Is There a Role for Biomechanical Engineering in Helping to Elucidate the Risk Profile of the Thoracic Aorta?

Clinical estimates of rupture and dissection risk of thoracic aortic aneurysms are based on nonsophisticated measurements of maximum diameter and growth rate. The use of aortic size alone may overlook the role that vessel heterogeneity plays in assessing the risk of catastrophic complications. Biomechanics may help provide a more nuanced approach to predict the behavior of thoracic aortic aneurysms. In this report, we review modeling studies with an emphasis on mechanical and fluid dynamics analyses. We identify open problems and highlight the future possibility of a multidisciplinary approach that includes biomechanics and imaging to evaluate the likelihood of rupture or dissection.

[1]  J. Elefteriades,et al.  Increased tissue microarray matrix metalloproteinase expression favors proteolysis in thoracic aortic aneurysms and dissections. , 2004, The Annals of thoracic surgery.

[2]  G. Moneta Pathogenesis of Acute Aortic Dissection: A Finite Element Stress Analysis , 2011 .

[3]  Mark F Fillinger,et al.  Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. , 2003, Journal of vascular surgery.

[4]  S. Hewitt,et al.  2007 , 2018, Los 25 años de la OMC: Una retrospectiva fotográfica.

[5]  J. M. Goicolea,et al.  Factors influencing the mechanical behaviour of healthy human descending thoracic aorta , 2010, Physiological measurement.

[6]  Friedhelm Beyersdorf,et al.  Flow-sensitive four-dimensional magnetic resonance imaging: flow patterns in ascending aortic aneurysms. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[7]  J. Elefteriades,et al.  Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm) , 2015, Open Heart.

[8]  Elena S. Di Martino,et al.  In vivo strain assessment of the abdominal aortic aneurysm. , 2015, Journal of biomechanics.

[9]  Toshiro Ohashi,et al.  Remodeling of vascular endothelial cells exposed to fluid shear stress: experimental and numerical approach , 2005 .

[10]  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.

[11]  Simon C Watkins,et al.  Mechanism of aortic medial matrix remodeling is distinct in patients with bicuspid aortic valve. , 2014, The Journal of thoracic and cardiovascular surgery.

[12]  S. Chien Mechanotransduction and endothelial cell homeostasis: the wisdom of the cell. , 2007, American journal of physiology. Heart and circulatory physiology.

[13]  Dimitrios P Sokolis,et al.  Biomechanical response of ascending thoracic aortic aneurysms: association with structural remodelling , 2012, Computer methods in biomechanics and biomedical engineering.

[14]  J. Abe,et al.  Stress and vascular responses: atheroprotective effect of laminar fluid shear stress in endothelial cells: possible role of mitogen-activated protein kinases. , 2003, Journal of pharmacological sciences.

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

[16]  Bartley P Griffith,et al.  Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta. , 2003, The Annals of thoracic surgery.

[17]  J. Humphrey,et al.  Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections. , 2015, Circulation research.

[18]  Julie A. Phillippi,et al.  Differential tensile strength and collagen composition in ascending aortic aneurysms by aortic valve phenotype. , 2013, The Annals of thoracic surgery.

[19]  Dimitrios P Sokolis,et al.  Regional and directional variations in the mechanical properties of ascending thoracic aortic aneurysms. , 2009, Medical engineering & physics.

[20]  G. Ateshian,et al.  Biomechanical roles of medial pooling of glycosaminoglycans in thoracic aortic dissection , 2014, Biomechanics and modeling in mechanobiology.

[21]  Salvatore Pasta,et al.  Effect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta. , 2012, The Journal of thoracic and cardiovascular surgery.

[22]  Giampaolo Martufi,et al.  Review: the role of biomechanical modeling in the rupture risk assessment for abdominal aortic aneurysms. , 2013, Journal of biomechanical engineering.

[23]  G. Hutchins,et al.  Correlation between intimal thickness and fluid shear in human arteries. , 1981, Atherosclerosis.

[24]  S Glagov,et al.  Fluid wall shear stress measurements in a model of the human abdominal aorta: oscillatory behavior and relationship to atherosclerosis. , 1994, Atherosclerosis.

[25]  David M. Williams,et al.  A biologic basis for asymmetric growth in descending thoracic aortic aneurysms: a role for matrix metalloproteinase 9 and 2. , 2006, Journal of vascular surgery.

[26]  D. Ku,et al.  Pulsatile flow in the human left coronary artery bifurcation: average conditions. , 1996, Journal of biomechanical engineering.

[27]  K. Eagle,et al.  Aortic Diameter ≥5.5 cm Is Not a Good Predictor of Type A Aortic Dissection: Observations From the International Registry of Acute Aortic Dissection (IRAD) , 2007, Circulation.

[28]  O. Dapunt,et al.  The natural history of thoracic aortic aneurysms. , 1994, The Journal of thoracic and cardiovascular surgery.

[29]  John A Elefteriades,et al.  Hyperplastic Cellular Remodeling of the Media in Ascending Thoracic Aortic Aneurysms , 2005, Circulation.

[30]  Benjamin M. Jackson,et al.  Increased ascending aortic wall stress in patients with bicuspid aortic valves. , 2011, The Annals of thoracic surgery.

[31]  P. Eriksson,et al.  Biomechanical properties of the thoracic aneurysmal wall: differences between bicuspid aortic valve and tricuspid aortic valve patients. , 2014, The Annals of thoracic surgery.

