A Computer Model for the Prediction of Left Epicardial Coronary Blood Flow in Normal, Stenotic and Bypassed Coronary Arteries, by Single or Sequential Grafting

Abstract

This article describes a computer model for calculating left epicardial coronary blood pressure and flow waveforms of a right dominant coronary circulation. Using the geometry of 16 vascular branches and employing the one-dimensional Navier—Stokes equations the model allows for the prediction of blood pressure and flow patterns in normal and stenosed vessels. This model was also used to predict the haemodynamic changes observed after insertion of two single saphenous vein bypass grafts, as compared with the corresponding changes after insertion of a sequential (snake-like) saphenous graft. In normal vessels during systole and diastole, the pressure and the flow waveforms obtained showed patterns that correlate very well with the findings observed by other investigators using intracoronary flowmeter or Doppler velocimeter techniques. In coronary artery disease (90% stenoses in LAD and diagonal branch 1), the authors' main contribution is the reconfirmation of a previously described finding of systolic flow rises in stenotic segments. This finding seems to be an important compensatory mechanism, in contrast to normal coronary vessels, which maintain a mainly diastolic flow pattern. The introduction of single or sequential bypass grafts leads to pressure and flow restoration after graft revascularization. Besides this finding, the general concept of a diastolic flow restoration post-stenotically, in the previously decreased and systolic augmented flow areas, is also observed. The two revascularization methods were also compared with regard to their specific advantages, disadvantages and indications and were also extensively compared with several in vivo studies.