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Lee S, Son M, Lee J, Byun I, Kim JW, Kim J, Seonwoo H. Computational Fluid Dynamics Analysis and Empirical Evaluation of Carboxymethylcellulose/Alginate 3D Bioprinting Inks for Screw-Based Microextrusion. Polymers (Basel) 2024; 16:1137. [PMID: 38675055 DOI: 10.3390/polym16081137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Three-dimensional microextrusion bioprinting technology uses pneumatics, pistons, or screws to transfer and extrude bioinks containing biomaterials and cells to print biological tissues and organs. Computational fluid dynamics (CFD) analysis can simulate the flow characteristics of bioinks in a control volume, and the effect on cell viability can be predicted by calculating the physical quantities. In this study, we developed an analysis system to predict the effect of a screw-based dispenser system (SDS) on cell viability in bioinks through rheological and CFD analyses. Furthermore, carboxymethylcellulose/alginate-based bioinks were used for the empirical evaluation of high-viscous bioinks. The viscosity of bioinks was determined by rheological measurement, and the viscosity coefficient for the CFD analysis was derived from a correlation equation by non-linear regression analysis. The mass flow rate derived from the analysis was successfully validated by comparison with that from the empirical evaluation. Finally, the cell viability was confirmed after bioprinting with bioinks containing C2C12 cells, suggesting that the developed SDS may be suitable for application in the field of bioengineering. Consequently, the developed bioink analysis system is applicable to a wide range of systems and materials, contributing to time and cost savings in the bioengineering industry.
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Affiliation(s)
- Sungmin Lee
- Department of Human Harmonized Robotics, College of Engineering, Sunchon National University, Suncheon 57922, Republic of Korea
- Interdisciplinary Program in IT-Bio Convergence System, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Minjae Son
- Department of Aerospace Engineering, Graduate School, College of Engineering, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Juo Lee
- Interdisciplinary Program in IT-Bio Convergence System, Sunchon National University, Suncheon 57922, Republic of Korea
- Department of Animal Science & Technology, College of Life Sciences and Natural Resources, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Iksong Byun
- Interdisciplinary Program in IT-Bio Convergence System, Sunchon National University, Suncheon 57922, Republic of Korea
- Department of Agricultural Machinery Engineering, College of Life Sciences and Natural Resources, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Jin-Woo Kim
- Department of Biological & Agricultural Engineering, University of Arkansas, Fayetteville, AR 72701, USA
- Materials Science & Engineering Program, University of Arkansas, Fayetteville, AR 72701, USA
| | - Jungsil Kim
- Department of Smart Bio-Industrial Mechanical Engineering, College of Agriculture and Life Sciences, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Hoon Seonwoo
- Interdisciplinary Program in IT-Bio Convergence System, Sunchon National University, Suncheon 57922, Republic of Korea
- Department of Convergent Biosystems Engineering, College of Life Science and Natural Resources, Sunchon National University, Suncheon 57922, Republic of Korea
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Satoh T, Sugiu K, Hiramatsu M, Haruma J, Date I. Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE24141. [PMID: 38621304 PMCID: PMC11023012 DOI: 10.3171/case24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. OBSERVATIONS The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. LESSONS Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.
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Affiliation(s)
- Toru Satoh
- Departments of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
| | - Kenji Sugiu
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Masafumi Hiramatsu
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Jun Haruma
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Isao Date
- Okayama Rosai Hospital, Okayama, Japan
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Zhao N, Zhang T, Zhang T, Wang B, Mu W, Wang F. Effect of blood viscosity on the hemodynamics of arteriovenous fistulae based on numerical investigation. Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38563312 DOI: 10.1080/10255842.2024.2333926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Arteriovenous fistula (AVF) is the most commonly used vascular access for hemodialysis in patients with end-stage renal disease. Vascular diseases such as atherosclerosis and thrombosis, triggered by altered hemodynamic conditions, are the main causes of access failure. Changes in blood viscosity accelerate access dysfunction by affecting local velocities and wall shear stress (WSS) distribution in the circulation. Numerical simulation was employed to analyze and compare the hemodynamic behavior of AVF under different blood viscosities (0.001-0.012 Pa∙s). An idealized three-dimensional model with end-to-side anastomosis was established. Transient simulations were conducted using pulsatile inlet velocity and outflow as boundary conditions. The simulation results reveal the blood flow state of AVF under different viscosity physiological conditions and derive the rule of change. When blood viscosity increases, the local velocity in the disturbed region slows down and the stagnation time becomes longer, resulting in increased deposition of substances. As blood viscosity increases, the level of shear stress on the entire wall of the fistula increases accordingly. WSS values at high viscosities above 0.007 Pa∙s showed significantly larger low-shear regions near the anastomosis and increased chances of inducing atheromatous plaques. This research has revealed the correlation between blood dynamic viscosity and the hemodynamic behavior of AVF. Elevated whole blood viscosity increases the incidence of access obstruction and vascular disease leading to fistula failure. The study provides a basis for optimizing the distribution of hemodynamic parameters in the fistula for hemodialysis patients.
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Affiliation(s)
- Ning Zhao
- School of Quality and Technical Supervision, Hebei University, Baoding, China
| | - Tian Zhang
- School of Quality and Technical Supervision, Hebei University, Baoding, China
| | - Tianyu Zhang
- School of Quality and Technical Supervision, Hebei University, Baoding, China
| | - Baohui Wang
- School of Quality and Technical Supervision, Hebei University, Baoding, China
| | - Weina Mu
- School of Quality and Technical Supervision, Hebei University, Baoding, China
- Baoding No.1 Central Hospital, Baoding, China
| | - Fan Wang
- School of Quality and Technical Supervision, Hebei University, Baoding, China
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S SN, Bhattacharjee A, Saha S. CFD analysis of the hyper-viscous effects on blood flow across abdominal aortic aneurysm in COVID patients: multiphysics approach. Comput Methods Biomech Biomed Engin 2024; 27:570-586. [PMID: 37021363 DOI: 10.1080/10255842.2023.2194474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/19/2023] [Indexed: 04/07/2023]
Abstract
Recent research has shown that individuals suffering from COVID-19 are accommodating an elevated level of blood viscosity due to the morphological changes in blood cells. As viscosity is a major flow parameter influencing the flow across a stenosis or an aneurysm, the examination of the significance of hyperviscosity in COVID patients is imperative in arterial pathologies. In this research, we have considered a patient-specific case in which the aneurysm is located along the abdominal aortal walls. Recent research on the side effects of COVID-19 voiced out the various effects on the circulatory system of humans. Also, as abdominal aneurysms exist very often among individuals, causing the death of 150-200 million every year, the hyper-viscous effects of blood on the flow across the diseased aorta are explored by considering the elevated viscosity levels. In vitro explorations contribute considerably to the clinical methods and treatments to be regarded. The objective of the present inquest is to research the flow field in aneurysmatic-COVID-affected patients considering the elastic nature of vessel walls, using the arbitrary Lagrangian-Eulerian approach. The study supports the various clinical findings that voiced the detrimental effects associated with blood hyperviscosity. The simulation results obtained, by solving the fluid mechanics' equations coupled with the solid mechanics' equations, employing a FEM solver suggest that the elevated stress imparted by the hyper-viscous flows on the walls of the aneurysmal aorta can trigger the fastening of the aneurysmal sac enlargement or rupture.
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Affiliation(s)
- Shankar Narayan S
- Department of Mathematics and Statistics, Ramaiah University of Applied Sciences, Bengaluru, India
- Department of Mathematics, Dayananda Sagar University, Bengaluru, India
| | | | - Sunanda Saha
- Department of Mathematics, Vellore Institute of Technology, Vellore, India
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Lo SCY, McCullough JWS, Xue X, Coveney PV. Uncertainty quantification of the impact of peripheral arterial disease on abdominal aortic aneurysms in blood flow simulations. J R Soc Interface 2024; 21:20230656. [PMID: 38593843 PMCID: PMC11003782 DOI: 10.1098/rsif.2023.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Peripheral arterial disease (PAD) and abdominal aortic aneurysms (AAAs) often coexist and pose significant risks of mortality, yet their mutual interactions remain largely unexplored. Here, we introduce a fluid mechanics model designed to simulate the haemodynamic impact of PAD on AAA-associated risk factors. Our focus lies on quantifying the uncertainty inherent in controlling the flow rates within PAD-affected vessels and predicting AAA risk factors derived from wall shear stress. We perform a sensitivity analysis on nine critical model parameters through simulations of three-dimensional blood flow within a comprehensive arterial geometry. Our results show effective control of the flow rates using two-element Windkessel models, although specific outlets need attention. Quantities of interest like endothelial cell activation potential (ECAP) and relative residence time are instructive for identifying high-risk regions, with ECAP showing greater reliability and adaptability. Our analysis reveals that the uncertainty in the quantities of interest is 187% of that of the input parameters. Notably, parameters governing the amplitude and frequency of the inlet velocity exert the strongest influence on the risk factors' variability and warrant precise determination. This study forms the foundation for patient-specific simulations involving PAD and AAAs which should ultimately improve patient outcomes and reduce associated mortality rates.
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Affiliation(s)
- Sharp C. Y. Lo
- Centre for Computational Science, University College London, London, UK
| | | | - Xiao Xue
- Centre for Computational Science, University College London, London, UK
| | - Peter V. Coveney
- Centre for Computational Science, University College London, London, UK
- Advanced Research Computing Centre, University College London, London, UK
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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Li B, Liu Y, Li G, Zhang Z, Feng Y, Mao B. A real-time patient-specific treatment strategy for enhanced external counterpulsation. Int J Numer Method Biomed Eng 2024; 40:e3808. [PMID: 38409940 DOI: 10.1002/cnm.3808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/23/2024] [Accepted: 02/11/2024] [Indexed: 02/28/2024]
Abstract
Diastolic/systolic blood pressure ratio (D/S) ≥ 1.2 is the gold standard of enhanced external counterpulsation (EECP) treatment, but it does not show a clear clinical correspondence with the configuration of the EECP mode. As such, a single target results in different treatment effects in different individuals. The local haemodynamic effect (wall shear stress, WSS) of EECP on vascular endothelial cells is conducive to promote the growth of collateral circulation vessels and restore the blood supply distal to the stenosis lesion. Considering the haemodynamic effects of WSS on human arteries, this study developed a real-time patient-specific treatment strategy of EECP for patients with cardio-cerebrovascular diseases. Based on patient-specific haemodynamic data from 113 individuals, an optimization algorithm was developed to achieve the individualization of a 0D lumped-parameter model of the human circulatory system, thereby simulating the patient-specific global haemodynamic effects. 0D/3D coupled cardio-cerebrovascular models of two subjects were established to simulate the local WSS. We then established statistical models to evaluate clinically unmeasurable WSS based on measurable global haemodynamic indicators. With the aim of attaining appropriate area- and time-averaged WSS (ATAWSS, 4-7 Pa), as evaluated by global haemodynamic indicators, a closed-loop feedback tuning method was developed to provide patient-specific EECP treatment strategies. Results showed that for clinical data collected from 113 individuals, the individualized 0D model can accurately simulate patient-specific global haemodynamic effects (average error <5%). Based on two subjects, the statistical models can be used to evaluate local ATAWSS (error <6%) for coronary arteries and for cerebral arteries. An EECP mode planned by the patient-specific treatment strategy can promote an appropriate ATAWSS within a 16 s calculation time. The real-time patient-specific treatment strategy of EECP is expected to improve the long-term outcome for each patient and have potential clinical significance.
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Affiliation(s)
- Bao Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Guangfei Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Zhe Zhang
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Yue Feng
- Medical Equipment Department, Peking University First Hospital, Beijing, China
| | - Boyan Mao
- Department of Biological Engineering, School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
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Ashrafee A, Yashfe SMS, Khan NS, Islam MT, Azam MG, Arafat MT. Design of experiment approach to identify the dominant geometrical feature of left coronary artery influencing atherosclerosis. Biomed Phys Eng Express 2024; 10:035008. [PMID: 38430572 DOI: 10.1088/2057-1976/ad2f59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/01/2024] [Indexed: 03/04/2024]
Abstract
Background and Objective. Coronary artery geometry heavily influences local hemodynamics, potentially leading to atherosclerosis. Consequently, the unique geometrical configuration of an individual by birth can be associated with future risk of atherosclerosis. Although current researches focus on exploring the relationship between local hemodynamics and coronary artery geometry, this study aims to identify the order of influence of the geometrical features through systematic experiments, which can reveal the dominant geometrical feature for future risk assessment.Methods. According to Taguchi's method of design of experiment (DoE), the left main stem (LMS) length (lLMS), curvature (kLMS), diameter (dLMS) and the bifurcation angle between left anterior descending (LAD) and left circumflex (LCx) artery (αLAD-LCx) of two reconstructed patient-specific left coronary arteries (LCA) were varied in three levels to create L9 orthogonal array. Computational fluid dynamic (CFD) simulations with physiological boundary conditions were performed on the resulting eighteen LCA models. Average helicity intensity (h2) and relative atheroprone area (RAA) of near-wall hemodynamic descriptors were analyzed.Results. The proximal LAD (LADproximal) was identified to be the most atheroprone region of the left coronary artery due to higherh2,large RAA of time averaged wall shear stress (TAWSS < 0.4 Pa), oscillatory shear index (OSI ∼ 0.5) and relative residence time (RRT > 4.17 Pa-1). In both patient-specific cases, based onh2and TAWSS,dlmsis the dominant geometric parameter while based on OSI and RRT,αLAD-LCxis the dominant one influencing hemodynamic condition in proximal LAD (p< 0.05). Based on RRT, the rank of the geometrical factors is:αLAD-LCx>dLMS>lLMS>kLMS, indicating thatαLAD-LCxis the most dominant geometrical factor affecting hemodynamics at proximal LAD which may influence atherosclerosis.Conclusion. The proposed identification of the rank of geometrical features of LCA and the dominant feature may assist clinicians in predicting the possibility of atherosclerosis, of an individual, long before it will occur. This study can further be translated to be used to rank the influence of several arterial geometrical features at different arterial locations to explore detailed relationships between the arterial geometrical features and local hemodynamics.
