Patient-specific Computational Hemodynamic Analysis for Interrupted Aortic Arch in an Adult: Implications for Aortic Dissection Initiation

Liqing Peng,Tinghui Zheng,Ding Yuan,Zhigang Yang,Yi Jiang,Da Li,Yue Qiu,Chenzhong Dai

doi:10.1038/s41598-019-45097-z

Liqing Peng, Tinghui Zheng + Show 6 more

Open Access

https://doi.org/10.1038/s41598-019-45097-z

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Abstract

The guideline for the treatment of interrupted aortic arch (IAA) in adults has not been established although most centers tend to propose surgery. There is no clear evidence for the preferred selection of surgical repair versus conservatively medical treatment for the uncertain effects of both treatments. However, reports of sporadic aortic dissection (AD) of descending aorta (DAo) in IAA in adults before surgery drew our attention. It is quite perplexing because there seems to be no risk factors for the development of AD at DAo such as long-term uncontrolled hypertension, atherosclerosis, aortic aneurysm or genetic disorder. In this paper, we carried out the numerical investigation on the hemodynamics in a patient-specific IAA model, which was reconstructed from computed tomography images. Hemodynamic parameters including the flow pattern, pressure distribution, and wall shear stress (WSS) indicators were obtained. The simulation revealed that the jet flows from the collateral arteries (CAs) induced risk hemodynamic forces on the lumen wall including high time-averaged wall shear stress (TAWSS), high pressure and rapid change of WSS direction throughout the cardiac cycle. Moreover, it is found that only a jet flow which circumferentially washes out the aortic wall might cause tears on the wall. It is concluded that the specific geometrical features of the extensive major CAs might result in the risky hemodynamics leading to the initiation and development of AD in this particular IAA patient. CFD analysis in IAA can provide a clinical reference, and the results should be further studied in depth in the future.

Highlights

Interrupted aortic arch (IAA) is defined as a complete loss of luminal and anatomic continuity between ascending and descending parts of the aorta[1]
The current study revealed that there were three features worth noting for the flow field of this interrupted aortic arch (IAA) patient
The upper segment of the descending aorta suffered from highly disturbed flow including helical, vortical and stagnant flow during the cardiac cycle

Summary

Introduction

Interrupted aortic arch (IAA) is defined as a complete loss of luminal and anatomic continuity between ascending and descending parts of the aorta[1]. Öztürk et al.[5] reported medical treatment of an adult with uncorrected isolated IAA resulted in no complications after 4 years of follow-up. The clinical presentation of IAA varies from the absence of symptoms to a headache, malaise, hypertension, claudication, differential blood pressure between the upper and lower extremities, limb swelling, congestive heart failure and aortic dissection. 5 cases of IAA in adult patients were reported with type B aortic dissection[6,7,8,9,10]. We conducted a computational fluid dynamics study in IAA of an adult to seek to determine the hemodynamic risk factors for aortic dissection based on computed tomography angiography (CTA) data sets

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Conclusion