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Zimmermann J, Bäumler K, Loecher M, Cork TE, Marsden AL, Ennis DB, Fleischmann D. Hemodynamic Effects of Entry and Exit Tear Size in Aortic Dissection Evaluated with In Vitro Magnetic Resonance Imaging and Fluid-Structure Interaction Simulation. ArXiv 2023:arXiv:2303.13639v1. [PMID: 36994169 PMCID: PMC10055490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Understanding the complex interplay between morphologic and hemodynamic features in aortic dissection is critical for risk stratification and for the development of individualized therapy. This work evaluates the effects of entry and exit tear size on the hemodynamics in type B aortic dissection by comparing fluid-structure interaction (FSI) simulations with in vitro 4D-flow magnetic resonance imaging (MRI). A baseline patient-specific 3D-printed model and two variants with modified tear size (smaller entry tear, smaller exit tear) were embedded into a flow- and pressure-controlled setup to perform MRI as well as 12-point catheter-based pressure measurements. The same models defined the wall and fluid domains for FSI simulations, for which boundary conditions were matched with measured data. Results showed exceptionally well matched complex flow patterns between 4D-flow MRI and FSI simulations. Compared to the baseline model, false lumen flow volume decreased with either a smaller entry tear (-17.8 and -18.5 %, for FSI simulation and 4D-flow MRI, respectively) or smaller exit tear (-16.0 and -17.3 %). True to false lumen pressure difference (initially 11.0 and 7.9 mmHg, for FSI simulation and catheter-based pressure measurements, respectively) increased with a smaller entry tear (28.9 and 14.6 mmHg), and became negative with a smaller exit tear (-20.6 and -13.2 mmHg). This work establishes quantitative and qualitative effects of entry or exit tear size on hemodynamics in aortic dissection, with particularly notable impact observed on FL pressurization. FSI simulations demonstrate acceptable qualitative and quantitative agreement with flow imaging, supporting its deployment in clinical studies.
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Affiliation(s)
- Judith Zimmermann
- Stanford University, Department of Radiology, Stanford, CA
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | | | - Michael Loecher
- Stanford University, Department of Radiology, Stanford, CA
- Veterans Affairs Health Care System, Division of Radiology, Palo Alto, CA
| | - Tyler E. Cork
- Stanford University, Department of Radiology, Stanford, CA
- Stanford University, Department of Bioengineering, Stanford, CA
- Veterans Affairs Health Care System, Division of Radiology, Palo Alto, CA
| | - Alison L. Marsden
- Stanford University, Department of Bioengineering, Stanford, CA
- Stanford University, Department of Pediatrics, Stanford, CA
| | - Daniel B. Ennis
- Stanford University, Department of Radiology, Stanford, CA
- Veterans Affairs Health Care System, Division of Radiology, Palo Alto, CA
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Bäumler K, Vedula V, Sailer AM, Seo J, Chiu P, Mistelbauer G, Chan FP, Fischbein MP, Marsden AL, Fleischmann D. Fluid-structure interaction simulations of patient-specific aortic dissection. Biomech Model Mechanobiol 2020; 19:1607-1628. [PMID: 31993829 DOI: 10.1007/s10237-020-01294-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 08/26/2019] [Accepted: 01/14/2020] [Indexed: 12/01/2022]
Abstract
Credible computational fluid dynamic (CFD) simulations of aortic dissection are challenging, because the defining parallel flow channels-the true and the false lumen-are separated from each other by a more or less mobile dissection membrane, which is made up of a delaminated portion of the elastic aortic wall. We present a comprehensive numerical framework for CFD simulations of aortic dissection, which captures the complex interplay between physiologic deformation, flow, pressures, and time-averaged wall shear stress (TAWSS) in a patient-specific model. Our numerical model includes (1) two-way fluid-structure interaction (FSI) to describe the dynamic deformation of the vessel wall and dissection flap; (2) prestress and (3) external tissue support of the structural domain to avoid unphysiologic dilation of the aortic wall and stretching of the dissection flap; (4) tethering of the aorta by intercostal and lumbar arteries to restrict translatory motion of the aorta; and a (5) independently defined elastic modulus for the dissection flap and the outer vessel wall to account for their different material properties. The patient-specific aortic geometry is derived from computed tomography angiography (CTA). Three-dimensional phase contrast magnetic resonance imaging (4D flow MRI) and the patient's blood pressure are used to inform physiologically realistic, patient-specific boundary conditions. Our simulations closely capture the cyclical deformation of the dissection membrane, with flow simulations in good agreement with 4D flow MRI. We demonstrate that decreasing flap stiffness from [Formula: see text] to [Formula: see text] kPa (a) increases the displacement of the dissection flap from 1.4 to 13.4 mm, (b) decreases the surface area of TAWSS by a factor of 2.3, (c) decreases the mean pressure difference between true lumen and false lumen by a factor of 0.63, and (d) decreases the true lumen flow rate by up to 20% in the abdominal aorta. We conclude that the mobility of the dissection flap substantially influences local hemodynamics and therefore needs to be accounted for in patient-specific simulations of aortic dissection. Further research to accurately measure flap stiffness and its local variations could help advance future CFD applications.
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Affiliation(s)
- Kathrin Bäumler
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
| | - Vijay Vedula
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Anna M Sailer
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Jongmin Seo
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Gabriel Mistelbauer
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Frandics P Chan
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Dominik Fleischmann
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
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Sailer AM, van Kuijk SMJ, Nelemans PJ, Chin AS, Kino A, Huininga M, Schmidt J, Mistelbauer G, Bäumler K, Chiu P, Fischbein MP, Dake MD, Miller DC, Schurink GWH, Fleischmann D. Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005709. [PMID: 28360261 DOI: 10.1161/circimaging.116.005709] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable. METHODS AND RESULTS The association of computed tomography imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (interquartile range 247-1824) days. Adverse events were defined as fatal or nonfatal aortic rupture, rapid aortic growth (>10 mm/y), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (hazard ratio [HR] 2.94, 95% confidence interval [CI]: 1.29-6.72; P=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95% CI: 1.01-1.04, P=0.003), maximum aortic diameter (HR 1.10 per mm, 95% CI: 1.02-1.18, P=0.015), false lumen outflow (HR 0.999 per mL/min, 95% CI: 0.998-1.000; P=0.055), and number of intercostal arteries (HR 0.89 per n, 95% CI: 0.80-0.98; P=0.024). A prediction model was constructed to calculate patient specific risk at 1, 2, and 5 years and to stratify patients into high-, intermediate-, and low-risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected C statistic of 70.1%. CONCLUSIONS Computed tomography imaging-based morphological features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type-B aortic dissection.
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Affiliation(s)
- Anna M Sailer
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Sander M J van Kuijk
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Patricia J Nelemans
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Anne S Chin
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Aya Kino
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Mark Huininga
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Johanna Schmidt
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Gabriel Mistelbauer
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Kathrin Bäumler
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Peter Chiu
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Michael P Fischbein
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Michael D Dake
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - D Craig Miller
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Geert Willem H Schurink
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Dominik Fleischmann
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
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