[32]  D. Ku,et al.  Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. , 1988, Archives of pathology & laboratory medicine.

[33]  C. Zarins,et al.  Arterial enlargement in response to high flow requires early expression of matrix metalloproteinases to degrade extracellular matrix. , 2002, Experimental and molecular pathology.

[34]  Thoralf M. Sundt,et al.  Mechanical Properties of Dilated Human Ascending Aorta , 2002, Annals of Biomedical Engineering.

[35]  Elena S. Di Martino,et al.  Three-dimensional geometrical characterization of abdominal aortic aneurysms: image-based wall thickness distribution. , 2009, Journal of biomechanical engineering.

[36]  G. Chejfec,et al.  Correlation of inflammatory infiltrate with the enlargement of experimental aortic aneurysms. , 1992, Journal of vascular surgery.

[37]  F. Granath,et al.  Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. , 2007, Circulation.

[38]  J. Powell,et al.  Inflammation and matrix metalloproteinases in the enlarging abdominal aortic aneurysm. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[39]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[40]  B. Strauss,et al.  Vascular matrix remodeling in patients with bicuspid aortic valve malformations: implications for aortic dilatation. , 2003, The Journal of thoracic and cardiovascular surgery.

[41]  C Martin,et al.  Biomechanical characterization of ascending aortic aneurysm with concomitant bicuspid aortic valve and bovine aortic arch. , 2013, Acta biomaterialia.

[42]  M. Thubrikar,et al.  Wall stress as a possible mechanism for the development of transverse intimal tears in aortic dissections. , 1999, Journal of medical engineering & technology.

[43]  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.

[44]  Wei Sun,et al.  Predictive biomechanical analysis of ascending aortic aneurysm rupture potential. , 2013, Acta biomaterialia.

[45]  W H Baker,et al.  Elastolytic and collagenolytic studies of arteries. Implications for the mechanical properties of aneurysms. , 1984, Archives of surgery.

[46]  John A Elefteriades,et al.  Mechanical deterioration underlies malignant behavior of aneurysmal human ascending aorta. , 2005, The Journal of thoracic and cardiovascular surgery.

[47]  J. Bavaria,et al.  Peak wall stress predicts expansion rate in descending thoracic aortic aneurysms. , 2013, The Annals of thoracic surgery.

[48]  J. Bavaria,et al.  Impact of Wall Thickness and Saccular Geometry on the Computational Wall Stress of Descending Thoracic Aortic Aneurysms , 2013, Circulation.

[49]  S. Chien,et al.  Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. , 2011, Physiological reviews.

[50]  Jeffrey A. Jones,et al.  Regional heterogeneity within the aorta: relevance to aneurysm disease. , 2008, The Journal of thoracic and cardiovascular surgery.

[51]  J Alison Noble,et al.  Imaging techniques for cardiac strain and deformation: comparison of echocardiography, cardiac magnetic resonance and cardiac computed tomography , 2013, Expert review of cardiovascular therapy.

[52]  Leonie Rouleau,et al.  Local mechanical and structural properties of healthy and diseased human ascending aorta tissue. , 2009, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[53]  Carsten J. Beller,et al.  Role of Aortic Root Motion in the Pathogenesis of Aortic Dissection , 2004, Circulation.

[54]  E. M. Pedersen,et al.  Wall shear stress and early atherosclerotic lesions in the abdominal aorta in young adults. , 1997, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[55]  B. Desjardins,et al.  Increased wall stress of saccular versus fusiform aneurysms of the descending thoracic aorta. , 2011, Annals of vascular surgery.

[56]  J. Elefteriades,et al.  Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. , 2010, Journal of the American College of Cardiology.

[57]  T Christian Gasser,et al.  Analysis of aortic wall stress and rupture risk in patients with abdominal aortic aneurysm with a gender perspective. , 2011, Journal of vascular surgery.

[58]  Thoralf M Sundt,et al.  The influence of mechanical properties on wall stress and distensibility of the dilated ascending aorta. , 2003, The Journal of thoracic and cardiovascular surgery.

[59]  A. Della Corte,et al.  Different patterns of extracellular matrix protein expression in the convexity and the concavity of the dilated aorta with bicuspid aortic valve: preliminary results. , 2005, The Journal of thoracic and cardiovascular surgery.

[60]  Elena S. Di Martino,et al.  Local Quantification of Wall Thickness and Intraluminal Thrombus Offer Insight into the Mechanical Properties of the Aneurysmal Aorta , 2015, Annals of Biomedical Engineering.

[61]  Trevor Q. Robbie,et al.  Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance , 2010, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[62]  T Christian Gasser,et al.  A constitutive model for vascular tissue that integrates fibril, fiber and continuum levels with application to the isotropic and passive properties of the infrarenal aorta. , 2011, Journal of biomechanics.

[63]  Salvatore Pasta,et al.  Difference in hemodynamic and wall stress of ascending thoracic aortic aneurysms with bicuspid and tricuspid aortic valve. , 2013, Journal of biomechanics.

[64]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[65]  P. Harris,et al.  Heterogeneity of Tensile Strength and Matrix Metalloproteinase Activity in the Wall of Abdominal Aortic Aneurysms , 2004, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[66]  S. Alper,et al.  Hemodynamic shear stress and its role in atherosclerosis. , 1999, JAMA.