients treated by RWEA (four males, two females, 15 ± 8 years). CFD analysis incorporated downstream vascular resistance and compliance to generate blood flow velocity, time-averaged WSS (TAWSS), and oscillatory shear index (OSI) results. These indices were quantified longitudinally and circumferentially in the dAo, and several visualization methods were used to highlight regions of potential hemodynamic susceptibility.
RESULTS: The total dAo area exposed to subnormal TAWSS and OSI was similar between groups, but several statistically significant local differences were revealed. Control subjects experienced left-handed rotating patterns of TAWSS and OSI down the dAo. TAWSS was elevated in CoA patients near the site of residual narrowings and OSI was elevated distally, particularly along the left dAo wall. Differences in WSS indices between groups were negligible more than 5 dAo diameters distal to the aortic arch.
CONCLUSIONS: Localized differences in WSS indices within the dAo of CoA patients treated by RWEA suggest that plaque may form in unique locations influenced by the surgical repair. These regions can be visualized in familiar and intuitive ways allowing clinicians to track their contribution to morbidity in longitudinal studies.
Author List
LaDisa JF Jr, Dholakia RJ, Figueroa CA, Vignon-Clementel IE, Chan FP, Samyn MM, Cava JR, Taylor CA, Feinstein JAAuthors
Joseph R. Cava MD, PhD Associate Professor in the Pediatrics department at Medical College of WisconsinJohn F. LaDisa PhD Professor in the Pediatrics department at Medical College of Wisconsin
Margaret Mary Samyn MD Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAnastomosis, Surgical
Aorta, Thoracic
Aortic Coarctation
Atherosclerosis
Blood Flow Velocity
Blood Pressure
Case-Control Studies
Child
Child, Preschool
Compliance
Computer Simulation
Female
Hemodynamics
Humans
Magnetic Resonance Angiography
Male
Models, Cardiovascular
Regional Blood Flow
Stress, Mechanical
Treatment Outcome
Vascular Resistance
Vascular Surgical Procedures
Young Adult