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Affiliation(s)
- Adiba Ashrafee
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Syed Muiz Sadat Yashfe
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Nusrat S Khan
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
| | - Md Tariqul Islam
- Department of Radiology and Imaging, Sheikh Hasina National Institute of Burn & Plastic Surgery, Dhaka - 1205, Bangladesh
| | - M G Azam
- Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka - 1207, Bangladesh
| | - M Tarik Arafat
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
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Mori T, Kimura H, Fujita A, Hayashi K, Hori T, Sugihara M, Ikeuchi Y, Kohta M, Tomiyama A, Sasayama T. A vertebrobasilar junction aneurysm successfully treated with a combination of surgical clipping and flow diverter placement based on the results of computational fluid dynamics analysis: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23736. [PMID: 38437674 PMCID: PMC10916842 DOI: 10.3171/case23736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The treatment of vertebrobasilar junction (VBJ) aneurysms is challenging. Although flow diverters (FDs) are a possible treatment option, geometrical conditions hinder intervention. VBJ aneurysms possess dual inflow vessels from the bilateral vertebral arteries (VAs), one of which is ideally occluded prior to FD treatment. However, it remains unclear which VA should be occluded. OBSERVATIONS A 75-year-old male with a growing VBJ complex aneurysm exhibiting invagination toward the brainstem and causing perifocal edema required intervention. Preoperative computational fluid dynamics (CFD) analysis demonstrated that left VA occlusion would result in more stagnant flow and less impingement of flow than right VA occlusion. According to the simulated strategy, surgical clipping of the left VA just proximal to the aneurysm was performed, followed by FD placement from the basilar artery trunk to the right VA. The patient demonstrated tolerance of the VA occlusion, and follow-up computed tomography angiography at 18 months after FD treatment confirmed the disappearance of the aneurysm. LESSONS Preoperative flow dynamics simulations using CFD analysis can reveal an optimal treatment strategy involving a hybrid surgery that combines FD placement and direct surgical occlusion for a VBJ complex aneurysm.
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Affiliation(s)
- Tatsuya Mori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Hidehito Kimura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Kosuke Hayashi
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Tatsuo Hori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Masahiro Sugihara
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Yusuke Ikeuchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Masaaki Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Akio Tomiyama
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
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Maroun A, Scott MB, Catania R, Berhane H, Jarvis K, Allen BD, Barker AJ, Markl M. Multiyear Interval Changes in Aortic Wall Shear Stress in Patients with Bicuspid Aortic Valve Assessed by 4D Flow MRI. J Magn Reson Imaging 2024. [PMID: 38426608 DOI: 10.1002/jmri.29305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In patients with bicuspid aortic valve (BAV), 4D flow MRI can quantify regions exposed to abnormal aortic hemodynamics, including high wall shear stress (WSS), a known stimulus for arterial wall dysfunction. However, the long-term multiscan reproducibility of 4D flow MRI-derived hemodynamic parameters is unknown. PURPOSE To investigate the long-term stability of 4D flow MRI-derived peak velocity, WSS, and WSS-derived heatmaps in patients with BAV undergoing multiyear surveillance imaging. STUDY TYPE Retrospective. POPULATION 20 BAV patients (mean age 48.4 ± 13.9 years; 14 males) with five 4D flow MRI scans, with intervals of at least 6 months between scans, and 125 controls (mean age: 50.7 ± 15.8 years; 67 males). FIELD STRENGTH/SEQUENCE 1.5 and 3.0T, prospectively ECG and respiratory navigator-gated aortic 4D flow MRI. ASSESSMENT Automated AI-based 4D flow analysis pipelines were used for data preprocessing, aorta 3D segmentation, and quantification of ascending aorta (AAo) peak velocity, peak systolic WSS, and heatmap-derived relative area of elevated WSS compared to WSS ranges in age and sex-matched normative control populations. Growth rate was derived from the maximum AAo diameters measured on the first and fifth MRI scans. STATISTICAL TESTS One-way repeated measures analysis of variance. P < 0.05 indicated significance. RESULTS One hundred 4D flow MRI exams (five per patient) were analyzed. The mean total follow-up duration was 5.5 ± 1.1 years, and the average growth rate was 0.3 ± 0.2 mm/year. Peak velocity, peak systolic WSS, and relative area of elevated WSS did not change significantly over the follow-up period (P = 0.64, P = 0.69, and P = 0.35, respectively). The patterns and areas of elevated WSS demonstrated good reproducibility on semiquantitative assessment. CONCLUSION 4D flow MRI-derived peak velocity, WSS, and WSS-derived heatmaps showed good multiyear and multiscan stability in BAV patients with low aortic growth rates. These findings underscore the reliability of these metrics in monitoring BAV patients for potential risk of dilation. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael B Scott
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roberta Catania
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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de Azevedo FS, Almeida GDC, Alvares de Azevedo B, Ibanez Aguilar IF, Azevedo BN, Teixeira PS, Camargo GC, Correia MG, Nieckele AO, Oliveira GMM. Stress Load and Ascending Aortic Aneurysms: An Observational, Longitudinal, Single-Center Study Using Computational Fluid Dynamics. Bioengineering (Basel) 2024; 11:204. [PMID: 38534478 DOI: 10.3390/bioengineering11030204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Ascending aortic aneurysm (AAoA) is a silent disease with high mortality; however, the factors associated with a worse prognosis are not completely understood. The objective of this observational, longitudinal, single-center study was to identify the hemodynamic patterns and their influence on AAoA growth using computational fluid dynamics (CFD), focusing on the effects of geometrical variations on aortic hemodynamics. Personalized anatomic models were obtained from angiotomography scans of 30 patients in two different years (with intervals of one to three years between them), of which 16 (53%) showed aneurysm growth (defined as an increase in the ascending aorta volume by 5% or more). Numerically determined velocity and pressure fields were compared with the outcome of aneurysm growth. Through a statistical analysis, hemodynamic characteristics were found to be associated with aneurysm growth: average and maximum high pressure (superior to 100 Pa); average and maximum high wall shear stress (superior to 7 Pa) combined with high pressure (>100 Pa); and stress load over time (maximum pressure multiplied by the time interval between the exams). This study provides insights into a worse prognosis of this serious disease and may collaborate for the expansion of knowledge about mechanobiology in the progression of AAoA.
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Affiliation(s)
- Fabiula Schwartz de Azevedo
- Department of Cardiology, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Gabriela de Castro Almeida
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Bruno Alvares de Azevedo
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Ivan Fernney Ibanez Aguilar
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Bruno Nieckele Azevedo
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | | | - Gabriel Cordeiro Camargo
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Marcelo Goulart Correia
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Angela Ourivio Nieckele
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
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Trenti C, Fedak PWM, White JA, Garcia J, Dyverfeldt P. Oscillatory shear stress is elevated in patients with bicuspid aortic valve and aortic regurgitation: a 4D flow cardiovascular magnetic resonance cross-sectional study. Eur Heart J Cardiovasc Imaging 2024; 25:404-412. [PMID: 37878753 PMCID: PMC10883729 DOI: 10.1093/ehjci/jead283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Patients with bicuspid aortic valve (BAV) and aortic regurgitation have higher rate of aortic complications compared with patients with BAV and stenosis, as well as BAV without valvular disease. Aortic regurgitation alters blood haemodynamics not only in systole but also during diastole. We therefore sought to investigate wall shear stress (WSS) during the whole cardiac cycle in BAV with aortic regurgitation. METHODS AND RESULTS Fifty-seven subjects that underwent 4D flow cardiovascular magnetic resonance imaging were included: 13 patients with BAVs without valve disease, 14 BAVs with aortic regurgitation, 15 BAVs with aortic stenosis, and 22 normal controls with tricuspid aortic valve. Peak and time averaged WSS in systole and diastole and the oscillatory shear index (OSI) in the ascending aorta were computed. Student's t-tests were used to compare values between the four groups where the data were normally distributed, and the non-parametric Wilcoxon rank sum tests were used otherwise. BAVs with regurgitation had similar peak and time averaged WSS compared with the patients with BAV without valve disease and with stenosis, and no regions of elevated WSS were found. BAV with aortic regurgitation had twice as high OSI as the other groups (P ≤ 0.001), and mainly in the outer mid-to-distal ascending aorta. CONCLUSION OSI uniquely characterizes altered WSS patterns in BAVs with aortic regurgitation, and thus could be a haemodynamic marker specific for this specific group that is at higher risk of aortic complications. Future longitudinal studies are needed to verify this hypothesis.
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Affiliation(s)
- Chiara Trenti
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
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12
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Peng T, Zhong Y, Lin X, Jiang B, Wang P, Jia Y. Analysis and numerical investigation of bile flow dynamics within the strictured biliary duct. Int J Numer Method Biomed Eng 2024; 40:e3790. [PMID: 37997039 DOI: 10.1002/cnm.3790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
The mechanics of bile flow in the biliary system plays an important role in studying bile stasis and gallstone formation. Bile duct stricture is an abnormal phenomenon that refers to the bile duct getting smaller or narrower. The main objective of this study is to study the influence of stricture on bile flow dynamics using numerical methods. We employed a numerical Computational Fluid Dynamics model of the bile flow within a strictured hepatic duct. We studied and compared the influence of stricture severity, stricture length, eccentricity, and bile flow property on the bile flow dynamics. The bile flow velocity, pressure distribution, pressure drop, and wall shear stress are provided in detail. The stricture alters the normal bile flow pattern and increases flow resistance. At the location upstream and downstream of the stricture, bile flow slows down. In the area of the stricture throat, bile flow is accelerated, and recirculation forms behind the stricture. The maximum pressure drop of the biliary system increases with the stricture length. The eccentricity makes the flow deflect away from the duct's centerline. The behavior of the deflected flow is significantly altered downstream of the stricture. Such bile flow behavior as deceleration and recirculation may lead to cholestasis. Stricture alters bile flow in the biliary tract, causing changes in biliary hydrodynamic indexes, which could potentially serve as an omen for gallstone formation and other related diseases. The consideration of the bile duct stricture could lead to better patient stratification.
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Affiliation(s)
- Tao Peng
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Yunlong Zhong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaodong Lin
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Bingyan Jiang
- State Key Laboratory of High Performance Complex Manufacturing, College of Mechanical and Electrical Engineering, Central South University, Hunan, China
| | - Ping Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanwei Jia
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
- State Key Laboratory of Analog and Mixed-Signal VLSI, Institute of Microelectronics, University of Macau, Macao, China
- Faculty of Science and Technology - Electrical and Computer Engineering, University of Macau, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Macau, China
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13
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Karuppuchamy V, Heldman DR. Evaluation of air impingement for dry-cleaning nonfat dry milk residues on a stainless-steel surface. J Food Sci 2024; 89:1143-1153. [PMID: 38193188 DOI: 10.1111/1750-3841.16912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/26/2023] [Accepted: 12/16/2023] [Indexed: 01/10/2024]
Abstract
The use of air jet impingement to remove residues from surfaces in food manufacturing operations offers an alternative to the use of water and liquid cleaning agents. During this investigation, air impingement was used to remove nonfat dry milk (NFDM) residues from a stainless-steel surface. The influence of the water activity (aw ) of the residue, the time after the residue reached an equilibrium water activity, and the thickness of residue at the time of removal from the surface have been investigated. All three factors had a significant effect on the time for removal. An increase in the water activity, the time at equilibrium, the sample thickness, or a combination of all three resulted in an increase in the time required to remove the deposits. Visible changes in the structure of deposits were observed as NFDM samples equilibrated to water activities above 0.43. NFDM residues with water activities less than 0.33 were removed within 1 s of using air impingement regardless of wall shear stress. When the water activities were greater than 0.50, the thickness of deposit was greater than 1 mm, and the time after reaching an equilibrium water activity was over 7 days, more than 5 min of air impingement with wall shear stress over 9.48 Pa was required to remove the residue. The results from these experiments indicated that air impingement has the potential to provide effective cleaning in manufacturing facilities for low-moisture foods. PRACTICAL APPLICATION: The introduction of water in low-moisture food environments is often undesirable due to the possibility of pathogenic microorganism growth. The normal cleaning operations in the food industry use water as a cleaning agent. This study evaluates the application of air impingement technology as a dry-cleaning method.
