Coupled Morphological–Hemodynamic Computational Analysis of Type B Aortic Dissection: A Longitudinal Study

Progressive false lumen aneurysmal degeneration in type B aortic dissection (TBAD) is a complex process with a multi-factorial etiology. Patient-specific computational fluid dynamics (CFD) simulations provide spatial and temporal hemodynamic quantities that facilitate understanding this disease progression. A longitudinal study was performed for a TBAD patient, who was diagnosed with the uncomplicated TBAD in 2006 and treated with optimal medical therapy but received surgery in 2010 due to late complication. Geometries of the aorta in 2006 and 2010 were reconstructed. With registration algorithms, we accurately quantified the evolution of the false lumen, while with CFD simulations we computed several hemodynamic indexes, including the wall shear stress (WSS), and the relative residence time (RRT). The numerical fluid model included large eddy simulation (LES) modeling for efficiently capturing the flow disturbances induced by the entry tears. In the absence of complete patient-specific data, the boundary conditions were based on a specific calibration method. Correlations between hemodynamics and the evolution field in time obtained by registration of the false lumen are discussed. Further testing of this methodology on a large cohort of patients may enable the use of CFD to predict whether patients, with originally uncomplicated TBAD, develop late complications.

[1]  T. Wonnacott,et al.  Relation between diameter and flow in major branches of the arch of the aorta. , 1992, Journal of biomechanics.

[2]  Robert M. Nerem,et al.  Hemodynamics and Vascular Endothelial Biology , 1993, Journal of cardiovascular pharmacology.

[3]  P. Puech-Leão,et al.  Predictive factors for rupture of thoracoabdominal aortic aneurysm. , 1998, Journal of vascular surgery.

[4]  H. Akashi,et al.  Long-term outcome and prognostic predictors of medically treated acute type B aortic dissections. , 2004, The Annals of thoracic surgery.

[5]  Jan Modersitzki,et al.  Numerical Methods for Image Registration , 2004 .

[6]  K. Hayashi,et al.  Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. , 2004, Circulation.

[7]  Keiji Tanaka,et al.  Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  Rossella Fattori,et al.  Partial thrombosis of the false lumen in patients with acute type B aortic dissection. , 2007, The New England journal of medicine.

[9]  Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. , 2007 .

[10]  R. S. Mitchell,et al.  Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. , 2008, The Annals of thoracic surgery.

[11]  Charles A. Taylor,et al.  On Coupling a Lumped Parameter Heart Model and a Three-Dimensional Finite Element Aorta Model , 2009, Annals of Biomedical Engineering.

[12]  J. Swanevelder,et al.  Diagnosis and management of aortic dissection , 2009 .

[13]  C V Riga,et al.  Analysis of flow patterns in a patient-specific aortic dissection model. , 2010, Journal of biomechanical engineering.

[14]  Andriy Myronenko,et al.  Point Set Registration: Coherent Point Drift , 2009, IEEE Transactions on Pattern Analysis and Machine Intelligence.

[15]  V. L. Rayz,et al.  Flow Residence Time and Regions of Intraluminal Thrombus Deposition in Intracranial Aneurysms , 2010, Annals of Biomedical Engineering.

[16]  Heow Pueh Lee,et al.  Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations. , 2011, Journal of biomechanics.

[17]  J. Mocco,et al.  Hemodynamic–Morphologic Discriminants for Intracranial Aneurysm Rupture , 2011, Stroke.

[18]  J-F Gerbeau,et al.  External tissue support and fluid–structure simulation in blood flows , 2012, Biomechanics and modeling in mechanobiology.

[19]  Yiannis Ventikos,et al.  A longitudinal study of Type-B aortic dissection and endovascular repair scenarios: computational analyses. , 2013, Medical engineering & physics.

[20]  Nan Xiao,et al.  Multi-scale computational model of three-dimensional hemodynamics within a deformable full-body arterial network , 2013, J. Comput. Phys..

[21]  D. Gallo,et al.  Inflow boundary conditions for image-based computational hemodynamics: impact of idealized versus measured velocity profiles in the human aorta. , 2013, Journal of biomechanics.

[22]  H. Rousseau,et al.  Endovascular Repair of Type B Aortic Dissection: Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial , 2013, Circulation. Cardiovascular interventions.

[23]  N. Cheshire,et al.  Initial findings and potential applicability of computational simulation of the aorta in acute type B dissection. , 2013, Journal of vascular surgery.

[24]  A Veneziani,et al.  Validation of an open source framework for the simulation of blood flow in rigid and deformable vessels , 2013, International journal for numerical methods in biomedical engineering.

[25]  C. Miller,et al.  Abstract 19062: Outcomes of Patients with Acute Type B (DeBakey III) Aortic Dissection: a 13 Year Single Center Experience , 2014 .

[26]  Stavroula Balabani,et al.  Development of a patient-specific simulation tool to analyse aortic dissections: assessment of mixed patient-specific flow and pressure boundary conditions. , 2014, Medical engineering & physics.

[27]  Nigel B. Wood,et al.  Geometric and Flow Features of Type B Aortic Dissection: Initial Findings and Comparison of Medically Treated and Stented Cases , 2014, Annals of Biomedical Engineering.

[28]  A. Evangelista,et al.  Role of entry tear size in type B aortic dissection. , 2014, Annals of cardiothoracic surgery.

[29]  Eric M Isselbacher,et al.  Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. , 2015, Journal of the American College of Cardiology.

[30]  C. Nienaber,et al.  Management of acute aortic dissection , 2015, The Lancet.

[31]  Robert C Gorman,et al.  Use of computational fluid dynamics studies in predicting aneurysmal degeneration of acute type B aortic dissections. , 2014, Journal of vascular surgery.

[32]  Alfio Quarteroni,et al.  Geometric multiscale modeling of the cardiovascular system, between theory and practice , 2016 .

[33]  Annalisa Quaini,et al.  Deconvolution‐based nonlinear filtering for incompressible flows at moderately large Reynolds numbers , 2016 .

[34]  J. Pepper,et al.  On the choice of outlet boundary conditions for patient-specific analysis of aortic flow using computational fluid dynamics. , 2017, Journal of biomechanics.

[35]  P. Watton,et al.  Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups. , 2017, Medical engineering & physics.

[36]  H. Rousseau,et al.  Endovascular Repair of Type B Aortic Dissection , 2022 .