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. 2022 Jun 24:9:855118.
doi: 10.3389/fcvm.2022.855118. eCollection 2022.

Isolating the Effect of Arch Architecture on Aortic Hemodynamics Late After Coarctation Repair: A Computational Study

Vahid Goodarzi Ardakani  1 , Harshinee Goordoyal  1 , Maria Victoria Ordonez  2 , Froso Sophocleous  2   3 , Stephanie Curtis  2 , Radwa Bedair  2 , Massimo Caputo  2   3 , Alberto Gambaruto  1 , Giovanni Biglino  2   3   4
Affiliations

Isolating the Effect of Arch Architecture on Aortic Hemodynamics Late After Coarctation Repair: A Computational Study

Vahid Goodarzi Ardakani et al. Front Cardiovasc Med. .

Abstract

Objectives: Effective management of aortic coarctation (CoA) affects long-term cardiovascular outcomes. Full appreciation of CoA hemodynamics is important. This study aimed to analyze the relationship between aortic shape and hemodynamic parameters by means of computational simulations, purposely isolating the morphological variable.

Methods: Computational simulations were run in three aortic models. MRI-derived aortic geometries were generated using a statistical shape modeling methodology. Starting from n = 108 patients, the mean aortic configuration was derived in patients without CoA (n = 37, "no-CoA"), with surgically repaired CoA (n = 58, "r-CoA") and with unrepaired CoA (n = 13, "CoA"). As such, the aortic models represented average configurations for each scenario. Key hemodynamic parameters (i.e., pressure drop, aortic velocity, vorticity, wall shear stress WSS, and length and number of strong flow separations in the descending aorta) were measured in the three models at three time points (peak systole, end systole, end diastole).

Results: Comparing no-CoA and CoA revealed substantial differences in all hemodynamic parameters. However, simulations revealed significant increases in vorticity at the site of CoA repair, higher WSS in the descending aorta and a 12% increase in power loss, in r-CoA compared to no-CoA, despite no clinically significant narrowing (CoA index >0.8) in the r-CoA model.

Conclusions: Small alterations in aortic morphology impact on key hemodynamic indices. This may contribute to explaining phenomena such as persistent hypertension in the absence of any clinically significant narrowing. Whilst cardiovascular events in these patients may be related to hypertension, the role of arch geometry may be a contributory factor.

Keywords: aortic coarctation; aortic hemodynamics; computational fluid dynamics; computational modeling; power loss; wall shear stress.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Aortic geometries derived from statistical shape modeling.
Figure 2
Figure 2
Realistic pulsatile velocity profile for 10 heartbeats.
Figure 3
Figure 3
Location of the cross-sections and the centerline.
Figure 4
Figure 4
Contour of pressure (mmHg) on the ascending aorta at end systole.
Figure 5
Figure 5
Result of the simulations at end systole. First row: vortical structure by iso-surface of λ2 = −30, 000 in the descending aorta. Second row: contour of vorticity (/s) along with velocity streamlines. Third row: contour of pressure along with velocity streamlines. Fourth row: velocity cross-section (m/s). The cross-sections are identified in the first row.
Figure 6
Figure 6
Contour of wall shear stress (WSS) on the descending aorta at end systole.
Figure 7
Figure 7
Plot of power loss along the aorta. Order of plots from top to bottom: end systole, peak systole, and end diastole.
Figure 8
Figure 8
Contour of velocity and velocity streamlines along the aorta at peak systole, end systole, and end diastole. Top row: No-CoA aorta; Middle row: r-CoA; Bottom Row: CoA.
See this image and copyright information in PMC

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