Physiological Pulsatile Flow Research Articles

Human Applications of the Anstadt Cup: Implications for Non–Blood-Contacting Biventricular Support

BackgroundDirect mechanical ventricular actuation (DMVA) with the Anstadt cup is effective for non–blood-contacting biventricular support. Pneumatic regulation of a silicone device augments ventricular pump function. Vacuum attachment facilitates diastolic augmentation critical for biventricular support. This report reviews outcomes in patients supported for bridge to transplantation. MethodsDMVA was approved by the institutional review board at Duke University for refractory cardiogenic shock in potential candidates for heart transplantation. Devices with silicone membranes were controlled by pneumatic drive systems. Explanted hearts underwent extensive histologic examination. ResultsFive patients met inclusion criteria. All exhibited immediate return of physiologic pulsatile flow and reduced pulmonary pressures during device insertion. Vasopressors, inotropes, and balloon pump support were discontinued at implantation or within 48 hours. Installation through left thoracotomy (n = 4) took <5 minutes. Postcardiotomy support (n = 1) enabled routine decannulation. Support ranged from 2 to 84 days. Long-term survivors (n = 2) received 2 days of DMVA bridging to heart transplantation and 7.5 days of DMVA for acute myocarditis. There were no device-related complications. An expert cardiovascular pathologist found no evidence of device-related myocardial trauma or injury (n = 4) and no adverse effects on bypass grafts (n = 1). Recovery was deemed futile (n = 3) after diffuse cerebral emboli from prior aortic cross-clamp and extended cardiopulmonary resuscitation and for preexisting sepsis leading to end-organ failure. ConclusionsDMVA with the Anstadt cup effectively supported the failing or arrested heart in humans without adverse cardiac effects. Unique diastolic augmentation, return of physiologic pulsatile flow, and no blood contact contribute to device efficacy.

Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study

BackgroundWe investigated differences in intracranial embolus distribution through communicating arteries in relation to supra-aortic vessel (SAV) patency.MethodsFor this experimental analysis, we created a silicone model of the extracranial and intracranial...

Hemodynamic Insights into Abdominal Aortic Aneurysms: Bridging the Knowledge Gap for Improved Patient Care

Background: Abdominal aortic aneurysms (AAAs) present a formidable public health concern due to their propensity for localized, anomalous expansion of the abdominal aorta. These insidious dilations, often in their early stages, mask the life-threatening potential for rupture, which carries a grave prognosis. Understanding the hemodynamic intricacies governing AAAs is paramount for predicting aneurysmal growth and the imminent risk of rupture. Objective: Our extensive investigation delves into this complex hemodynamic environment intrinsic to AAAs, utilizing comprehensive numerical analyses of the physiological pulsatile blood flow and realistic boundary conditions to explore the multifaceted dynamics influencing aneurysm rupture risk. Our study introduces novel elements by integrating these parameters into the overall context of aneurysm pathophysiology, thus advancing our understanding of the intricate mechanics governing their evolution and rupture. Methods: Conservation of mass and momentum equations are used to model the blood flow in an AAAs, and these equations are solved using a finite volume-based ANSYS Fluent solver. Resistance pressure outlets following a three-element Windkessel model were imposed at each outlet to accurately model the blood flow and the AAAs’ shear stress. Results: Our results uncover elevated blood flow velocities within an aneurysm, suggesting an augmented risk of future rupture due to increased stress in the aneurysm wall. During the systole phase, high wall shear stress (WSS) was observed, typically associated with a lower risk of rupture, while a low oscillatory shear index (OSI) was noted, correlating with a decreased risk of aneurysm expansion. Conversely, during the diastole phase, low WSS and a high OSI were identified, potentially weakening the aneurysm wall, thereby promoting expansion and rupture. Conclusion: Our study underscores the indispensable role of computational fluid dynamic (CFD) techniques in the diagnostic, therapeutic, and monitoring realms of AAAs. This body of research significantly advances our understanding of aneurysm pathophysiology, thus offering pivotal insights into the intricate mechanics underpinning their progression and rupture, informing clinical interventions and enhancing patient care.

