Abstract
The abnormal diameter of the coronary artery is twice or more than the normal diameter, which is a coronary artery aneurysm (CAA). According to the clinical statistics, CAA shows high occurrence on right coronary artery (RCA). The most common cause of CAA in adults is atherosclerosis, which destroys the elastic fibers in the middle layer of the blood vessel. Under the intravascular pressure, the weak wall bulges outward and form CAA. This article aims to explain the hemodynamic mechanism of coronary artery aneurysm shows high occurrence on RCA. Occurrence of CAA was simulated by the volume growth of coronary artery. Firstly, a 0–3D multi-scale model of normal coronary artery was constructed to obtain the hemodynamic environments of coronary artery. Then, fluid-structure interaction of normal and atherosclerotic blood vessel was performed to obtain volume growth rate of the coronary artery. Atherosclerosis was simulated by modifying Young’s modulus in middle layer of the blood vessel. Finally, creep simulation was performed to compare the deformation of the blood vessels under the accumulation of time. Under normal condition, the volume growth rate of the RCA is 2.28 times and 1.55 times of the LAD and the LCX. After atherosclerosis, the volume growth rate of the RCA was 2.69 times and 2.12 times of the LAD and the LCX. And the volume growth rate of the RCA was 3.85 times and 3.45 times of the LAD and the LCX after further deepening of atherosclerosis. The expansion time above the average volume growth rate of the RCA, the LAD and the LCX respectively were 0.194, 0.168 and 0.179 s. The RCA is 2.06 times the original, the LAD and LCX are 1.53 times and 1.56 times after 10 years in creep simulation. It can be concluded that the RCA is more prone to aneurysms originated from the larger expansion of the RCA under normal physiological condition, and the larger expansion is magnified under atherosclerosis condition with destroyed vessel elasticity, and further magnified during the time accumulated viscoelastic creep to develop to aneurysm eventually.
Highlights
The abnormal diameter of the coronary artery is twice or more than the normal diameter, which is a coronary aneurysm (Syed, 1997; Pahlavan and Niroomand, 2006; Jariwala et al, 2018) (Coronary Artery Aneurysm, coronary artery aneurysm (CAA)).The most common cause of CAA in adults is atherosclerosis, which destroys the elastic fibers in the middle layer of the blood vessel
The study of coronary aneurysms is more common in a few clinical reports, and its hemodynamic mechanism research is still insufficient
It can be seen that the average diameter of the right coronary artery (RCA) is greater than the left anterior descending artery (LAD) and the left circumflex artery (LCX)
Summary
The abnormal diameter of the coronary artery is twice or more than the normal diameter, which is a coronary aneurysm (Syed, 1997; Pahlavan and Niroomand, 2006; Jariwala et al, 2018) (Coronary Artery Aneurysm, CAA).The most common cause of CAA in adults is atherosclerosis, which destroys the elastic fibers in the middle layer of the blood vessel. The abnormal diameter of the coronary artery is twice or more than the normal diameter, which is a coronary aneurysm (Syed, 1997; Pahlavan and Niroomand, 2006; Jariwala et al, 2018) (Coronary Artery Aneurysm, CAA). There were totally 878 dilated coronary arteries, and the main branch of right coronary artery (RCA) was mostly involved (41.80%), followed by the main branch of left anterior descending artery (LAD) (25.40%), the main branch of left circumflex artery (LCX) (21.64%), and the left main coronary artery (LM) (4.78%). It can be seen that the coronary aneurysm presents high occurrence on RCA. Due to the rareness of coronary aneurysm, there are only a few reports of clinical cases and their treatment (Swaye et al, 1983; Dahhan, 2015). Why does coronary aneurysm present high occurrence on right coronary artery?
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