Document Detail

Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis.
MedLine Citation:
PMID:  21801315     Owner:  NLM     Status:  MEDLINE    
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.
John F LaDisa; Ronak J Dholakia; C Alberto Figueroa; Irene E Vignon-Clementel; Frandics P Chan; Margaret M Samyn; Joseph R Cava; Charles A Taylor; Jeffrey A Feinstein
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-07-31
Journal Detail:
Title:  Congenital heart disease     Volume:  6     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2011 Sep-Oct
Date Detail:
Created Date:  2011-09-14     Completed Date:  2012-01-13     Revised Date:  2014-09-21    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  432-43     Citation Subset:  IM    
Copyright Information:
© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.
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MeSH Terms
Anastomosis, Surgical
Aorta, Thoracic / physiopathology,  surgery*
Aortic Coarctation / diagnosis,  physiopathology,  surgery*
Atherosclerosis / etiology,  physiopathology
Blood Flow Velocity
Blood Pressure
Case-Control Studies
Child, Preschool
Computer Simulation*
Magnetic Resonance Angiography
Models, Cardiovascular*
Regional Blood Flow
Stress, Mechanical
Treatment Outcome
Vascular Resistance
Vascular Surgical Procedures* / adverse effects
Young Adult
Grant Support
R15 HL096096/HL/NHLBI NIH HHS; R15 HL096096-01/HL/NHLBI NIH HHS; R15HL096096-01/HL/NHLBI NIH HHS

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