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Affiliation(s)
- Veeramani Karuppuchamy
- Department of Food Science and Technology, The Ohio State University, Columbus, Ohio, USA
| | - Dennis R Heldman
- Department of Food Science and Technology, The Ohio State University, Columbus, Ohio, USA
- Department of Food, Agricultural, and Biological Engineering, The Ohio State University, Columbus, Ohio, USA
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14
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Behir B, Benslimane A, Mehdaoui H, Mehdi B. Impact of hematocrit on pulsatile blood flow in stenosed arteries: a computational study in healthy, diabetic, and anemic models. Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38297822 DOI: 10.1080/10255842.2024.2310720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
In this study, researchers aim to enhance the realism of circulatory system simulations, focusing on factors affecting flow variations, particularly in stenotic arteries of individuals with altered hematocrit levels. Through extensive data collection and varied conditions, the goal is to attain more precise and valid results. The study conducts approximate simulations to comprehensively describe the dynamic motion of pulsatile flow. Different values of inlet velocity (UDF) are introduced, considering potential arterial distortion or occlusion due to plaque deposition, along with variations in hematocrit (Hct) levels commonly observed in patients. Three distinct types of pulsatile blood flow, corresponding to diabetes (Hct 65%), healthy (Hct 45%), and anemia (Hct 25%), are studied and compared. The research illuminates that stenosis in arteries with varying hematocrit levels significantly impacts hydrodynamic features, potentially predisposing individuals to cardiovascular diseases. Through meticulous analysis, several conclusions about hemodynamic characteristics are drawn. It is observed that both velocity and wall shear stress exhibit variation along the affected artery, influenced by stenosis and changes in hematocrit levels. Notably, the highest influence on velocity and wall shear stress is observed with Hct 65%, compared to Hct 45% and Hct 25% at the moment of stenosis. These findings hold substantial practical implications for the field of cardiovascular health, providing valuable insights into blood flow behavior in stenotic arteries with diverse hematocrit levels. Ultimately, this research contributes to more effective clinical interventions.
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Affiliation(s)
- Badreddine Behir
- Laboratory of Mechanics, Materials and Energetics (L2ME), Faculty of Technology, University of Bejaia, Bejaia, Algeria
| | - Abdelhakim Benslimane
- Laboratory of Mechanics, Materials and Energetics (L2ME), Faculty of Technology, University of Bejaia, Bejaia, Algeria
| | - Hamza Mehdaoui
- Laboratory of Mechanics, Materials and Energetics (L2ME), Faculty of Technology, University of Bejaia, Bejaia, Algeria
| | - Boukhari Mehdi
- Laboratory of Materials Technology and Process Engineering (LTMGP), Faculty of Technology, University of Bejaia, Bejaia, Algeria
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15
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Wang T, Yong Y, Ge X, Wang J. A computational model-based study on the feasibility of predicting post-splenectomy thrombosis using hemodynamic metrics. Front Bioeng Biotechnol 2024; 11:1276999. [PMID: 38274008 PMCID: PMC10808826 DOI: 10.3389/fbioe.2023.1276999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/30/2023] [Indexed: 01/27/2024] Open
Abstract
For portal hypertensive patients with splenomegaly and hypersplenism, splenectomy is an effective surgery to relieve the complications. However, patients who have undergone splenectomy often suffer from portal venous system thrombosis, a sequela that requires prophylaxis and timely treatment to avoid deterioration and death. The aim of this study is to investigate the feasibility of predicting post-splenectomy thrombosis using hemodynamic metrics based on computational models. First, 15 portal hypertensive patients who had undergone splenectomy were enrolled, and their preoperative clinical data and postoperative follow-up results were collected. Next, computational models of the portal venous system were constructed based on the preoperative computed tomography angiography images and ultrasound-measured flow velocities. On this basis, splenectomy was mimicked and the postoperative area of low wall shear stress (ALWSS) was simulated for each patient-specific model. Finally, model-simulated ALWSS was statistically compared with the patient follow-up results to investigate the feasibility of predicting post-splenectomy thrombosis using hemodynamic metrics. Results showed that ALWSS could predict the occurrence of post-splenectomy thrombosis with the area under the receiver operating characteristic curve (AUC) equal to 0.75. Moreover, statistical analysis implied that the diameter of the splenic vein is positively correlated with ALWSS (r = 0.883, p < 0.0001), and the anatomical structures of the portal venous system also influence the ALWSS. These findings demonstrated that the computational model-based hemodynamic metric ALWSS, which is associated with the anatomorphological features of the portal venous system, is capable of predicting the occurrence of post-splenectomy thrombosis, promoting better prophylaxis and postoperative management for portal hypertensive patients receiving splenectomy.
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Affiliation(s)
- Tianqi Wang
- School of Gongli Hospital Medical Technology, University of Shanghai for Science and Technology, Shanghai, China
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yan Yong
- College of Science, University of Shanghai for Science and Technology, Shanghai, China
| | - Xinyang Ge
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua, China
| | - Jitao Wang
- Department of Hepatobiliary Surgery, Xingtai Institute of Cancer Control, Xingtai, China
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16
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van Tuijl RJ, Timmins KM, Velthuis BK, van Ooij P, Zwanenburg JJM, Ruigrok YM, van der Schaaf IC. Hemodynamic Parameters in the Parent Arteries of Unruptured Intracranial Aneurysms Depend on Aneurysm Size and Are Different Compared to Contralateral Arteries: A 7 Tesla 4D Flow MRI Study. J Magn Reson Imaging 2024; 59:223-230. [PMID: 37144669 DOI: 10.1002/jmri.28756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Different Circle of Willis (CoW) variants have variable prevalences of aneurysm development, but the hemodynamic variation along the CoW and its relation to presence and size of unruptured intracranial aneurysms (UIAs) are not well known. PURPOSE Gain insight into hemodynamic imaging markers of the CoW for UIA development by comparing these outcomes to the corresponding contralateral artery without an UIA using 4D flow magnetic resonance imaging (MRI). STUDY TYPE Retrospective, cross-sectional study. SUBJECTS Thirty-eight patients with an UIA, whereby 27 were women and a mean age of 62 years old. FIELD STRENGTH/SEQUENCE Four-dimensional phase-contrast (PC) MRI with a 3D time-resolved velocity encoded gradient echo sequence at 7 T. ASSESSMENT Hemodynamic parameters (blood flow, velocity pulsatility index [vPI], mean velocity, distensibility, and wall shear stress [peak systolic (WSSMAX ), and time-averaged (WSSMEAN )]) in the parent artery of the UIA were compared to the corresponding contralateral artery without an UIA and were related to UIA size. STATISTICAL TESTS Paired t-tests and Pearson Correlation tests. The threshold for statistical significance was P < 0.05 (two-tailed). RESULTS Blood flow, mean velocity, WSSMAX , and WSSMEAN were significantly higher, while vPI was lower, in the parent artery relative to contralateral artery. The WSSMAX of the parent artery significantly increased linearly while the WSSMEAN decreased linearly with increasing UIA size. CONCLUSIONS Hemodynamic parameters and WSS differ between parent vessels of UIAs and corresponding contralateral vessels. WSS correlates with UIA size, supporting a potential hemodynamic role in aneurysm pathology. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Rick J van Tuijl
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kimberley M Timmins
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim van Ooij
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Li D, Jiang Y, Zhuge C, Wu A. Treatment of aneurysmal artery with PED: A case report. Medicine (Baltimore) 2023; 102:e36377. [PMID: 38050221 PMCID: PMC10695510 DOI: 10.1097/md.0000000000036377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Pipeline embolization devices are a new treatment for intracranial aneurysms, especially irregular, giant aneurysms. PATIENT CONCERNS A 48-year-old female patient presented with a headache in the frontal part for 3 weeks. DIAGNOSES Cerebral computed tomographic angiography and magnetic resonance angiography showed a saccular aneurysm in the right internal carotid artery that wrapped the parent artery. Digital subtraction angiography provided images with 1 large saccular internal carotid aneurysm. INTERVENTIONS The patient was treated by flow diverter stent and coil embolization and dual antiplatelet therapy with aspirin and ticagrelor in the ICU and was discharged after 10 days without complications. OUTCOMES One year after interventional therapy, repeated digital subtraction angiography showed no recurrence of aneurysm and embolization well, and the patient reported improvement in neurological symptoms. LESSONS Aneurysmal parent artery is a rare phenomenon. The combination of flow diverter stents and coil embolization to treat cases with large saccular aneurysms has important clinical significance and this may provide a reference for clinical treatment of aneurysmal parent artery.
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Affiliation(s)
- Da Li
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Yunxia Jiang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Chengjun Zhuge
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - An Wu
- Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, People’s Republic of China
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Aalbregt E, Indrakusuma R, Jalalzadeh H, Planken RN, van Schuppen J, Meijboom L, Balm R, Nederveen AJ, Yeung KK, van Ooij P. Four-Dimensional Flow MRI-Derived Hemodynamics in Abdominal Aortic Aneurysms: Reproducibility and Associations With Diameter, Intraluminal Thrombus Volume, and Vorticity. J Magn Reson Imaging 2023. [PMID: 38006298 DOI: 10.1002/jmri.29138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Maximum diameter measurements are used to assess the rupture risk of abdominal aortic aneurysms (AAAs); however, these are not precise enough to predict all ruptures. Four-dimensional (4D) flow MRI-derived parameters provide additional information by visualizing hemodynamics in AAAs but merit further investigation before they are clinically applicable. PURPOSE To assess the reproducibility of 4D flow MRI-derived hemodynamics, to investigate possible correlations with lumen and maximum diameter, and to explore potential relationships with vorticity and aneurysm growth. STUDY TYPE Prospective single-arm study. POPULATION A total of 22 (71.5 ± 6.1 years, 20 male) asymptomatic AAA patients with a maximum diameter of at least 30 mm. FIELD STRENGTH/SEQUENCE A 3.0 T/Free-breathing 4D flow MRI phase-contrast acquisition with retrospective ECG-gating. ASSESSMENT Patients underwent two consecutive 4D flow MRI scans 1-week apart. Aortic volumes were segmented from time-averaged phase contrast magnetic resonance angiographies. Reproducibility was assessed by voxelwise analysis after registration. Mean flow velocity, mean wall shear stress (WSS), mean lumen diameter, and qualitative vorticity scores were assessed. In addition, Dixon MRI and retrospective surveillance data were used to study maximum diameter (including thrombus), intraluminal thrombus volume (ILT), and growth rate. STATISTICAL TESTS For reproducibility assessment, Bland-Altman analyses, Pearson correlation, Spearman's correlation, and orthogonal regression were conducted. Potential correlations between hemodynamics and vorticity scores were assessed using linear regression. P < 0.05 was considered statistically significant. RESULTS Test-retest median Pearson correlation coefficients for flow velocity and WSS were 0.85 (IQR = 0.08) m/sec and 0.82 (IQR = 0.10) Pa, respectively. Mean WSS significantly correlated with mean flow velocity (R = 0.75) and inversely correlated with mean lumen diameter (R = -0.73). No significant associations were found between 4D flow MRI-derived hemodynamic parameters and maximum diameter (flow velocity: P = 0.98, WSS: P = 0.22). DATA CONCLUSION A 4D flow MRI is robust for assessing the hemodynamics within AAAs. No correlations were found between hemodynamic parameters and maximum diameter, ILT volume and growth rate. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Eva Aalbregt
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Reza Indrakusuma
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hamid Jalalzadeh
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R Nils Planken
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lilian Meijboom
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Ron Balm
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pim van Ooij
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Valeti C, Gurusamy S, Krishnakumar K, Easwer HV, Kannath SK, Sudhir BJ, Patnaik BSV. Numerical investigation of unruptured middle cerebral artery bifurcation aneurysms: influence of aspect ratio. Comput Methods Biomech Biomed Engin 2023:1-16. [PMID: 37968912 DOI: 10.1080/10255842.2023.2279508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
An aneurysm is a disease condition, which is due to the pathological weakening of an arterial wall. These aneurysms are often found in various branch points and bifurcations of an artery in the cerebral circulation. Most aneurysms come to medical attention, either due to brain hemorrhages caused by rupture or found unruptured. To consider surgically invasive treatment modalities, clinicians need scientific methods such as, hemodynamic analysis to assess rupture risk. The arterial wall loses its structural integrity when wall shear stress (WSS) and other hemodynamic parameters exceed a certain threshold. In the present study, numerical simulations are carried out for unruptured middle cerebral artery (MCA) aneurysms. Three distinct representative sizes are chosen from a larger patient pool of 26 MCA aneurysms. Logically, these aneurysms represent three growth stages of any patient with similar anatomical structure. Simulations are performed to compare the three growth phases (with different aspect ratios) of an aneurysm and correlate their hemodynamic parameters. Simulations with patient specific boundary conditions reveal that, aneurysms with a higher aspect ratio (AR) correspond to an attendant decrease in both time-averaged wall shear stress (TAWSS) and spatial wall shear stress gradients (WSSG). Smaller MCAs were observed to have higher positive wall shear stress divergence (WSSD), exemplifying the tensile nature of arterial wall stretching. Present study identifies positive wall shear stress divergence (PWSSD) to be a potential biomarker for evaluating the growth of an aneurysm.
