Szopos Marcela, Poussineau Nicole, Maday Yvon, Canniffe Carla, Celermajer David S, Bonnet Damien, Ou Phalla
Université de Strasbourg, Institut de Recherche Mathématique Avancée, Unité Mixte De Recherche 7501, Strasbourg, France.
Université Pierre et Marie Curie-Paris 6, Faculté de Mathématiques, Unité Mixte De Recherche 7598, Laboratoire JL Lions, Paris, France.
J Thorac Cardiovasc Surg. 2014 Oct;148(4):1572-82. doi: 10.1016/j.jtcvs.2013.11.055. Epub 2013 Dec 31.
To assess whether combining a computational modeling technique with data from patient magnetic resonance imaging studies can detect different fluid dynamics and vascular biomechanical properties of the ascending and horizontal aorta in patients with angulated "gothic" arch geometry compared with those with normal "Romanesque" arch geometry after aortic coarctation repair.
Advanced computational fluid dynamics techniques (coupled Navier-Stokes and elastodynamics equations) were used to predict the fluid-wall interactions in large arteries. We modeled the fluid dynamics and shear stress in the ascending and horizontal aorta in cases of "gothic" arch and normal "Romanesque" aortic arch geometry. A total of 30 patients after aortic coarctation repair prospectively underwent 3-dimensional magnetic resonance imaging angiography of the thoracic aorta. Measurements of the ascending and horizontal aorta were assessed using multiplanar reformatting images.
Our computational model demonstrated that wall shear stress is greater in those with an angulated "gothic" aortic arch than in those with a "Romanesque" arch. In particular, wall shear stress affected the anterior and posterior segments of the ascending aorta and the inferior and superior segments of the horizontal aorta (vs the left and right segments). In vivo, a "gothic" arch was associated with dilatation of the ascending and horizontal aorta, which was eccentric rather than concentric (P<.05).
Our results have shown that wall shear stress is eccentric and significantly increased in the ascending and horizontal aorta in patients with a "gothic" aortic arch after repair of coarctation. This suggests that patients with an angulated "gothic" aortic arch might warrant increased surveillance for aortic complications.
评估将一种计算建模技术与患者磁共振成像研究数据相结合，能否检测出与正常“罗马式”主动脉弓几何形态的患者相比，在主动脉缩窄修复术后具有成角“哥特式”主动脉弓几何形态的患者升主动脉和水平主动脉不同的流体动力学和血管生物力学特性。
采用先进的计算流体动力学技术（耦合纳维 - 斯托克斯方程和弹性动力学方程）来预测大动脉中的流体 - 壁相互作用。我们对“哥特式”主动脉弓和正常“罗马式”主动脉弓几何形态情况下的升主动脉和水平主动脉的流体动力学和剪切应力进行了建模。总共30例主动脉缩窄修复术后的患者前瞻性地接受了胸主动脉的三维磁共振血管造影。使用多平面重组图像评估升主动脉和水平主动脉的测量值。
我们的计算模型表明，成角“哥特式”主动脉弓患者的壁面剪切应力大于“罗马式”主动脉弓患者。特别是，壁面剪切应力影响升主动脉的前后段以及水平主动脉的上下段（相对于左右段）。在体内，“哥特式”主动脉弓与升主动脉和水平主动脉的扩张相关，这种扩张是偏心的而非同心的（P<0.05）。
我们的结果表明，在主动脉缩窄修复术后，“哥特式”主动脉弓患者升主动脉和水平主动脉的壁面剪切应力是偏心的且显著增加。这表明具有成角“哥特式”主动脉弓的患者可能需要加强对主动脉并发症监测。
