Investigating the role of thrombosis and false lumen orbital orientation in the hemodynamics of Type B aortic dissection

Figures

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  Fig. 1. Patient-specific Models. Patient-specific models with red labels denoting the entry tear (E), re-entry tear (R), and fenestration (F) locations. The following cross-sections at areas of interest are shown in green: ascending thoracic aorta (ATA), descending thoracic aorta (DTA/DTA1.5/DTA2), intra-abdominal aorta (IAA). Patient 3’s large fenestration of 3.7 mm (red box) is located between the DTA and DTA2 cross-sections. The true lumen, the false lumen, and the solid are shown in purple, light purple, and grey, respectively. The location of the thrombus (i.e. no flow) in the false lumen (FL) of Patient 3 is highlighted in blue. Graphics generated using ParaView (v5.11, https://www.paraview.org).

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  Fig. 2. CT-to-FSI Pipeline. Pipeline from patient’s CT images to final FSI results. The code written to accelerate the pipeline and simplify the analysis of multiple patients is highlighted in orange.

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  Fig. 3. LVOT Areas and Inlet Flow Rates. (a) Computed tomography (CT) images showing the left ventricular outflow tract (LVOT) Areas of Patient 1 (4.28 cm\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^2$$\end{document}2), 2 (3.72 cm\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^2$$\end{document}2), and 3 (6.96 cm\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^2$$\end{document}2). The images are rotated so that the axial view is perpendicular to blood flow in the sagittal view. (b) Imposed inlet flow rate over one cardiac cycle (t = 779 ms). The stroke volume of each patient is used to scale the baseline inlet flow from Bäumler et al.42, which…

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  Fig. 4. Velocity magnitude, flow rate, and luminal pressure difference at key cross-sections Patient-specific models with cross-sections of interest colored by velocity magnitude at peak systole (t = 234 ms) for (a) Patient 1, (b) Patient 2, and (c) Patient 3. Red labels denote the location of the entry tear (E), re-entry tear (R), and large fenestration (F). The graphs show patients’ true lumen (TL) flow rate (solid blue line), false lumen (FL) flow rate (dashed blue line), luminal pressure difference \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Delta P_{TL-FL}$$\end{document}ΔPTL-FL (red line), and FL flow ratio \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$FR_{FL}$$\end{document}FRFL at cross-sections of interest (DTA, DTA2, and IAA) over one cardiac cycle. Graphics generated using ParaView (v5.11,…

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  Fig. 5. Flow Velocity Streamlines. (a) Patients’ velocity streamlines colored by velocity magnitude at peak systole (t = 234 ms). (b) Zoomed-in views of the aortic arch and entry tear/large fenestration showing: (i) a flow jet through the entry tear/large fenestration and (ii) a recirculating flow in the false lumen (FL). A helical flow can also be observed in the FL of Patient 2 and 3. Graphics generated using ParaView (v5.11, https://www.paraview.org).

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  Fig. 6. TAWSS and OSI Distibutions. (a) Time averaged wall shear stress (TAWSS) distribution and (b) oscillatory shear index (OSI) distribution for Patient 1 (P1), Patient 2 (P2), and Patient 3 (P3). (E) and (R) mark the entry and re-entry tear(s) locations, (F) marks the location of a large fenestration in the descending thoracic aorta of Patient 3. Graphics generated using ParaView (v5.11, https://www.paraview.org).

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  Fig. 7. Velocity Magnitude, Flow rate, and Luminal Pressure Difference at Key Cross-sections of Patient 3’s Additional Models. (a) Patient 3’s ET (entry tear only) and (b) ET_FN (entry tear and fenestration) models with cross-sections of interest colored by velocity magnitude at peak systole (t = 234 ms), and red labels denoting the location of the entry tear (E) and large fenestration (F). The graphs show the true lumen (TL) flow rate (solid blue line), false lumen (FL) flow rate (dashed blue line), luminal pressure difference \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Delta P_{TL-FL}$$\end{document}ΔPTL-FL (red line), and FL flow ratio \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$FR_{FL}$$\end{document}FRFL at cross-sections of interest (DTA, DTA2, and IAA) over one cardiac cycle. Graphics generated using ParaView…

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  Fig. 8. Hemodynamic effects of the arterial wall and dissection flap stiffness on patient 3 Models. (a) Maximum (solid lines) and minimum (dash lines) of the luminal pressure difference \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Delta P_{TL-FL}$$\end{document}ΔPTL-FL and (b) false lumen (FL) flow ratio \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$FR_{FL}$$\end{document}FRFL of Patient 3’s original model (yellow lines), ET_FN model (red lines), and ET model (blue lines) under an increasing elastic modulus \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$E_{wall}$$\end{document}Ewall, with \documentclass[12pt]{minimal} \usepackage{amsmath}…