Abstract
Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid–solid interaction models are developed. Since there is no clear approach for managing the CoA regarding its severity, this study proposes the use of WSS indices and pressure gradient to better establish a framework for treatment procedures in CoA patients with different severities. This provides a platform for improving CoA therapy on a patient-specific level, in which physicians can perform treatment methods based on WSS indices on top of using a mere experience. Results show how severe CoA affects the aorta in comparison to the milder cases, which can give the medical community valuable information before and after any intervention.
Highlights
Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta
O’Rourke and Cartmill proposed that the majority of unhealthiness for CoA could be described on the base of unusual haemodynamics through the ascending aorta and connected branches by indicating its alarmingly altered conduit and cushioning functions linking to C oA17
This study proposes the use of wall shear stress (WSS) indices and pressure gradient to better establish a framework for stent placement in CoA patients with different severities, which could lead to less stent failures and follow-up complications
Summary
Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Since there is no clear approach for managing the CoA regarding its severity, this study proposes the use of WSS indices and pressure gradient to better establish a framework for treatment procedures in CoA patients with different severities. The present study evaluates the proportion of flow post-coarctation to better understand the affected and altered haemodynamic parameters caused by the area reduction in the throat of CoA that would help clinicians introduce the intervention framework based on WSS indices and pressure gradient, which has not been investigated before. This study emphasizes; the importance of choosing the optimum treatment methods for CoA patients considering its severity (as considerable differences of disturbed hemodynamics are found for different CoA severities in this study), and the great impact of doing FSI simulations for each patient and considering the altered WSS indices (as several stent failure and complications have been reported) This approach is based on logical engineering equations rather than utilizing stents based on experience. There is no idealized FSI CoA geometries study that investigates the disturbed hemodynamics, which can give a reasonable view of this study’s aim without the impact of the different morphological factors on important hemodynamics parameters
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