Flow Dynamic Factors Correlated With Device-Related Thrombosis After Left Atrial Appendage Occlusion

Figures

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  Figure 1. Workflow Adopted for This Study, Utilizing a Sequence of Finite Element Analysis and Computational Fluid Dynamics CT = computed tomography; ECAP = endothelial cell activation potential; OSI = oscillatory shear index; TAWSS = time averaged wall shear stress; TTE = transthoracic echocardiogram.

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  Figure 2. Sample of TAWSS, OSI, and ECAP Contours for the Top Surface of Each Device for the DRT and CTL Populations Sample of time averaged wall shear stress (A), oscillatory shear index (B), and endothelial cell activation potential (C) contours for the top surface of each device for the device-related thrombosis, and control populations. Thrombus locations from in-vivo imaging are shown by the black line for each drt patient displayed. The line represents the border of the thrombus. DRT = device-related thrombosis; CTL = control; other abbreviations as in Figure 1.

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  Central Illustration. Flow Dynamic Factors Correlated With Device-Related Thrombosis After Left Atrial Appendage Occlusion Patient-specific modeling (A) of the left atrium and left atrial appendage occlusion devices for use in a combined finite element and computational fluid dynamics simulations (B) to identify fluid dynamics predictors of device related thrombosis (DRT). (C) Patients with DRT had lower time averaged wall shear stress, high oscillatory shear index, and high endothelial cell activation potential, indicating an increased likelihood of thrombosis. ECAP = endothelial cell activation potential; OSI = oscillatory shear index; TAWSS = time averaged wall shear stress; abbreviations as in Figures 1 and 2.