In Vivo Quantification of Cardiac-Pulsatility-Induced Motion Before and After Double-Branched Endovascular Aortic Arch Repair

Figures

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  Figure 1.. Three-dimensional (3D) rendering of part of the preoperative computed tomography (CT) volume, showing the saccular aneurysm in the aortic arch (red arrow).

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  Figure 2.. The selected points for motion amplitude calculations for the preoperative (A) and postoperative (B) electrocardiogram (ECG)-gated computed tomography (CT) scans. Points 1 and 2: ventral/dorsal ascending aorta and first stent ring, respectively; point 3: top of the aortic arch; points 4 and 5: ventral/dorsal descending aorta and last stent ring, respectively; points 6 and 7: (end of the) brachiocephalic trunk (BCT) (stent); 8 on the BCT bifurcation; points 9 and 10: (end of the) left common carotid artery (LCCA) (stent); 11 on the LCCA bifurcation. The blue-bordered boxes show the path traveled by point 1 during the cardiac cycle in the two scans.

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  Figure 3.. The calculated diameters at the three scan moments: preoperative, before discharge and at 5.5 months postoperative, that is, second postoperative scan. Two diameters were calculated at each 1 cm level of the centerline (bright green), forming a diameter pair. Each diameter pair is shown in a different color with a corresponding number. The white diameter pairs indicate the native aorta diameters upstream and downstream of the main body in the aortic arch.

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  Figure 4.. The motion amplitudes in x —(lateral), y —(ventral-dorsal), and z —(caudal-cranial) direction and the corresponding pathlengths at the different scan moments (preoperative, discharge and 5.5 months postoperative) in which the motion pattern of each coordinate (X, Y, or Z) is shown in the columns for each point (1–9 as specified in Figure 1). The sum of individual distances between each phase for each point is specified as the traveled pathlength for each point.

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  Figure 5.. The (A) static phase-averaged curvature and (B) curvature change of the pre-operative (left), discharge (middle) and 2nd postoperative (right) electrocardiogram (ECG)-gated computed tomography (CT) scan of the brachiocephalic trunk (BCT, blue), left common carotid artery (LCCA, red/orange) and aortic arch (green). The vertical black lines indicate the start and end of the to be stented part of the arteries. CLL, center lumen line.

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  Figure 6.. The diameters of the different scan moments (A) and the corresponding cardiac-pulsatility-induced changes in diameter (B) for the diameter pairs along the centerline, spaced at 1 cm of the centerline of the stented aortic arch and a diameter of the of the native aorta upstream (diameter pair 1) and downstream (diameter pair 19) of the stent. The curves show the mean diameter value (calculated from the diameter pair), whereas the filled areas around the curves show the spread of the 2 diameters of each diameter pair.