Key result
Computational fluid dynamics simulations demonstrated that patients with coarctation of the aorta have a greater percentage of the aorta exposed to subnormal wall shear stress and elevated oscillatory shear index compared to a normal patient.
Patient-specific computational fluid dynamics models of aortic coarctation reveal that abnormal hemodynamics and biomechanical stresses persist or worsen during exercise despite treatment, potentially explaining long-term morbidity.
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Abnormal aortic shear patterns may underlie coarctation morbidity; leaves open whether targeted interventions can normalize hemodynamics.
Treatments for coarctation of the aorta (CoA) can alleviate blood pressure (BP) gradients (Δ), but long-term morbidity still exists that can be explained by altered indices of hemodynamics and biomechanics. We introduce a technique to increase our understanding of these indices for CoA under resting and nonresting conditions, quantify their contribution to morbidity, and evaluate treatment options. Patient-specific computational fluid dynamics (CFD) models were created from imaging and BP data for one normal and four CoA patients (moderate native CoA: Δ12 mmHg, severe native CoA: Δ25 mmHg and postoperative end-to-end and end-to-side patients: Δ0 mmHg). Simulations incorporated vessel deformation, downstream vascular resistance and compliance. Indices including cyclic strain, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) were quantified. Simulations replicated resting BP and blood flow data. BP during simulated exercise for the normal patient matched reported values. Greatest exercise-induced increases in systolic BP and mean and peak ΔBP occurred for the moderate native CoA patient (SBP: 115 to 154 mmHg; mean and peak ΔBP: 31 and 73 mmHg). Cyclic strain was elevated proximal to the coarctation for native CoA patients, but reduced throughout the aorta after treatment. A greater percentage of vessels was exposed to subnormal TAWSS or elevated OSI for CoA patients. Local patterns of these indices reported to correlate with atherosclerosis in normal patients were accentuated by CoA. These results apply CFD to a range of CoA patients for the first time and provide the foundation for future progress in this area.
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LaDisa et al. (2011) studied Coarctation of the aorta (n=5). Coarctation of the aorta (native or treated) vs. Normal patient anatomy was evaluated on Hemodynamic and biomechanical indices (cyclic strain, TAWSS, OSI, BP gradients). Computational fluid dynamics simulations demonstrated that patients with coarctation of the aorta have a greater percentage of the aorta exposed to subnormal wall shear stress and elevated oscillatory shear index compared to a normal patient.
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