The Influence of Minor Aortic Branches in Patient-Specific Flow Simulations of Type-B Aortic Dissection

Figures

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  Figure 1. A schematic of the medical imaging timeline is shown top left (i). A 3D rendering of the CTA data is shown to its right (ii) with a detail view indicating a lumbar segmental branch (a) and the inferior mesenteric artery (IMA) (b). The baseline segmentation is shown with minor branches numbered (except the IMA, which is on the reverse side) before their reconstruction (iii). The vessel marked (a) in the CTA rendering detail is indicated as branch 25. A detail view (e) provides a closer view of the first re-entry tear and minor branches before reconstruction and smoothing. The final \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin domain is shown to the right (iv), with detail views (c) and (d) showing the primary entry tear (c) and first re-entry tear and reconstructed branches (d).

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  Figure 2. A schematic diagram of the inlet and outlet boundaries for case D (excluding segmental branches) and case \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin (including segmental branches). Each group of major branches are indicated on D, while each group of minor branches are indicated on \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin. The branch abbreviations are indicated top left, while the symbolic representation of the three-element Windkessel is depicted at the bottom right. Detail view (a) shows the major abdominal branches, two S1 branches, both S3 and two S4 minor branches, and the variety of luminal tears located at the level of the renal arteries. Detail view (b) shows four S4 branches and the inferior mesenteric artery (IMA) near the iliac bifurcation.…

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  Figure 3. Flow rate analysis of D, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin and 4DMR throughout the dissection with a diagram of flow analysis planes at 10 mm increments. Plots on the right hand side indicate the total plane flow (TL + FL) through the primary entry tear (PET) and selected planes in CFD and 4DMR. Plots on the left side provide forward and reverse flow analysis in the FL only. The top left plot shows reverse/forward flow ratio along the dissection, extracted from all planes shown on the diagram. The bottom left two plots show forward and reverse flow across the cycle from CFD and 4DMR at plane D, indicated, along with velocity contours from this plane at peak systole indicating poor FL velocity signal in 4DMR. Solid/dashed lines correspond to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt}…

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  Figure 4. Vertical histogram comparing maximum and cycle-averaged (mean) transmural pressure (TMP) in cases D and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin along the full length of the dissection. Maximum values are indicated by the lighter, transparent bars, while mean values are indicated by the darker, solid bars. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin provides lower magnitudes of mean and maximum TMP everywhere except plane D, which lies proximally to the first re-entry tear at plane e, as shown in the inset detail.

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  Figure 5. Simulated and measured velocity magnitude contours throughout the dissection at peak systole (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_{1}$$\end{document}T1) and late systole (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_{2}$$\end{document}T2). Contours from D and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin (left, centre columns) are compared with contours of measured velocity magnitude from 4DMR (right column), as indicated. Contour scales are matched between planes a–h and are adjusted on planes i–k, separated with a dotted line. Note that planes are not exactly to scale. Contours from omitted…

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  Figure 6. Bland–Altman plots comparing CFD and 4DMR velocity magnitude in cases D and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_{1}$$\end{document}T1 (peak systole) on the indicated planes. Bias values [calculated as mean(\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$v_{\text {CFD}}-v_{4{\text {DMR}}})$$\end{document}vCFD-v4DMR) in each case] are indicated by a horizontal dotted line and are assessed quantitatively in Table 3 at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy}…

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  Figure 7. TAWSS contours in cases D and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\delta$$\end{document}δ, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\beta$$\end{document}β, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\gamma$$\end{document}γ and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy}…

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  Figure 8. Contours of OSI and ECAP in D and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$D_{\min }$$\end{document}Dmin. Probe points at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\epsilon$$\end{document}ϵ, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sigma$$\end{document}σ and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\mu$$\end{document}μ indicate higher levels of ECAP in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym}…