Analysis of physiological pulsating flow of fractional Maxwell fluid in a locally narrow artery

The purpose of this paper is to provide a novel reference for the early diagnosis and treatment of atherosclerosis. Two-dimensional governing equations of fractional-order Maxwell fluid flow in a local stenotic artery are established, taking real physiological pulsating blood flow at inlet into consideration. Drawing support from the finite difference method as well as the L1 formula, vorticity and stream functions are introduced to acquire numerical solutions for velocity, stream function, and pressure. The distribution of blood flow in narrowed arteries within a real physiological pulse cycle is discussed. Furthermore, the influences of the degree of stenosis δ, the stenosis length parameter L0, fractional order parameter α, and relaxation time λ on crucial medical indicators, including the time average of the wall shear stress, oscillatory shear index, relative residence time, and pressure distribution are revealed. The results show that the deceleration and reversal phases of real physiological pulsatile flow critically affect the progression of arterial stenosis, and increasing the fractional order parameter α weakens the development of stenosis, while increasing λ has the opposite effect. This study is expected to serve as a reference for formulating standards of key medical indicators in the early diagnosis of vascular stenosis.

A Universal Device to Convert a Continuous Flow Assist Device to a Pulsatile Flow Device to Simulate Normal Blood Flow and Pressure Patterns.

Continuous follow assist devices (CFAD) are the most commonly used mechanical circulatory support devices. Compared to Pulsatile flow assist devices (PFAD), CFADs deliver a non-physiologic type of flow, which might contribute to complications related to lack of pulsatility in these devices. Moreover, lack of pulsatility complicates the clinical management of these patients who often present with good perfusion but with no palpable pulse and none or a negligible pulse pressure on blood pressure measurement. Presented here is a concept of a universal converter device that can be added inline other CFADs to convert the flow from continuous to pulsatile, simulating a normal flow and pressure pattern. After initial implantation and stabilization with a CFAD, adding this converter might potentially provide the benefits of pulsatile physiologic flow. The device is made of 2 components connected in parallel, working in tandem in user determined cycles. The continuous flow through a specifically positioned openings create a smooth conversion to a pulsatile flow. This device can convert a continuous flow to a physiologic pulsatile flow to achieve a native-like flow pattern and potentially prevent some CFAD complications. This paper presents the concept of pulsatility generation and simulation for other assist devices. Such a device can be a universal add-on or a supplemental option for CFADs.

Soft Robotic Dynamic Cardiomyoplasty with Electrically Contractile Artificial Muscle (AHM)

<h3>Purpose</h3> Ventricular assist devices (VADs) have clinically evolved as a promising alternative for the treatment of end-stage heart failure. The greatest challenges of these devices still remain infections, bleedings and thromboembolic events. Moreover, non-pulsatile blood flow has led to new complications such as formation of arteriovenous malformations with subsequent bleeding in the gastro-intestinal tract and aortic valve regurgitation. Aim of our experimental study was the development of soft electrically contractile artificial muscles wrapped around the heart. This enables a physiological pulsatile flow of the heart and does not require anticoagulation, the main cause of major adverse cardiac and cerebrovascular events in VAD therapy as there is no direct blood contact between the artificial muscle and blood. <h3>Methods</h3> Silver coated nylon (SCN) conductive actuator filaments were fabricated, aligned in a braided fashion and linked together with silicone akin to human striated muscle. Wrapped in layers around lamb hearts with closed mitral valve as a heart sleeve in-vitro, the aortic pressure and contraction rate during upon electrical stimulation of the AHM with 32.5 V electricity was monitored. <h3>Results</h3> After a series of modifications and improvements, in analogy to the human heart stable pressures of 120 mmHg in systole, 80 mmHg in diastole and a mean stimulation rate was 84 /minute could be achieved. <h3>Conclusion</h3> This represents the first successful study demonstrating that an electrically contractile artificial muscle/soft robot can generate pressures and contraction rates necessary to support the left ventricle of the heart.

