Document Detail


Patient-specific multiscale modeling of blood flow for coronary artery bypass graft surgery.
MedLine Citation:
PMID:  22539149     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We present a computational framework for multiscale modeling and simulation of blood flow in coronary artery bypass graft (CABG) patients. Using this framework, only CT and non-invasive clinical measurements are required without the need to assume pressure and/or flow waveforms in the coronaries and we can capture global circulatory dynamics. We demonstrate this methodology in a case study of a patient with multiple CABGs. A patient-specific model of the blood vessels is constructed from CT image data to include the aorta, aortic branch vessels (brachiocephalic artery and carotids), the coronary arteries and multiple bypass grafts. The rest of the circulatory system is modeled using a lumped parameter network (LPN) 0 dimensional (0D) system comprised of resistances, capacitors (compliance), inductors (inertance), elastance and diodes (valves) that are tuned to match patient-specific clinical data. A finite element solver is used to compute blood flow and pressure in the 3D (3 dimensional) model, and this solver is implicitly coupled to the 0D LPN code at all inlets and outlets. By systematically parameterizing the graft geometry, we evaluate the influence of graft shape on the local hemodynamics, and global circulatory dynamics. Virtual manipulation of graft geometry is automated using Bezier splines and control points along the pathlines. Using this framework, we quantify wall shear stress, wall shear stress gradients and oscillatory shear index for different surgical geometries. We also compare pressures, flow rates and ventricular pressure-volume loops pre- and post-bypass graft surgery. We observe that PV loops do not change significantly after CABG but that both coronary perfusion and local hemodynamic parameters near the anastomosis region change substantially. Implications for future patient-specific optimization of CABG are discussed.
Authors:
Sethuraman Sankaran; Mahdi Esmaily Moghadam; Andrew M Kahn; Elaine E Tseng; Julius M Guccione; Alison L Marsden
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-04-27
Journal Detail:
Title:  Annals of biomedical engineering     Volume:  40     ISSN:  1573-9686     ISO Abbreviation:  Ann Biomed Eng     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-11     Completed Date:  2013-02-01     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  0361512     Medline TA:  Ann Biomed Eng     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2228-42     Citation Subset:  IM    
Affiliation:
Department of MAE, UCSD, La Jolla, CA 92093-0411, USA.
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MeSH Terms
Descriptor/Qualifier:
Aorta / pathology,  physiopathology
Blood Flow Velocity
Blood Pressure
Coronary Angiography
Coronary Artery Bypass*
Coronary Circulation*
Coronary Vessels / physiopathology*,  radiography,  surgery
Humans
Image Processing, Computer-Assisted*
Male
Middle Aged
Models, Cardiovascular*
Grant Support
ID/Acronym/Agency:
R01 HL077921/HL/NHLBI NIH HHS; R01 HL086400/HL/NHLBI NIH HHS; R01HL077921/HL/NHLBI NIH HHS; R01HL086400/HL/NHLBI NIH HHS; RHL102596A//PHS HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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