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Affiliation(s)
- Chanikya Valeti
- Department of Applied Mechanics and Biomedical Engineering, IIT Madras, Chennai, India
| | - Saravanan Gurusamy
- Department of Civil, Structural and Environmental Engineering, Trinity College, Dublin, Ireland
| | - K Krishnakumar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Hariharan Venkat Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Santhosh K Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - B J Sudhir
- Department of Applied Mechanics and Biomedical Engineering, IIT Madras, Chennai, India
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - B S V Patnaik
- Department of Applied Mechanics and Biomedical Engineering, IIT Madras, Chennai, India
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20
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Shchetynska-Marinova T, Gerdes L, Hohneck AL, Winter L, Amendt K, Schwenke K, Gerken ALH, Du Y, Dürschmied D, Sigl M. First experiences of ultrasound vector flow imaging at the femoropopliteal artery in peripheral arterial disease. VASA 2023; 52:394-401. [PMID: 37847231 DOI: 10.1024/0301-1526/a001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Background: The femoropopliteal artery (FPA) plays a central role in diagnosing and treating peripheral arterial disease (PAD). FPA lesions are the most frequent cause of intermittent claudication, and no other artery of the lower extremities is recanalised more frequently. Generally, ultrasound is the primary imaging tool in PAD, particularly FPA. With the development of high-frame-rate ultrasound technology in addition to traditional ultrasound modes, vector flow imaging (VFI) has provided deeper haemodynamic insights when used in the carotid artery. Here, we report the use of VFI at the FPA level in routine PAD examinations. Patients and methods: In this single-centre prospective study, we evaluated consecutive patients with PAD using B-mode imaging, colour Doppler, pulsed wave Doppler (PW) and vector flow. Hemodynamic parameters at predefined locations at the carotid artery and FPA were compared. Results: Qualitatively adequate VFI at all sites was possible in 76% of the patients with PAD. With decreasing volume flow from the common carotid artery to the internal carotid artery and from the common femoral artery via the superficial femoral artery to the popliteal artery, the correlation between VFI- and PW-derived-volume flow was high at every site. Based on different techniques, the VFI-derived values were significantly lower than the PW-derived values. The mean wall shear stress was significantly lower at all femoropopliteal sites than at the carotid sites, whereas the oscillatory shear index at the femoral site was higher than that at the carotid sites rather than at the popliteal location. Conclusions: Our findings suggest that vector flow data acquisition in the FPA is feasible in most patients with PAD. Therefore, with knowledge of the method and its limitations, VFI provides haemodynamic information beyond traditional ultrasound techniques and is a promising new tool for flow analysis in PAD.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Laurin Gerdes
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Anna-Lena Hohneck
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Laura Winter
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Klaus Amendt
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Kay Schwenke
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Andreas L H Gerken
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Daniel Dürschmied
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Germany
| | - Martin Sigl
- Division of Angiology, First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Germany
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Singh S, Yadav SK, Meena VK, Vashisth P, Kalyanasundaram D. Orthopedic Scaffolds: Evaluation of Structural Strength and Permeability of Fluid Flow via an Open Cell Neovius Structure for Bone Tissue Engineering. ACS Biomater Sci Eng 2023; 9:5900-5911. [PMID: 37702616 DOI: 10.1021/acsbiomaterials.3c00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The ability of bone to regenerate itself through mechanobiological responses is its dynamic property. Mechanical cues from a neighboring environment produce the structural strain to promote blood flow and bone marrow mobility that in turn aids the bone regeneration process. Occurrences of these phenomena are crucial for the success of metallic scaffolds implanted in the host bone tissue. Thus, permeability and fluid flow-induced wall shear stress (WSS) are two parameters that directly influence cell bioactivities inside a scaffold and are crucial for effective bone tissue regeneration. Given that the scaffolds shall be implanted in the body, permeability assessment was carried out using non-Newtonian fluid. In this work, the triply periodic minimal surface scaffolds with Neovius architectures were fabricated by using selective laser melting technology. The estimation of fluid flow was carried out using computational fluid dynamics (CFD) analysis with a non-Newtonian blood fluid model. Further, the structural strength of various open cell Neovius lattices was evaluated using a static compression test, and in vitro cell culture using Alamar blue assay was evaluated. Results revealed that the values of intrinsic blood flow permeability of the three-dimensional (3D)-printed open cell porous scaffold with Neovius architecture were of the same order of magnitude as those of human bone, ranging from 0.0025 × 10-9 to 0.0152 × 10-9 m2. The structural elastic modulus and compressive strength of NOCL40, NOCL50, and NOCL60 lattices range from 3.27 to 3.71 GPa and 194 to 205 MPa, respectively. All of the values are comparable to the human bone, thus making these lattices a suitable alternative for orthopedic applications.
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Affiliation(s)
- Sonu Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Sunil Kumar Yadav
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Vijay Kumar Meena
- Central Scientific Instruments Organization, Council of Scientific & Industrial Research, Chandigarh 160030, India
| | - Priya Vashisth
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Dinesh Kalyanasundaram
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi 110029, India
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Bańka P, Wybraniec M, Bochenek T, Gruchlik B, Burchacka A, Swinarew A, Mizia-Stec K. Influence of Aortic Valve Stenosis and Wall Shear Stress on Platelets Function. J Clin Med 2023; 12:6301. [PMID: 37834945 PMCID: PMC10573628 DOI: 10.3390/jcm12196301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Aortic valve stenosis (AS) is a common heart valve disease in the elderly population, and its pathogenesis remains an interesting area of research. The degeneration of the aortic valve leaflets gradually progresses to valve sclerosis. The advanced phase is marked by the presence of extracellular fibrosis and calcification. Turbulent, accelerated blood flow generated by the stenotic valve causes excessive damage to the aortic wall. Elevated shear stress due to AS leads to the degradation of high-molecular weight multimers of von Willebrand factor, which may involve bleeding in the mucosal tissues. Conversely, elevated shear stress has been associated with the release of thrombin and the activation of platelets, even in individuals with acquired von Willebrand syndrome. Moreover, turbulent blood flow in the aorta may activate the endothelium and promote platelet adhesion and activation on the aortic valve surface. Platelets release a wide range of mediators, including lysophosphatidic acid, which have pro-osteogenic effects in AS. All of these interactions result in blood coagulation, fibrinolysis, and the hemostatic process. This review summarizes the current knowledge on high shear stress-induced hemostatic disorders, the influence of AS on platelets and antiplatelet therapy.
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Affiliation(s)
- Paweł Bańka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Tomasz Bochenek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Bartosz Gruchlik
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Aleksandra Burchacka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Andrzej Swinarew
- Faculty of Science and Technology, University of Silesia in Katowice, 40-007 Katowice, Poland
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
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Lee CH, Chung JW, Guk HS, Hong JM, Rosenson RS, Jeong SK. Cerebral artery signal intensity gradient from Time-of-Flight Magnetic Resonance Angiography and clinical outcome in lenticulostriate infarction: a retrospective cohort study. Front Neurol 2023; 14:1220840. [PMID: 37799283 PMCID: PMC10547899 DOI: 10.3389/fneur.2023.1220840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Lenticulostriate infarction requires further research of arterial hemodynamic factors, as the disease is diagnosed in the absence of major arterial stenosis or cardioembolism. Methods In this multicenter retrospective cohort study, we included patients who were hospitalized for lenticulostriate infarction from January 2015 to March 2021 at three stroke centers in South Korea. We obtained hemodynamic information on cerebral arteries using signal intensity gradient (SIG), an in-vivo approximated wall shear stress (WSS) derived from Time-of-Flight Magnetic Resonance Angiography (TOF-MRA). A favorable outcome was defined as a modified Rankin Scale of 0 to 2 at hospital discharge. Results A total of 294 patients were included, of whom 146 (49.7%) had an unfavorable outcome. The unfavorable outcome group showed significantly lower SIG in both middle cerebral arteries (MCAs) than the favorable group (5.2 ± 1.2 SI/mm vs. 5.9 ± 1.2, p < 0.001), and similar findings were observed in other cerebral arteries. The SIGs in both MCAs were independently associated with favorable outcome, with an odds ratio of 1.42 (95% confidence interval, 1.11-1.80; p = 0.005) for the right MCA and 1.49 (95% CI, 1.15-1.93; p = 0.003) for the left MCA, after adjusting for potential confounders. Similar findings were observed in other cerebral artery SIGs. Conclusion Cerebral artery SIG from TOF-MRA was significantly associated with short-term functional outcomes in patients with lenticulostriate infarction. Further studies are needed to investigate the temporal relationships of SIG in patients with cerebral infarction.
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Affiliation(s)
- Chan-Hyuk Lee
- Department of Neurology, Asan Medical Center, Seoul, Republic of Korea
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyung Seok Guk
- Department of Neurology, Gunsan Medical Center, Gunsan, Republic of Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Robert S. Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Seul-Ki Jeong
- Seul-Ki Jeong Neurology Clinic, Seoul, Republic of Korea
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Brüning J, Yevtushenko P, Schlief A, Jochum T, van Gijzen L, Meine S, Romberg J, Kuehne T, Arndt A, Goubergrits L. In-silico enhanced animal study of pulmonary artery pressure sensors: assessing hemodynamics using computational fluid dynamics. Front Cardiovasc Med 2023; 10:1193209. [PMID: 37745132 PMCID: PMC10517052 DOI: 10.3389/fcvm.2023.1193209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
To assess whether in-silico models can be used to predict the risk of thrombus formation in pulmonary artery pressure sensors (PAPS), a chronic animal study using pigs was conducted. Computed tomography (CT) data was acquired before and immediately after implantation, as well as one and three months after the implantation. Devices were implanted into 10 pigs, each one in the left and right pulmonary artery (PA), to reduce the required number of animal experiments. The implantation procedure aimed at facilitating optimal and non-optimal positioning of the devices to increase chances of thrombus formation. Eight devices were positioned non-optimally. Three devices were positioned in the main PA instead of the left and right PA. Pre-interventional PA geometries were reconstructed from the respective CT images, and the devices were virtually implanted at the exact sites and orientations indicated by the follow-up CT after one month. Transient intra-arterial hemodynamics were calculated using computational fluid dynamics. Volume flow rates were modelled specifically matching the animals body weights. Wall shear stresses (WSS) and oscillatory shear indices (OSI) before and after device implantation were compared. Simulations revealed no relevant changes in any investigated hemodynamic parameters due to device implantation. Even in cases, where devices were implanted in a non-optimal manner, no marked differences in hemodynamic parameters compared to devices implanted in an optimal position were found. Before implantation time and surface-averaged WSS was 2.35 ± 0.47 Pa, whereas OSI was 0.08 ± 0.17 , respectively. Areas affected by low WSS magnitudes were 2.5 ± 2.7 cm2 , whereas the areas affected by high OSI were 18.1 ± 6.3 cm2 . After device implantation, WSS and OSI were 2.45 ± 0.49 Pa and 0.08 ± 0.16 , respectively. Surface areas affected by low WSS and high OSI were 2.9 ± 2.7 cm2 , and 18.4 ± 6.1 cm2 , respectively. This in-silico study indicates that no clinically relevant differences in intra-arterial hemodynamics are occurring after device implantation, even at non-optimal positioning of the sensor. Simultaneously, no embolic events were observed, suggesting that the risk for thrombus formation after device implantation is low and independent of the sensor position.
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Affiliation(s)
- Jan Brüning
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pavlo Yevtushenko
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adriano Schlief
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Titus Kuehne
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Leonid Goubergrits
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
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25
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Zhao Y, Zhu Z, Jiang H, Yu Y, Liu J, Luan J, Wang Y, Ma Z. The Stress Phase Angle Measurement Using Spectral Domain Optical Coherence Tomography. Sensors (Basel) 2023; 23:7597. [PMID: 37688052 PMCID: PMC10490597 DOI: 10.3390/s23177597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
The stress phase angle (SPA), defined as the temporal phase angle between circumferential stress (CS) in the arterial wall and wall shear stress (WSS), is utilized to investigate the interactions between CS and WSS. SPA serves as an important parameter for the early diagnosis of cardiovascular disease. In this study, we proposed a novel method for measuring SPA using spectral domain optical coherence tomography (SD-OCT). The multi-M-mode scan strategy is adopted for interference spectrum acquisition. The phases of CS and WSS are extracted from the corresponding structural and flow velocity images of SD-OCT. The method is validated by measuring SPA in the outflow tract (OFT) of chick embryonic hearts and the common carotid artery of mice. To the best of our knowledge, this is the first time that OCT has been used for SPA measurement.
