Application of computational fluid dynamics in the aortic root reconstruction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yi ¹ ,  TAO Liang ¹ , ZHOU Hong ¹ , LONG Yanli ¹ , CHENG Guan ²

1. School of Medicine, Wuhan University of Science and Technology, Wuhan, 430081, P.R.China;
2. Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, 430022, P.R.China;

Corresponding author：

TAO Liang, Email: 328933027@qq.com

Keywords：

Computational fluid dynamics; hemodynamics; aortic root surgery

DOI：

10.7507/1007-4848.202008040

Video：

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Objective To investigate the application of computational fluid dynamics (CFD) in hemodynamic evaluation of aortic root reconstruction.Methods The clinical data of 1 patient with severe aortic valve stenosis was analyzed. Enhanced CT images were used as the original data, and professional software was used to reconstruct the three-dimensional (3D) model and fluid mechanics simulation of the aorta (including preoperative, postoperative and ideal conditions).Results The 3D reconstruction model could directly present the distribution of valve calcification and the dilatation of the ascending aorta. The remodeled sinotubular junction and sinus structure were observed in the model under postoperative and ideal conditions. The improvement of ascending aorta dilatation was evaluated statistically by the diameter distribution before and after surgery. CFD simulation showed that the area of high flow velocity, pressure intensity and wall shear stress before surgery were consistent with the expansion area of the ascending aorta, and the restricted blood flow acceleration was observed at the angle between the arch and the descending aorta. In the ideal condition, the streamline of blood at the descending aorta was more stable and flat compared with preoperative or postoperative conditions, and there was no obvious abnormal high pressure and high wall shear stress area in the ascending aorta. The cardiopulmonary bypass time was 106 min, of which the aortic cross-clamp time was 60 min. The cardiac echocardiography indicated that the aortic valve worked well, and the peak systolic blood velocity was 1.7 m/s. The length of hospital stay after surgery was 12 d, including 2 d in ICU. The ventilator use time was 11.6 h. The patient did not have any remarkable discomfort during the 1-year follow-up.Conclusion CFD can be used to evaluate anatomic and hemodynamic abnormalities before aortic root reconstruction surgery. Postoperative reconstruction simulation can be performed again to evaluate the surgical effect, and meanwhile, virtual improvement can be tried for the unresolved problems to accumulate diagnosis and treatment experience, so as to provide patients with more accurate and personalized diagnosis and treatment procedure.

Citation： LI Yi, TAO Liang, ZHOU Hong, LONG Yanli, CHENG Guan. Application of computational fluid dynamics in the aortic root reconstruction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1482-1487. doi: 10.7507/1007-4848.202008040 Copy

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7.	Rahman O, Scott M, Bollache E, et al. Interval changes in aortic peak velocity and wall shear stress in patients with bicuspid aortic valve disease. Int J Cardiovasc Imaging, 2019, 35(10): 1925-1934.
8.	Chi Q, He Y, Luan Y, et al. Numerical analysis of wall shear stress in ascending aorta before tearing in type A aortic dissection. Comput Biol Med, 2017, 89: 236-247.
9.	Pasta S, Gentile G, Raffa GM, et al. In silico shear and intramural stresses are linked to aortic valve morphology in dilated ascending aorta. Eur J Vasc Endovasc Surg, 2017, 54(2): 254-263.
10.	Calò K, De Nisco G, Gallo D, et al. Exploring wall shear stress spatiotemporal heterogeneity in coronary arteries combining correlation-based analysis and complex networks with computational hemodynamics. Proc Inst Mech Eng H, 2020, 234(11): 1209-1222.
11.	徐芸, 尹立雪, 王胰, 等. 血流向量成像技术评价高血压患者左心室收缩期能量损耗. 中华超声影像学杂志, 2018, 27(1): 1-5.

1. De Paulis R, Salica A. Surgical anatomy of the aortic valve and root-implications for valve repair. Ann Cardiothorac Surg, 2019, 8(3): 313-321.
2. 李伟浩, 沈晨阳, 张小明, 等. 计算流体力学技术在胸主动脉疾病中的应用. 中华外科杂志, 2015, 53(8): 637-640.
3. Zhu YL, Chen R, Juan YH, et al. Clinical validation and assessment of aortic hemodynamics using computational fluid dynamics simulations from computed tomography angiography. Biomed Eng Online, 2018, 17(1): 53.
4. Berdajs D, Mosbahi S, Forro Z, et al. Aortic root haemodynamics following David procedure: Numerical analysis of 3-dimensional haemodynamics. Eur J Cardiothorac Surg, 2016, 49(6): 1588-1598.
5. Nyrnes SA, Fadnes S, Wigen MS, et al. Blood speckle-tracking based on high-frame rate ultrasound imaging in pediatric cardiology. J Am Soc Echocardiogr, 2020, 33(4): 493-503.
6. 蔡宇燕, 魏薪, 唐红, 等. 应用VFM技术探讨正常成人不同年龄阶段主动脉弓流场特点及规律. 西部医学, 2017, 29(4): 499-502.
7. Rahman O, Scott M, Bollache E, et al. Interval changes in aortic peak velocity and wall shear stress in patients with bicuspid aortic valve disease. Int J Cardiovasc Imaging, 2019, 35(10): 1925-1934.
8. Chi Q, He Y, Luan Y, et al. Numerical analysis of wall shear stress in ascending aorta before tearing in type A aortic dissection. Comput Biol Med, 2017, 89: 236-247.
9. Pasta S, Gentile G, Raffa GM, et al. In silico shear and intramural stresses are linked to aortic valve morphology in dilated ascending aorta. Eur J Vasc Endovasc Surg, 2017, 54(2): 254-263.
10. Calò K, De Nisco G, Gallo D, et al. Exploring wall shear stress spatiotemporal heterogeneity in coronary arteries combining correlation-based analysis and complex networks with computational hemodynamics. Proc Inst Mech Eng H, 2020, 234(11): 1209-1222.
11. 徐芸, 尹立雪, 王胰, 等. 血流向量成像技术评价高血压患者左心室收缩期能量损耗. 中华超声影像学杂志, 2018, 27(1): 1-5.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of computational fluid dynamics in the aortic root reconstruction

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