Key result
Left upper lobectomy altered left atrial hemodynamics by causing blood flow impingement from the pulmonary veins and generating fine-scale vortices with increased viscous energy dissipation.
Why the study?
Left upper lobectomy with pulmonary vein resection risks thrombus formation in the pulmonary vein stump even without cardiac disease, but the causal mechanism remains an open question.
Does left upper lobectomy alter left atrial hemodynamics to promote flow stasis and thrombus formation?
Does left upper lobectomy alter left atrial hemodynamics to promote flow stasis and thrombus formation?
Computational fluid dynamics modeling demonstrates that left upper lobectomy alters left atrial hemodynamics, enhancing flow stasis and providing a mechanistic explanation for the increased risk of thrombus formation in the pulmonary vein stump.
Answers are grounded in this paper and cite their sources.
May heighten post-lobectomy arrhythmia risk; leaves open causal links to clinical events.
The left atrium (LA) functions to transport oxygenated blood from the pulmonary veins (PVs) to the left ventricle (LV). LA hemodynamics has received much attention because thrombosis in the LA in pathological states, such as atrial fibrillation, is a major factor leading to thromboembolic stroke. In the last 5 years, multiple cohort studies have revealed that left upper lobectomy (LUL) with PV resection risks thrombus formation in the PV stump even in the normal LA without a history of cardiac disease; the causal mechanism is, however, an open question. The present study investigated the potential effect of an LUL on LA hemodynamics associated with thrombus formation through computational simulation using four-dimensional computed tomography (4D-CT) images. Time series of patient-specific LA geometries before and after LUL were extracted from the 4D-CT images and these motions were estimated through non-rigid registration. Adopting the LA geometries and prescribed moving wall boundary conditions, the LA blood flow was determined using a Cartesian-grid computational fluid dynamics solver. The obtained results show that the LUL resulted in blood flow impingement from the left and right PV inflows into the LA upper region throughout most of the cardiac cycle. This characteristic alteration of the LA hemodynamics generated fine-scale vortices with viscous energy dissipations, enhancing the flow stasis associated with thrombus formation in the PV stump. These findings show that an LUL affects the hemodynamics not only in the PV stump but also throughout the LA region. They also highlight the importance of computational analysis of LA hemodynamics in understanding the underlying mechanism of LUL-induced thrombus formation.
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Otani et al. (2022) studied Lung cancer (n=1). Left upper lobectomy vs. Pre-operative state was evaluated on Left atrial hemodynamics (flow patterns and viscous energy dissipation). Left upper lobectomy altered left atrial hemodynamics by causing blood flow impingement from the pulmonary veins and generating fine-scale vortices with increased viscous energy dissipation.
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