Viscoelasticity of human descending thoracic aorta in a mock circulatory loop

Healthy human descending thoracic aortas, obtained during organ donation for transplant and research, were tested in a mock circulatory loop to measure the mechanical response to physiological pulsatile pressure and flow. The viscoelastic properties of the aortic segments were investigated at three different pulse rates. The same aortic segments were also subjected to quasi-static pressure tests in order to identify the aortic dynamic stiffness ratio, which is defined as the ratio between the stiffness in case of pulsatile pressure and the stiffness measured for static pressurization, both at the same value of pressure. The loss factor was also identified. The shape of the deformed aorta under static and dynamic pressure was measured by image processing to verify the compatibility of the end supports with the natural deformation of the aorta in the human body. In addition, layer-specific experiments on 10 human descending thoracic aortas allowed to precisely identify the mass density of the aortic tissue, which is an important parameter in cardiovascular dynamic models.

An Experimental Set-Up for the &amp;lt;i&amp;gt;in Vitro&amp;lt;/i&amp;gt; Simulation of a Physiological Pulsatile Flow in the Abdominal Aorta

In vitro experimental set-up is an important tool for investigating abdominal aortic aneurysm (AAA). Accurate reproduction of the physiological pulsatile flow waveform in the abdominal aorta at various anatomic locations is an important component of these experimental methods. The objective of this study is to establish an experimental set-up to generate a physiological pulsatile flow for in vitro simulations of the abdominal aorta. The physiological flow was established by a computer-controlled peristaltic pump and the flow field in a circular straight pipe is measured under pulsatile flow conditions by a 2-dimensional particle image velocimetry system (2D-PIV). Experimental results show that the in vitro experimental set-up provides a flow with a period of 2 s, a reasonable cross-sectional velocity distribution and an approximate inlet velocity profile that is close to the human abdominal aorta.

In-vitro and In-Vivo Assessment of 4D Flow MRI Reynolds Stress Mapping for Pulsatile Blood Flow.

Imaging hemodynamics play an important role in the diagnosis of abnormal blood flow due to vascular and valvular diseases as well as in monitoring the recovery of normal blood flow after surgical or interventional treatment. Recently, characterization of turbulent blood flow using 4D flow magnetic resonance imaging (MRI) has been demonstrated by utilizing the changes in signal magnitude depending on intravoxel spin distribution. The imaging sequence was extended with a six-directional icosahedral (ICOSA6) flow-encoding to characterize all elements of the Reynolds stress tensor (RST) in turbulent blood flow. In the present study, we aimed to demonstrate the feasibility of full RST analysis using ICOSA6 4D flow MRI under physiological conditions. First, the turbulence analysis was performed through in vitro experiments with a physiological pulsatile flow condition. Second, a total of 12 normal subjects and one patient with severe aortic stenosis were analyzed using the same sequence. The in-vitro study showed that total turbulent kinetic energy (TKE) was less affected by the signal-to-noise ratio (SNR), however, maximum principal turbulence shear stress (MPTSS) and total turbulence production (TP) had a noise-induced bias. Smaller degree of the bias was observed for TP compared to MPTSS. In-vivo study showed that the subject-variability on turbulence quantification was relatively low for the consistent scan protocol. The in vivo demonstration of the stenosis patient showed that the turbulence analysis could clearly distinguish the difference in all turbulence parameters as they were at least an order of magnitude larger than those from the normal subjects.

An Inexpensive Cardiovascular Flow Simulator for Cardiac Catheterization Procedure Using a Pulmonary Artery Catheter.

Cardiac catheterization associated with central vein cannulation can involve potential thrombotic and infectious complications due to multiple cannulation trials or improper placement. To minimize the risks, medical simulators are used for training. Simulators are also employed to test medical devices such as catheters before performing animal tests because they are more cost-effective and still reveal necessary improvements. However, commercial simulators are expensive, simplified for their purpose, and provide limited access sites. Inexpensive and anatomical cardiovascular simulators with central venous access for cannulation are sparse. Here, we developed an anatomically and physiologically accurate cardiovascular flow simulator to help train medical professionals and test medical devices. Our simulator includes an anatomical right atrium/ventricle, femoral and radial access sites, and considers the variability of arm position. It simulates physiological pulsatile blood flow with a setting for constant flow from 3 to 6 L/min and mimics physiological temperature (37°C). We demonstrated simulation by inserting a catheter into the system at radial/femoral access sites, passing it through the vasculature, and advancing it into the heart. We expect that our simulator can be used as an educational tool for cardiac catheterization as well as a testing tool that will allow for design iteration before moving to animal trials.