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Affiliation(s)
- Yuqian Zhao
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China; (Y.Z.); (Z.Z.); (Y.Y.); (J.L.); (Y.W.)
| | - Zhibo Zhu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China; (Y.Z.); (Z.Z.); (Y.Y.); (J.L.); (Y.W.)
| | - Huiwen Jiang
- College of Information Science and Engineering, Northeastern University, Shenyang 110819, China;
| | - Yao Yu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China; (Y.Z.); (Z.Z.); (Y.Y.); (J.L.); (Y.W.)
| | - Jian Liu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China; (Y.Z.); (Z.Z.); (Y.Y.); (J.L.); (Y.W.)
| | - Jingmin Luan
- School of Computer and Communication Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China;
| | - Yi Wang
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China; (Y.Z.); (Z.Z.); (Y.Y.); (J.L.); (Y.W.)
| | - Zhenhe Ma
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China; (Y.Z.); (Z.Z.); (Y.Y.); (J.L.); (Y.W.)
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Wasilewski J, Czaja-Ziółkowska MZ, Gąsior M. The site-specific distribution of atheromatous plaques in the coronary arteries. Postepy Kardiol Interwencyjnej 2023; 19:195-201. [PMID: 37854963 PMCID: PMC10580840 DOI: 10.5114/aic.2023.131471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/19/2023] [Indexed: 10/20/2023] Open
Abstract
The etiology of atherosclerosis is still unknown, but there are several hypotheses trying to explain this complex disease. Most consider atherosclerosis as a cholesterol storage disease. However, hypercholesterolemia is not a cause but a risk factor. Besides, like other well-known systemic risk factors, it does not explain the uneven distribution of atheromatous plaques in the vasculature. Atherosclerotic lesions develop mainly at vulnerable "risk points" of the arterial wall such as curvatures and near side branches, and predominantly in the left anterior descending (LAD), while the left circumflex (LCx) artery is relatively spared. Furthermore, atheromatous plaques are present mainly in the proximal segments in the LAD and LCx, in contrast to the right coronary artery (RCA), where plaques are more evenly distributed. The hemodynamic theory explains to some extent the distribution of atherosclerotic lesions and considers atherosclerosis as a reactive biological response of endothelial cells to wall shear stress. In this review, we discuss the interplay of concentration of low-density lipoproteins at the luminal surface and local hemodynamic forces (disturbed flow) that reduce wall shear stress in the process of plaque formation. Moreover, we present the distribution of atheromatous plaques in the coronary arteries in autopsy studies and imaging methods such as cardiac computed tomography angiography and invasive coronary angiography.
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Affiliation(s)
- Jarosław Wasilewski
- 3 Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Mariusz Gąsior
- 3 Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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27
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Li C, Feng H, Wang X, Wang Y. The influencing mechanism of iliac vein stent implantation for hemodynamics at the bifurcation. Comput Methods Biomech Biomed Engin 2023; 26:1452-1461. [PMID: 36082958 DOI: 10.1080/10255842.2022.2120352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
In the intervention with stent implantation for iliac vein compression syndrome (IVCS), it remains unclear about the influencing mechanism of the structure and implantation position of the stent for the hemodynamics of the affected site. In this paper, an iliac vein model was established. Besides, the computational fluid dynamics (CFD) was utilized to analyze the time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) in a sine period after stent implantation based on the three different implantation positions of two iliac vein stents (the left branch outlet, contralateral disturbed flow and main iliac vein). The influence of the structure and implantation position of the stent on blood flow was revealed. These findings were verified by the particle image velocimetry (PIV) experiment. The results indicated that the maximum blood flow velocity of the iliac vein decreased after the stent implantation. Among the three positions, the influence of stent implantation on the iliac vein blood flow was the least when the stent implantation was performed at the left branch outlet; the influence of stent implantation on the iliac vein blood flow was the greatest when the stent implantation was performed at the contralateral disturbed flow. Moreover, there was little influence of Venastent implantation on the blood flow. These results could provide a scientific foundation for implantation treatment and stent design related to IVCS.
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Affiliation(s)
- Changsheng Li
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Xiaotian Wang
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, P.R. China
| | - Yonggang Wang
- Suzhou Venmed Technology Co., Ltd, Suzhou, P.R. China
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Chiastra C, Zuin M, Rigatelli G, D’Ascenzo F, De Ferrari GM, Collet C, Chatzizisis YS, Gallo D, Morbiducci U. Computational fluid dynamics as supporting technology for coronary artery disease diagnosis and treatment: an international survey. Front Cardiovasc Med 2023; 10:1216796. [PMID: 37719972 PMCID: PMC10501454 DOI: 10.3389/fcvm.2023.1216796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Computational fluid dynamics (CFD) is emerging as an effective technology able to improve procedural outcomes and enhance clinical decision-making in patients with coronary artery disease (CAD). The present study aims to assess the state of knowledge, use and clinical acceptability of CFD in the diagnosis and treatment of CAD. Methods We realized a 20-questions international, anonymous, cross-sectional survey to cardiologists to test their knowledge and confidence on CFD as a technology applied to patients suffering from CAD. Responses were recorded between May 18, 2022, and June 12, 2022. Results A total of 466 interventional cardiologists (mean age 48.4 ± 8.3 years, males 362), from 42 different countries completed the survey, for a response rate of 45.9%. Of these, 66.6% declared to be familiar with the term CFD, especially for optimization of existing interventional techniques (16.1%) and assessment of hemodynamic quantities related with CAD (13.7%). About 30% of respondents correctly answered to the questions exploring their knowledge on the pathophysiological role of some CFD-derived quantities such as wall shear stress and helical flow in coronary arteries. Among respondents, 85.9% would consider patient-specific CFD-based analysis in daily interventional practice while 94.2% declared to be interested in receiving a brief foundation course on the basic CFD principles. Finally, 87.7% of respondents declared to be interested in a cath-lab software able to conduct affordable CFD-based analyses at the point-of-care. Conclusions Interventional cardiologists reported to be profoundly interested in adopting CFD simulations as a technology supporting decision making in the treatment of CAD in daily practice.
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Affiliation(s)
- Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, Madre Teresa Hospital, Padova, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | | | - Yiannis S. Chatzizisis
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diego Gallo
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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29
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Lee SB, Kim KW, Park SH, Baba Y, Lee C, Choi YH, Kim HH. Effects of size and shape of the side holes of a double J stent on the ureter fluid flow after stenosis. Comput Methods Biomech Biomed Engin 2023:1-14. [PMID: 37647248 DOI: 10.1080/10255842.2023.2252550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/19/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
The effect of side holes morphology changes in double J stent (DJS) on encrustation was analyzed using computational fluid dynamics (CFD). We analyzed DJS side holes with inner diameter of 1 mm and outer diameters of 1 (type A), 1.2 (type B) and 1.4 (type C) mm, respectively. Concentric stenosis with three intraureteral degree (0%, 12%, and 88%) was analyzed. The flow rate, shear stress and wall shear stress (WSS) distribution were investigated. Urine flow through SH1 before the ureteropelvic junction (UPJ) differed based on the ureteral stenosis degree. The sum of flow rates through the SHs increased with diameter. In the stented ureter with 12% stenosis, the flow rate through SH1 approximately doubled than that without ureteral stenosis, and the flow rate through SH1 was maximal for the type 'C' stent in both 12% and 88% ureteral stenosis. The mean shear stress in the SHs increased with the degree of stenosis. The WSS around the SHs was higher for type 'C' than types A and B. From the flow rates and shear stresses in and around the SHs, the larger SH diameter of the DJS from the UPJ to mid-ureter is expected to induce encrustation reduction, especially in patients with urinary lithiasis.
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Affiliation(s)
- Seung Bae Lee
- Department of Urology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Kyung-Wuk Kim
- Department of Mechanical Engineering, Soongsil University, Seoul, Korea
| | - Se-Hyun Park
- Department of Mechanical Engineering, Graduate School of Engineering College of Convergence Technology, Gyeongsang National University, Jinju, Korea
| | - Yasutaka Baba
- Department of Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Changje Lee
- Research Institute of Maritime Industry, Korea Maritime and Ocean University, Busan, Korea
| | - Young Ho Choi
- Department of Radiology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hyoung-Ho Kim
- School of Mechanical Material Convergence Engineering, Gyeongsang National University, Jinju, Korea
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30
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Hossain MMN, Hu NW, Abdelhamid M, Singh S, Murfee WL, Balogh P. Angiogenic Microvascular Wall Shear Stress Patterns Revealed Through Three-dimensional Red Blood Cell Resolved Modeling. Function (Oxf) 2023; 4:zqad046. [PMID: 37753184 PMCID: PMC10519277 DOI: 10.1093/function/zqad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
The wall shear stress (WSS) exerted by blood flowing through microvascular capillaries is an established driver of new blood vessel growth, or angiogenesis. Such adaptations are central to many physiological processes in both health and disease, yet three-dimensional (3D) WSS characteristics in real angiogenic microvascular networks are largely unknown. This marks a major knowledge gap because angiogenesis, naturally, is a 3D process. To advance current understanding, we model 3D red blood cells (RBCs) flowing through rat angiogenic microvascular networks using state-of-the-art simulation. The high-resolution fluid dynamics reveal 3D WSS patterns occurring at sub-endothelial cell (EC) scales that derive from distinct angiogenic morphologies, including microvascular loops and vessel tortuosity. We identify the existence of WSS hot and cold spots caused by angiogenic surface shapes and RBCs, and notably enhancement of low WSS regions by RBCs. Spatiotemporal characteristics further reveal how fluctuations follow timescales of RBC "footprints." Altogether, this work provides a new conceptual framework for understanding how shear stress might regulate EC dynamics in vivo.
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Affiliation(s)
- Mir Md Nasim Hossain
- Mechanical and Industrial Engineering, New Jersey Institute of Technology, Newark, NJ 07114, USA
| | - Nien-Wen Hu
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Maram Abdelhamid
- Mechanical and Industrial Engineering, New Jersey Institute of Technology, Newark, NJ 07114, USA
| | - Simerpreet Singh
- Mechanical and Industrial Engineering, New Jersey Institute of Technology, Newark, NJ 07114, USA
| | - Walter L Murfee
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Peter Balogh
- Mechanical and Industrial Engineering, New Jersey Institute of Technology, Newark, NJ 07114, USA
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Gray SG, Weinberg PD. Biomechanical determinants of endothelial permeability assessed in standard and modified hollow-fibre bioreactors. J R Soc Interface 2023; 20:20230222. [PMID: 37608710 PMCID: PMC10445023 DOI: 10.1098/rsif.2023.0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
Effects of mechanical stress on the permeability of vascular endothelium are important to normal physiology and in the development of atherosclerosis. Here we elucidate novel effects using commercially available and modified hollow-fibre bioreactors, in which endothelial cells form confluent monolayers lining plastic capillaries with porous walls, contained in a cartridge. The capillaries were perfused with a near-aortic waveform, and permeability was assessed by the movement of rhodamine-labelled albumin from the intracapillary to the extracapillary space. Permeability was increased by acute application of shear stress and decreased by chronic shear stress compared with a static control: this has previously been shown only for multidirectional flows. Increasing viscosity reduced permeability under both acute and chronic shear; since shear rate remained unchanged, these effects resulted from altered shear stress. Reducing pulsatility increased permeability, contrary to the widely held assumption that flow which is highly oscillatory causes endothelial dysfunction. Chronic convection across the monolayer increased effective permeability more than could be explained by the addition of advective transport, contrary to results from previous acute experiments. The off-the-shelf and modified bioreactors provide an excellent tool for investigating the biomechanics of endothelial permeability and have revealed novel effects of flow duration, viscosity, pulsatility and transmural flow.
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Affiliation(s)
- Stephen G. Gray
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Peter D. Weinberg
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
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Knüppel F, Sun A, Wurm FH, Hussong J, Torner B. Effect of Particle Migration on the Stress Field in Microfluidic Flows of Blood Analog Fluids at High Reynolds Numbers. Micromachines (Basel) 2023; 14:1494. [PMID: 37630030 PMCID: PMC10456677 DOI: 10.3390/mi14081494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
In the present paper, we investigate how the reductions in shear stresses and pressure losses in microfluidic gaps are directly linked to the local characteristics of cell-free layers (CFLs) at channel Reynolds numbers relevant to ventricular assist device (VAD) applications. For this, detailed studies of local particle distributions of a particulate blood analog fluid are combined with wall shear stress and pressure loss measurements in two complementary set-ups with identical flow geometry, bulk Reynolds numbers and particle Reynolds numbers. For all investigated particle volume fractions of up to 5%, reductions in the stress and pressure loss were measured in comparison to a flow of an equivalent homogeneous fluid (without particles). We could explain this due to the formation of a CFL ranging from 10 to 20 μm. Variations in the channel Reynolds number between Re = 50 and 150 did not lead to measurable changes in CFL heights or stress reductions for all investigated particle volume fractions. These measurements were used to describe the complete chain of how CFL formation leads to a stress reduction, which reduces the apparent viscosity of the suspension and results in the Fåhræus-Lindqvist effect. This chain of causes was investigated for the first time for flows with high Reynolds numbers (Re∼100), representing a flow regime which can be found in the narrow gaps of a VAD.
