Key result
Patient-specific CFD simulations map LAA flow dynamics throughout the cardiac cycle.
Patient-specific 3D anatomical modeling and computational fluid dynamics can simulate flow dynamics inside the left atrial appendage to potentially aid in planning percutaneous closure procedures.
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Hypothesis-generating for CFD-guided LAA closure planning; prospective validation required before clinical adoption.
Introduction: Left atrial appendage (LAA) is a complex structure responsible for 90% of thrombus formation in patients with non-valvular atrial fibrillation (NVAF). In case of NVAF and contraindications to anticoagulation therapy, the percutaneous LAA closure is a treatment strategy to reduce the cardioembolic risk. This procedure is particularly difficult because of LAA anatomical and flow dynamics complexity and further related investigation would enhance the feasibility and efficacy of the intervention. Purpose: The aim of this study is to investigate the correlation between LAA morphology and corresponding flow dynamics for the planning of percutaneous LAA closure to prevent thromboembolic events. Methods: 4 CT dataset from patients scheduled for percutaneous LAA closure procedure have been segmented and processed through a specific tool to define the corresponding 3D anatomical model of left atrium, including LAA, pulmonary veins (PVs) and mitral valve (MV). A custom plug-in software was developed to measure the LAA volume variations during cardiac cycle directly from the 3D models. Computational fluid dynamics (CFD) simulations based on 4 patient-specific anatomies, each falling in one of the four LAA shape groups (chicken wing, cactus, windsock and cauliflower), were carried out to analyze the flow dynamics inside the LAA during the entire cardiac cycle. A time-dependent velocity profile was assigned on the 4 PVs as inlet condition, while the outlet condition imposed on the MV switched from closed to open configuration, to simulate systolic and diastolic ventricular phases, respectively.
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Fanni et al. (2018) studied Non-valvular atrial fibrillation (n=4). Computational fluid dynamics (CFD) simulations was evaluated on Flow dynamics inside the LAA during the entire cardiac cycle. Computational fluid dynamics simulations based on four patient-specific left atrial appendage anatomies were developed to analyze flow dynamics during the cardiac cycle.
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