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Affiliation(s)
- Finn Knüppel
- Institute of Turbomachinery, Faculty for Mechanical Engineering and Ship Design, University of Rostock, 18055 Rostock, Germany; (F.K.); (F.-H.W.)
| | - Ang Sun
- Institute for Fluid Mechanics and Aerodynamics, Technical University of Darmstadt, 64287 Darmstadt, Germany; (A.S.); (J.H.)
| | - Frank-Hendrik Wurm
- Institute of Turbomachinery, Faculty for Mechanical Engineering and Ship Design, University of Rostock, 18055 Rostock, Germany; (F.K.); (F.-H.W.)
| | - Jeanette Hussong
- Institute for Fluid Mechanics and Aerodynamics, Technical University of Darmstadt, 64287 Darmstadt, Germany; (A.S.); (J.H.)
| | - Benjamin Torner
- Institute of Turbomachinery, Faculty for Mechanical Engineering and Ship Design, University of Rostock, 18055 Rostock, Germany; (F.K.); (F.-H.W.)
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Liu C, Wu G, Xu J, Xiao Q, Wang H. Numerical investigation of the effect of carotid bifurcation stenosis degree on pulsatility characteristics. Front Physiol 2023; 14:1169198. [PMID: 37485057 PMCID: PMC10359475 DOI: 10.3389/fphys.2023.1169198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Arterial bifurcations are regions that are susceptible to hemodynamic effects and thrombus formation. In the current study, the hemodynamic effects of a simplified 3D model of an arterial bifurcation were simulated using the commercial computational fluid dynamics software FLUENT. The non-Newtonian properties of blood were modeled using the Carreau model, and the pulsation dynamics and heat transfer characteristics of blood at different degrees of stenosis in the arterial bifurcation were analyzed. The results indicate that arterial stenosis caused by a thrombus when the pulsation velocity reaches its peak has an essential impact on blood transport. The stenosis of the bifurcation increases the peak pulsatile flow pressure drop, and each 0.5 mm stenosis of the arterial bifurcation increases the mean wall shear stress of the bifurcated segment by approximately 0.25 Pa. From the heat transfer perspective, arterial stenosis has little effect on the heat transfer coefficient. The heat transfer coefficient measured inside the bifurcation is much larger than that measured outside the bifurcation. The stenosis of the arterial bifurcation causes an increase in the mean velocity of the arterial cross-section, and the volume-averaged absolute vorticity is introduced to quantify the secondary flow effect during the pulsation cycle, where the arterial stenosis causes an increase in the mean absolute vorticity at pulsation velocity and accelerates the decay of the vorticity at uniform velocity. In this paper, the hemodynamics of carotid bifurcation pulsation is analyzed in conjunction with flow field properties to reveal the flow field dynamics factors and heat transfer characteristics of local stenosis of the carotid bifurcation and to conduct an exploratory study for the diagnosis and treatment of carotid bifurcation thrombosis.
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Affiliation(s)
- Chao Liu
- Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- First People’s Hospital of Yunnan Province, Kunming, China
| | - Gao Wu
- Faculty of Metallurgical and Energy Engineering, Kunming University of Science and Technology, Kunming, China
| | - Jianxin Xu
- Faculty of Metallurgical and Energy Engineering, Kunming University of Science and Technology, Kunming, China
| | - Qingtai Xiao
- Faculty of Metallurgical and Energy Engineering, Kunming University of Science and Technology, Kunming, China
| | - Hua Wang
- Faculty of Metallurgical and Energy Engineering, Kunming University of Science and Technology, Kunming, China
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Muskat JC, Babbs CF, Goergen CJ, Rayz VL. Transport of nitrite from large arteries modulates regional blood flow during stress and exercise. Front Cardiovasc Med 2023; 10:1146717. [PMID: 37378407 PMCID: PMC10291090 DOI: 10.3389/fcvm.2023.1146717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/04/2023] [Indexed: 06/29/2023] Open
Abstract
Background Acute cardiovascular stress increases systemic wall shear stress (WSS)-a frictional force exerted by the flow of blood on vessel walls-which raises plasma nitrite concentration due to enhanced endothelial nitric oxide synthase (eNOS) activity. Upstream eNOS inhibition modulates distal perfusion, and autonomic stress increases both the consumption and vasodilatory effects of endogenous nitrite. Plasma nitrite maintains vascular homeostasis during exercise and disruption of nitrite bioavailability can lead to intermittent claudication. Hypothesis During acute cardiovascular stress or strenuous exercise, we hypothesize enhanced production of nitric oxide (NO) by vascular endothelial cells raises nitrite concentrations in near-wall layers of flowing blood, resulting in cumulative NO concentrations in downstream arterioles sufficient for vasodilation. Confirmation and implications Utilizing a multiscale model of nitrite transport in bifurcating arteries, we tested the hypothesis for femoral artery flow under resting and exercised states of cardiovascular stress. Results indicate intravascular transport of nitrite from upstream endothelium could result in vasodilator-active levels of nitrite in downstream resistance vessels. The hypothesis could be confirmed utilizing artery-on-a-chip technology to measure NO production rates directly and help validate numerical model predictions. Further characterization of this mechanism may improve our understanding of symptomatic peripheral artery occlusive disease and exercise physiology.
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Affiliation(s)
- J. C. Muskat
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - C. F. Babbs
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - C. J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - V. L. Rayz
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
- Mechanical Engineering, Purdue University, West Lafayette, IN, United States
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Wang X, Ghayesh MH, Kotousov A, Zander AC, Dawson JA, Psaltis PJ. Fluid-structure interaction study for biomechanics and risk factors in Stanford type A aortic dissection. Int J Numer Method Biomed Eng 2023:e3736. [PMID: 37258411 DOI: 10.1002/cnm.3736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/04/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
Aortic dissection is a life-threatening condition with a rising prevalence in the elderly population, possibly as a consequence of the increasing population life expectancy. Untreated aortic dissection can lead to myocardial infarction, aortic branch malperfusion or occlusion, rupture, aneurysm formation and death. This study aims to assess the potential of a biomechanical model in predicting the risks of a non-dilated thoracic aorta with Stanford type A dissection. To achieve this, a fully coupled fluid-structure interaction model was developed under realistic blood flow conditions. This model of the aorta was developed by considering three-dimensional artery geometry, multiple artery layers, hyperelastic artery wall, in vivo-based physiological time-varying blood velocity profiles, and non-Newtonian blood behaviours. The results demonstrate that in a thoracic aorta with Stanford type A dissection, the wall shear stress (WSS) is significantly low in the ascending aorta and false lumen, leading to potential aortic dilation and thrombus formation. The results also reveal that the WSS is highly related to blood flow patterns. The aortic arch region near the brachiocephalic and left common carotid artery is prone to rupture, showing a good agreement with the clinical reports. The results have been translated into their potential clinical relevance by revealing the role of the stress state, WSS and flow characteristics as the main parameters affecting lesion progression, including rupture and aneurysm. The developed model can be tailored for patient-specific studies and utilised as a predictive tool to estimate aneurysm growth and initiation of wall rupture inside the human thoracic aorta.
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Affiliation(s)
- Xiaochen Wang
- School of Mechanical Engineering, University of Adelaide, Adelaide, Australia
| | - Mergen H Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, Australia
| | - Andrei Kotousov
- School of Mechanical Engineering, University of Adelaide, Adelaide, Australia
| | - Anthony C Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, Australia
| | - Joseph A Dawson
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Trauma Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Peter J Psaltis
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
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Malone AJ, Cournane S, Naydenova I, Meaney JF, Fagan AJ, Browne JE. Development and Evaluation of a Multifrequency Ultrafast Doppler Spectral Analysis (MFUDSA) Algorithm for Wall Shear Stress Measurement: A Simulation and In Vitro Study. Diagnostics (Basel) 2023; 13:diagnostics13111872. [PMID: 37296724 DOI: 10.3390/diagnostics13111872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular pathology is the leading cause of death and disability in the Western world, and current diagnostic testing usually evaluates the anatomy of the vessel to determine if the vessel contains blockages and plaques. However, there is a growing school of thought that other measures, such as wall shear stress, provide more useful information for earlier diagnosis and prediction of atherosclerotic related disease compared to pulsed-wave Doppler ultrasound, magnetic resonance angiography, or computed tomography angiography. A novel algorithm for quantifying wall shear stress (WSS) in atherosclerotic plaque using diagnostic ultrasound imaging, called Multifrequency ultrafast Doppler spectral analysis (MFUDSA), is presented. The development of this algorithm is presented, in addition to its optimisation using simulation studies and in-vitro experiments with flow phantoms approximating the early stages of cardiovascular disease. The presented algorithm is compared with commonly used WSS assessment methods, such as standard PW Doppler, Ultrafast Doppler, and Parabolic Doppler, as well as plane-wave Doppler. Compared to an equivalent processing architecture with one-dimensional Fourier analysis, the MFUDSA algorithm provided an increase in signal-to-noise ratio (SNR) by a factor of 4-8 and an increase in velocity resolution by a factor of 1.10-1.35. The results indicated that MFUDSA outperformed the others, with significant differences detected between the typical WSS values of moderate disease progression (p = 0.003) and severe disease progression (p = 0.001). The algorithm demonstrated an improved performance for the assessment of WSS and has potential to provide an earlier diagnosis of cardiovascular disease than current techniques allow.
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Affiliation(s)
- Andrew J Malone
- School of Physics, Clinical and Optometric Sciences, IEO Centre, Faculty of Science and Health, Technological University Dublin, D07 H6K8 Dublin, Ireland
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Seán Cournane
- Medical Physics and Clinical Engineering Department, St Vincent's Hospital, D04 T6F4 Dublin, Ireland
| | - Izabela Naydenova
- School of Physics, Clinical and Optometric Sciences, IEO Centre, Faculty of Science and Health, Technological University Dublin, D07 H6K8 Dublin, Ireland
| | - James F Meaney
- National Centre for Advanced Medical Imaging (CAMI), St James Hospital and with the School of Medicine, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Andrew J Fagan
- Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | - Jacinta E Browne
- School of Physics, Clinical and Optometric Sciences, IEO Centre, Faculty of Science and Health, Technological University Dublin, D07 H6K8 Dublin, Ireland
- Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA
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Satoh T, Yasuhara T, Umakoshi M, Date I. Trigeminal neuralgia caused by a persistent primitive trigeminal artery: preoperative three-dimensional multifusion imaging and computational fluid dynamics analysis. Illustrative case. J Neurosurg Case Lessons 2023; 5:CASE2381. [PMID: 37158390 PMCID: PMC10550693 DOI: 10.3171/case2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is caused by trigeminal nerve compression by colliding vessels. Preoperative three-dimensional (3D) multifusion images are useful for surgical simulations. Moreover, computational fluid dynamics (CFD) analysis of colliding vessels may be useful for hemodynamic evaluation at the site of neurovascular contact (NVC). OBSERVATIONS A 71-year-old woman had TN due to compression of the trigeminal nerve by the superior cerebellar artery (SCA) fused with the persistent primitive trigeminal artery (PTA). Preoperative 3D multifusion simulation images of silent magnetic resonance (MR) angiography and MR cisternography depicted the NVC, including the trigeminal nerve, SCA, and PTA. CFD analysis revealed the hemodynamic condition of the NVC, including the SCA and PTA. The wall shear stress magnitude (WSSm) at the NVC showed a local elevation due to flow confluence from the SCA and PTA. High WSSm was observed in the NVC. LESSONS Preoperative simulation images of MR angiography and MR cisternography may depict the NVC. CFD analysis can provide the hemodynamic condition at the NVC.
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Affiliation(s)
- Toru Satoh
- Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Postgraduate Medical School, Okayama, Japan
| | - Michiari Umakoshi
- Department of Neurological Surgery, Okayama University Postgraduate Medical School, Okayama, Japan
| | - Isao Date
- Okayama Rosai Hospital, Okayama, Japan
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Arshad M, Cheng S, van Reeuwijk M, Sherwin SJ, Weinberg PD. Modification of the swirling well cell culture model to alter shear stress metrics. Biotechnol Bioeng 2023; 120:1254-1268. [PMID: 36633017 PMCID: PMC10952219 DOI: 10.1002/bit.28331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/07/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Effects of hemodynamic shear stress on endothelial cells have been extensively investigated using the "swirling well" method, in which cells are cultured in dishes or multiwell plates placed on an orbital shaker. A wave rotates around the well, producing complex patterns of shear. The method allows chronic exposure to flow with high throughput at low cost but has two disadvantages: a number of shear stress characteristics change in a broadly similar way from the center to the edge of the well, and cells at one location in the well may release mediators into the medium that affect the behavior of cells at other locations, exposed to different shears. These properties make it challenging to correlate cell properties with shear. The present study investigated simple alterations to ameliorate these issues. Flows were obtained by numerical simulation. Increasing the volume of fluid in the well-altered dimensional but not dimensionless shear metrics. Adding a central cylinder to the base of the well-forced fluid to flow in a square toroidal channel and reduced multidirectionality. Conversely, suspending a cylinder above the base of the well made the flow highly multidirectional. Increasing viscosity in the latter model increased the magnitude of dimensional but not dimensionless metrics. Finally, tilting the well changed the patterns of different wall shear stress metrics in different ways. Collectively, these methods allow similar flows over most of the cells cultured and/or allow the separation of different shear metrics. A combination of the methods overcomes the limitations of the baseline model.
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Affiliation(s)
- Mehwish Arshad
- Department of BioengineeringImperial College LondonLondonUK
- Department of AeronauticsImperial College LondonLondonUK
| | - Shuyu Cheng
- Department of BioengineeringImperial College LondonLondonUK
| | - Maarten van Reeuwijk
- Department of Civil and Environmental EngineeringImperial College LondonLondonUK
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Motlana MK, Ngoepe MN. Computational Fluid Dynamics (CFD) Model for Analysing the Role of Shear Stress in Angiogenesis in Rheumatoid Arthritis. Int J Mol Sci 2023; 24:ijms24097886. [PMID: 37175591 PMCID: PMC10178063 DOI: 10.3390/ijms24097886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterised by an attack on healthy cells in the joints. Blood flow and wall shear stress are crucial in angiogenesis, contributing to RA's pathogenesis. Vascular endothelial growth factor (VEGF) regulates angiogenesis, and shear stress is a surrogate for VEGF in this study. Our objective was to determine how shear stress correlates with the location of new blood vessels and RA progression. To this end, two models were developed using computational fluid dynamics (CFD). The first model added new blood vessels based on shear stress thresholds, while the second model examined the entire blood vessel network. All the geometries were based on a micrograph of RA blood vessels. New blood vessel branches formed in low shear regions (0.840-1.260 Pa). This wall-shear-stress overlap region at the junctions was evident in all the models. The results were verified quantitatively and qualitatively. Our findings point to a relationship between the development of new blood vessels in RA, the magnitude of wall shear stress and the expression of VEGF.
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Affiliation(s)
- Malaika K Motlana
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, Cape Town 7701, South Africa
| | - Malebogo N Ngoepe
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, Cape Town 7701, South Africa
- Centre for Research in Computational and Applied Mechanics (CERECAM), University of Cape Town, Rondebosch, Cape Town 7701, South Africa
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40
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Gao W, Dong Y, Dong F, Hong S, Song D, Liu M, Wei Z, Du Y, Li S, Xu J. Feasibility study of combining wall shear stress and elastography to assess the vascular status of carotid artery. Curr Med Imaging 2023:CMIR-EPUB-130366. [PMID: 37018521 DOI: 10.2174/1573405620666230327125840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION At present, early detection of the potential risk of atherosclerosis and prevention is of great significance to reduce the occurrence of stroke. AIM This study aims to explore the value of combining the wall shear stress measured by ultrasound vector flow imaging technique and sound touch elastography of common carotid artery in normal adults using the Mindray Resona 7 ultrasound system. METHODS Forty volunteers (mean age 39.5 y, 23 females, 17 males) were divided into four groups according to their age. All volunteers underwent ultrasound carotid artery examination, and the values of wall shear stress and elasticity on the posterior wall of the common carotid artery were measured using advanced imaging functions, vector flow imaging technique, and sound touch elastography. RESULTS Different cut-off values of wall shear stress were used to investigate the significance between two groups with corresponding sound touch elastography values. It can be seen that the statistical difference could be found when the mean wall shear stress was larger than 1.5 Pa approximately (statistical significance was defined when P < 0.05), and the sound touch elastography value was positively correlated with the wall shear stress value. CONCLUSION This study reveals that the combination of wall shear stress and sound touch elastography is an effective and feasible method for assessing carotid artery health. When the mean wall shear stress value is over 1.5 Pa, the corresponding sound touch elastography value increases significantly. The risk of atherosclerosis increases with the stiffness of blood vessel walls.
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Affiliation(s)
- Wenjing Gao
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Yinghui Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Shaofu Hong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Di Song
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Mengmeng Liu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Zhanghong Wei
- ShenZhen People's Hospital Department of Ultrasound Shenzhen China
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, Guangdong, China
| | - Shuangshuang Li
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, Guangdong, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
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Zhai X, Hu P, Wang Y, Zhang H, Cao L, Huang T, Lu J, Luo Y. Association of local solid mechanical, hemodynamic and morphological characteristics with ruptured intracranial aneurysm. Int J Numer Method Biomed Eng 2023; 39:e3674. [PMID: 36541137 DOI: 10.1002/cnm.3674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/31/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
The rupture of intracranial aneurysms (IAs) is a complicated phenomenon of which the mechanism is not fully understood. The purpose of this study is to associate local solid mechanical, hemodynamic, and morphological characteristics with rupture regions through statistical means, in an attempt to identify the parameters that are indicative of rupture propensity for IAs. Twenty patient-specific ruptured IA models were reconstructed from digital subtraction angiography (DSA), and applied in the analysis of wall tension, wall shear stress (WSS) and curvature. The precise rupture locations were marked out through intraoperative videos. Pearson correlation analysis was employed to investigate the correlations of these three parameters with patient characteristics and global geometric features. Univariate and multivariate logistic regression analysis were further performed on wall tension, WSS and curvature with regards to rupture and nonrupture regions. Receiver operating characteristic (ROC) analysis defining area under the curve (AUC) was performed on these three parameters. The univariate model of wall tension (AUC, 0.9750), WSS (AUC, 0.9300), curvature (0.8150) and their combined multivariate model (AUC, 0.9875) all present high AUC values. The wall tension, WSS and curvature are acceptable parameters relating to rupture regions. The rupture odd is more sensitive to the wall tension and WSS than curvature. Each logistic model is capable in discriminating ruptures from nonrupture regions, while the multivariate model is the most efficient.
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Affiliation(s)
- Xiaodong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yadong Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Lan Cao
- Boea Wisdom (Hangzhou) Network Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Tianming Huang
- Boea Wisdom (Hangzhou) Network Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Jia Lu
- Department of Mechanical Engineering, The University of Iowa, Iowa City, Iowa, USA
| | - Yuanming Luo
- Department of Mechanical Engineering, The University of Iowa, Iowa City, Iowa, USA
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42
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Fan M, Kim WJ, Heldman DR. Effect of temperature, wall shear stress, and NaOH concentration on cleaning effectiveness. J Food Sci 2023; 88:1523-1532. [PMID: 36851821 DOI: 10.1111/1750-3841.16493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
The objective of this research was to evaluate the effect of various operational parameters and their interaction on cleaning rate of NaOH. The parameters include wall shear stress, temperatures, and NaOH concentrations of cleaning fluid. The higher cleaning effectiveness for proteinaceous deposits was achieved at higher wall shear stress. The wall shear stress of 2.42 Pa removed over 90% of foulant after 10 min of operation, which was significantly higher than the removal of lower wall shear stress (0.84 and 0.39 Pa). Similarly, the cleaning rate increased with increase in temperature and concentration of cleaning solution. The use of cleaning solution (0.05% NaOH) at 65°C provided significantly higher cleaning rate than 25°C. A cleaning solution concentration of 0.5% NaOH provided significantly higher removal of foulant than 0% or 0.05% concentrations. However, analysis on the interaction between temperature and the wall shear stress suggested that the temperature above 45°C and wall shear stress above 0.65 Pa did not provide significant improvement in cleaning efficacy. When a cleaning solution temperature was maintained at 45°C, higher wall shear stress provided more rapid removal of the foulant when the cleaning agent concentration was 0.05% or 0.5%. In water rinse conducted without chemical agents, no much improvements in foulant removal were observed with increase in wall shear stress. The change of activation energy (Ea ) indicates that water rinse was sensitive to temperature change at higher wall shear stress. However, cleaning with cleaning agents was less sensitive to temperature variation compared to the water rinse. PRACTICAL APPLICATION: Considering the intense use of water and chemical compounds during cleaning operation, finding operating condition to ensure acceptable cleanness with minimized input is desired. Temperature, cleaning agent concentration, and wall shear stress are the major components to influence the cleaning efficacy. The result of the study demonstrates the potential for optimization of in-place cleaning by appropriate adjustments of the CIP operating parameters.
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Affiliation(s)
- Mengyuan Fan
- Dale A. Seiberling Food Engineering Laboratory, The Ohio State University, Columbus, Ohio, USA.,Innovation Center, Kemin Industries, Inc., Zhuhai, People's Republic of China
| | - Woo-Ju Kim
- Dale A. Seiberling Food Engineering Laboratory, The Ohio State University, Columbus, Ohio, USA.,Department of Food Science and Technology, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Dennis R Heldman
- Dale A. Seiberling Food Engineering Laboratory, The Ohio State University, Columbus, Ohio, USA
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Nightingale M, Scott MB, Sigaeva T, Guzzardi D, Garcia J, Malaisrie SC, McCarthy P, Markl M, Fedak PWM, Di Martino ES, Barker AJ. Magnetic resonance imaging-based hemodynamic wall shear stress alters aortic wall tissue biomechanics in bicuspid aortic valve patients. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00019-3. [PMID: 36797175 PMCID: PMC10338641 DOI: 10.1016/j.jtcvs.2022.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/06/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In this study we aimed to conclusively determine whether altered aortic biomechanics are associated with wall shear stress (WSS) independent of region of tissue collection. Elevated WSS in the ascending aorta of patients with bicuspid aortic valve has been shown to contribute to local maladaptive aortic remodeling and might alter biomechanics. METHODS Preoperative 4-dimensional flow magnetic resonance imaging was performed on 22 patients who underwent prophylactic aortic root and/or ascending aorta replacement. Localized elevated WSS was identified in patients using age-matched healthy atlases (n = 60 controls). Tissue samples (n = 78) were collected and categorized according to WSS (elevated vs normal) and region. Samples were subjected to planar biaxial testing. To fully quantify the nonlinear biomechanical response, the tangential modulus (local stiffness) at a low-stretch (LTM) and high-stretch (HTM) linear region and the onset (TZo) and end stress of the nonlinear transition zone were measured. A linear mixed effect models was implemented to determine statistical relationships. RESULTS A higher LTM in the circumferential and axial direction was associated with elevated WSS (P = .007 and P = .018 respectively) independent of collection region. Circumferential TZo and HTM were higher with elevated WSS (P = .024 and P = .003); whereas the collection region was associated with variations in axial TZo (P = .013), circumferential HTM (P = .015), and axial HTM (P = .001). CONCLUSIONS This study shows strong evidence that biomechanical changes in the aorta are strongly associated with hemodynamics, and not region of tissue collection for bicuspid valve aortopathy patients. Elevated WSS is associated with tissue behavior at low stretch ranges (ie, LTM and TZo).
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Affiliation(s)
- Miriam Nightingale
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | - Taisiya Sigaeva
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - David Guzzardi
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julio Garcia
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Chris Malaisrie
- Division of Surgery-Cardiac Surgery, Northwestern University, Evanston, Ill
| | - Patrick McCarthy
- Division of Surgery-Cardiac Surgery, Northwestern University, Evanston, Ill
| | - Michael Markl
- Department of Radiology, Northwestern University, Evanston, Ill; Department of Bioengineering, Northwestern University, Evanston, Ill
| | - Paul W M Fedak
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elena S Di Martino
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Alex J Barker
- Department of Radiology, Northwestern University, Evanston, Ill; Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo.
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Qin JJ, Obeidy P, Gok M, Gholipour A, Grieve SM. 4D-flow MRI derived wall shear stress for the risk stratification of bicuspid aortic valve aortopathy: A systematic review. Front Cardiovasc Med 2023; 9:1075833. [PMID: 36698944 PMCID: PMC9869052 DOI: 10.3389/fcvm.2022.1075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose Current intervention guidelines for bicuspid aortic valve (BAV) associated ascending aorta (AAo) dilatation are suboptimal predictors of clinical outcome. There is growing interest in identifying better biomarkers such as wall shear stress (WSS) to help risk stratify BAV aortopathy. The aim of the systematic review is to synthesize existing evidence of the relationship between WSS and aortopathy in the BAV population. Methods A comprehensive literature search of available major databases was performed in May 2022 to include studies that used four-dimensional flow cardiac magnetic resonance (4D-flow) MRI to quantify WSS in the AAo in adult BAV populations. Summary results and statistical analysis were provided for key numerical results. A narrative summary was provided to assess similarities between studies. Results A total of 26 studies that satisfied selection criteria and quality assessment were included in the review. The presence of BAV resulted in significantly elevated WSS magnitude and circumferential WSS, but not axial WSS. The presence of aortic stenosis had additional impact on WSS and flow alterations. BAV phenotypes were associated with different WSS distributions and flow profiles. Altered protein expression in the AAo wall associated with WSS supported the contribution of altered hemodynamics to aortopathy in addition to genetic factors. Conclusion WSS has the potential to be a valid biomarker for BAV aortopathy. Future work would benefit from larger study cohorts with longitudinal evaluations to further characterize WSS association with aortopathy, mortality, and morbidities. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337077, identifier CRD42022337077.
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Affiliation(s)
- Jiaxing Jason Qin
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Peyman Obeidy
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mustafa Gok
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Alireza Gholipour
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,*Correspondence: Stuart M. Grieve,
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Karageorgos GM, Kemper P, Lee C, Weber R, Kwon N, Meshram N, Mobadersany N, Grondin J, Marshall RS, Miller EC, Konofagou EE. Adaptive Wall Shear Stress Imaging in Phantoms, Simulations and In Vivo. IEEE Trans Biomed Eng 2023; 70:154-165. [PMID: 35776824 PMCID: PMC10103592 DOI: 10.1109/tbme.2022.3186854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
WSS measurement is challenging since it requires sensitive flow measurements at a distance close to the wall. The aim of this study is to develop an ultrasound imaging technique which combines vector flow imaging with an unsupervised data clustering approach that automatically detects the region close to the wall with optimally linear flow profile, to provide direct and robust WSS estimation. The proposed technique was evaluated in phantoms, mimicking normal and atherosclerotic vessels, and spatially registered Fluid Structure Interaction (FSI) simulations. A relative error of 6.7% and 19.8% was obtained for peak systolic (WSSPS) and end diastolic (WSSED) WSS in the straight phantom, while in the stenotic phantom, a good similarity was found between measured and simulated WSS distribution, with a correlation coefficient, R, of 0.89 and 0.85 for WSSPS and WSSED, respectively. Moreover, the feasibility of the technique to detect pre-clinical atherosclerosis was tested in an atherosclerotic swine model. Six swines were fed atherogenic diet, while their left carotid artery was ligated in order to disturb flow patterns. Ligated arterial segments that were exposed to low WSSPS and WSS characterized by high frequency oscillations at baseline, developed either moderately or highly stenotic plaques (p < 0.05). Finally, feasibility of the technique was demonstrated in normal and atherosclerotic human subjects. Atherosclerotic carotid arteries with low stenosis had lower WSSPS as compared to control subjects (p < 0.01), while in one subject with high stenosis, elevated WSS was found on an arterial segment, which coincided with plaque rupture site, as determined through histological examination.
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Kobsa S, Akiyama K, Nemeth SK, Kurlansky PA, Naka Y, Takeda K, Itatani K, Werth EG, Brown LM, Ferrari G, Takayama H. Correlation between aortic valve protein levels and vector flow mapping of wall shear stress and oscillatory shear index in patients supported with continuous-flow left ventricular assist devices. J Heart Lung Transplant 2023; 42:64-75. [PMID: 36400676 DOI: 10.1016/j.healun.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Continuous-flow left ventricular assist devices commonly lead to aortic regurgitation, which results in decreased pump efficiency and worsening heart failure. We hypothesized that non-physiological wall shear stress and oscillatory shear index alter the abundance of structural proteins in aortic valves of left ventricular assist device (LVAD) patients. METHODS Doppler images of aortic valves of patients undergoing heart transplants were obtained. Eight patients had been supported with LVADs, whereas 10 were not. Aortic valve tissue was collected and protein levels were analyzed using mass spectrometry. Echocardiographic images were analyzed and wall shear stress and oscillatory shear index were calculated. The relationship between normalized levels of individual proteins and in vivo echocardiographic measurements was evaluated. RESULTS Of the 57 proteins of interest, there was a strong negative correlation between levels of 15 proteins and the wall shear stress (R < -0.500, p ≤ 0.05), and a moderate negative correlation between 16 proteins and wall shear stress (R -0.500 to -0.300, p ≤ 0.05). Gene ontology analysis demonstrated clusters of proteins involved in cellular structure. Proteins negatively correlated with WSS included those with cytoskeletal, actin/myosin, cell-cell junction and extracellular functions. C: In aortic valve tissue, 31 proteins were identified involved in cellular structure and extracellular junctions with a negative correlation between their levels and wall shear stress. These findings suggest an association between the forces acting on the aortic valve (AV) and leaflet protein abundance, and may form a mechanical basis for the increased risk of aortic leaflet degeneration in LVAD patients.
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Nakamura K, Nakao M, Wakatabe M, Orii K, Nakajima T, Miyazaki S, Kunihara T. Changes in Internal Thoracic Artery Blood Flow According to the Degree of Stenosis of the Anterior Descending Branch of the Left Coronary Artery. Ann Thorac Cardiovasc Surg 2023; 29:29-39. [PMID: 36418107 PMCID: PMC9939674 DOI: 10.5761/atcs.oa.22-00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Computational fluid dynamics has enabled the evaluation of coronary flow reserve. The purpose of this study was to clarify the hemodynamic variation and reserve potential of the left internal thoracic artery (LITA). METHODS Four patients were selected on the basis of various native coronary stenosis patterns and graft design. The wall shear stress and oscillatory shear index were measured, and one patient was selected. Next, we created three hypothetical lesions with 75%, 90%, and 99% stenosis in front of the graft anastomosis, and compared the changes in LITA blood flow and coronary flow distribution. RESULTS In the 75% to 90% stenosis model, blood flow was significantly higher in the native coronary flow proximal to the coronary artery bypass anastomosis regardless of time phase. In the 99% stenosis model, blood flow from the LITA was significantly dominant compared to native coronary flow at the proximal site of anastomosis. The range of LITA flow variability was the largest at 99% stenosis, with a difference of 70 ml/min. CONCLUSION The 99% stenosis model showed the highest LITA flow. The range of LITA flow variability is large, suggesting that it may vary according to the rate of native coronary stenosis.
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Affiliation(s)
- Ken Nakamura
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan,Corresponding author: Ken Nakamura. Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8, Nishi- shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Mitsutaka Nakao
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | - Makoto Wakatabe
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | - Kouan Orii
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | - Takatomo Nakajima
- Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | | | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Murakami M, Jiang F, Kageyama N, Chen X. Computational Fluid Dynamics Analysis of Blood Flow Changes during the Growth of Saccular Abdominal Aortic Aneurysm. Ann Vasc Dis 2022; 15:260-267. [PMID: 36644268 PMCID: PMC9816029 DOI: 10.3400/avd.oa.22-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022] Open
Abstract
Computational fluid dynamics analysis of the growth process of saccular abdominal aortic aneurysm was performed. A 3D model of aortic aneurysm was created based on CT images. Properties in terms of wall shear stress, mean flow velocity, mean pressure, energy loss, and pressure loss coefficient were calculated using thermal fluid analysis software "ANSYS CFX." As the aneurysm expanded, the mean flow velocity decreased and the wall shear stress, mean pressure, energy loss, and pressure loss coefficient increased. Wall shear stress increased when the aneurysm was small, suggesting that is related to the development and growth of the aneurysm. (This is secondary publication from J Jpn Coll Angiol 2021; 61: 3-10.).
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Affiliation(s)
- Masanori Murakami
- Department of Cardiovascular Surgery, National Hospital Organization, Kanmon Medical Center, Shimonoseki, Yamaguchi, Japan,Corresponding author: Masanori Murakami, MD, PhD. Department of Cardiovascular Surgery, National Hospital Organization, Kanmon Medical Center, 1-1 Choufusotoura-chou, Shimonoseki, Yamaguchi 752-8510, Japan Tel: +81-83-241-1199, Fax: +81-83-241-1301, E-mail:
| | - Fei Jiang
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
| | - Nobuyasu Kageyama
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
| | - Xian Chen
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
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Hill SJ, Young A, Prendergast B, Redwood S, Rajani R, De Vecchi A. Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification. Front Cardiovasc Med 2022; 9:934305. [PMID: 36588546 PMCID: PMC9797989 DOI: 10.3389/fcvm.2022.934305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Transcatheter mitral valve replacement is a promising alternative to open-heart surgery in elderly patients. Patients with severe mitral annulus calcification (MAC) are a particularly high-risk population, where postprocedural complications can have catastrophic effects. Amongst these, obstruction of the left ventricular outflow tract can lead to ventricular hypertrophic remodeling and subsequent heart failure, while subclinical valve thrombosis can result in early bioprosthetic valve failure. Methods To elucidate the mechanisms of left ventricular outflow tract obstruction and valve thrombosis following valve-in-MAC procedures, we used image processing and Computational Fluid Dynamics (CFD) software to generate patient- and device-specific models based on preprocedural CT data. Personalized computer simulations were performed to predict the left ventricular haemodynamics after implantation in three patients with severe MAC. Results The simulations have successfully captured the increased pressure gradient in the left ventricular outflow tract as a result of the partial obstruction due to the implanted valve. Regions of wall shear stress above the threshold value for platelet activation were also observed on the bioprosthetic frame as a result of the reduced outflow tract area, which led to increases in flow resistance and blood residence time inside the ventricle. Consistent with these findings, areas of slow recirculating flow and blood stasis formed near the valve frame, creating potential pro-thrombotic conditions. Discussion This study provides insight into the relationship between size and shape of the outflow tract post-implantation, pressure gradients and pro-thrombotic flow metrics such as wall shear stress and blood residence time. Results show the potential of CFD modeling to bring key functional metrics into preprocedural assessment for a comprehensive evaluation of post-procedural risks beyond anatomical factors. Following further validation and extension to the atrial chamber, this approach can provide an in-depth analysis of the likelihood of valvular thrombosis.
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Affiliation(s)
- Samuel Joseph Hill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,*Correspondence: Samuel Joseph Hill,
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascular Directorate, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Redwood
- Cardiovascular Directorate, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Adelaide De Vecchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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50
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Hou G, Fu M, Wang X, Liu Z, Zhang Y, Zhu D, Pang H, Li R, Shen L. Modified no-touch technique for radio-cephalic arteriovenous fistula increases primary patency and decreases juxta-anastomotic stenosis. J Vasc Access 2022:11297298221139339. [PMID: 36519744 DOI: 10.1177/11297298221139339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Low primary patency rate is a major problem of radio-cephalic arteriovenous fistula (RC-AVF) creation. Radial artery deviation and reimplantation (RADAR) is associated with low juxta-anastomotic stenosis rate. However, inflow artery stenosis is prominent with RADAR. To further reduce injury to veins and arteries during operation, a modified no-touch technique (MNTT) was used to create RC-AVF. METHODS We retrospectively reviewed our prospectively maintained database of patients with end-stage renal disease (ESRD)s undergoing RC-AVF creation for hemodialysis using either the MNTT between January 2021 and January 2022 (MNTT group) or conventional surgical procedure ( end-to-side vein-to-artery anastomosis) between October 2016 and October 2017 (Control group). Patients who chose to undergo RC-AVF surgery underwent standardized preoperative mapping and postoperative fistula evaluations using duplex ultrasound. Additionally, 4D flow MRI data were used to visualize and quantify the hemodynamics of one RC-AVF by MNTT. Outcomes included primary patency, juxta-anastomotic stenosis, and maturation rates. RESULTS Forty patients underwent RC-AVFs by MNTT, compared to 60 patients in the control group. The MNTT group had a higher primary unassisted patency rate than the control group (p = 0.038). Juxta-anastomotic stenosis (all on the cephalic vein) occurred in 4 (10%) patients who underwent MNTT. RC-AVF maturation rates after 3 months were not different between both groups (maturation rate: 90% and 81.7% in the MNTT and control groups, respectively, p = 0.253). COX regression showed that both conventional AVF surgery (p = 0.031) and smaller cephalic vein diameter (p = 0.034) were associated with higher odds of RC-AVF failure. The AVF flow within the proximal vein remained helical during cardiac cycle. The distribution of wall shear stress (WSS) and oscillatory shear index (OSI) differed from that of conventional surgical AVF. CONCLUSION RC-AVF by MNTT increases primary patency rate and decreases juxta-anastomotic stenosis rate. The improvement in hemodynamics may be one of the important reasons for the better patency rate of in the RC-AVF by MNTT group.
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Affiliation(s)
- Guocun Hou
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaohe Wang
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhen Liu
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Yuanyuan Zhang
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Dongming Zhu
- Department of Medical Imaging, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Hongquan Pang
- Department of Medical Imaging, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Shen
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
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