Micro-pillar sensor based wall-shear mapping in pulsating flows: In-situ calibration and measurements in an aortic heart-valve tester

Accurate wall-shear stress (WSS) in-vitro measurements within complex geometries such as the human aortic arch under pulsatile flow are still difficult to achieve, meanwhile such data are important for classifying impacts of prosthetic valves on aortic walls. Micro-cantilever beams can serve to sense the WSS in such flows for applications in in-vitro flow tester. However, within pulsatile flows and complex 3D curved geometries such as the aortic arch, the flexible sensor structures are subject to oscillating boundary layer thickness and profile shape, which may not have been taken into account in the calibration procedure. The fluid–structure interaction is sensitive to these changes, thus reflecting also the flow-induced deflection of the sensor tip which is actually the sensing signal. We develop herein a methodology for in-situ calibration of the response of the sensors directly in the complex geometry of the aortic arch, assisted by reference data from numerical simulations of the flow under the same boundary conditions. For this procedure, a quick exchange of the heart valve in the tester with a tubular insert is done to provide a smooth contour in the curved aorta model. Arrays of 500 μm long micro-pillar WSS sensors in the aorta model are calibrated under physiological pulsatile flow and used then for mapping the WSS evolution in the arch induced by two different heart valve, showing their difference of impact. The developed methodology completes the in-house built in-vitro flow tester with a reliable WSS measurement technique and provides a unique hydrodynamic testing facility for heart valve prostheses and their impact on the WSS distal along the aortic walls.

Pediatric Sized REBOA Catheter Testing in a Pulsatile Aortic Flow Model

Background – Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of pediatric abdomino-pelvic hemorrhage from trauma or iatrogenic injury is limited by a lack of appropriately sized balloon catheters that can be delivered through less than a 7 French sheath.&#x0D; Methods – We bench tested the occlusion capability of eight commercially available balloon catheters deliverable through 4Fr, 5Fr and 6Fr sheaths in an anatomic pulsatile flow model of the pediatric aorta with variable luminal diameters (5mm, 6mm, 7mm, 8mm, 9mm, 10mm, and 12mm). Inflated balloon migration and the deflated balloon’s effect on aortic flow were recorded. The flow chamber was calibrated to approximate size-appropriate physiologic aortic blood flow.&#x0D; Results – Seven of eight devices were able to occlude the test lumen diameter corresponding to their manufacture specifications. Deflated luminal flow restriction in the smallest test lumen was lowest in the Fogarty devices (0-3%) followed by Cordis (8-10%) and Numed (14-26%) devices. The Fogarty devices demonstrated the most distal migration (10-15mm) followed by Numed (1-5mm). Device migration was undetectable in the Cordis devices. &#x0D; Conclusion – There are commercially available balloon catheters, deliverable through smaller than 7Fr sheaths which can occlude pediatric sized aortic test lumens in the setting of physiologic pulsatile flow. These results will help inform future research, device development and practice in the field of pediatric REBOA.

Wall Shear Stress Assessment of the False Lumen in Acute Type B Aortic Dissection Visualized by 4-Dimensional Flow Magnetic Resonance Imaging: An Ex-Vivo Study.

Four-dimensional flow magnetic resonance imaging (4D flow MRI) can accurately visualize and quantify flow and provide hemodynamic information such as wall shear stress (WSS). This imaging technique can be used to obtain more insight in the hemodynamic changes during cardiac cycle in the true and false lumen of uncomplicated acute Type B Aortic Dissection (TBAD). Gaining more insight of these forces in the false lumen in uncomplicated TBAD during optimal medical treatment, might result in prediction of adverse outcomes. A porcine aorta dissection model with an artificial dissection was positioned in a validated ex-vivo circulatory system with physiological pulsatile flow. 4D flow MR images with 3 set heartrates (HR; 60 bpm, 80 bpm and 100 bpm) were acquired. False lumen volume per cycle (FLV), mean and peak systolic WSS were determined from 4D flow MRI data. For validation, the experiment was repeated with a second porcine aorta dissection model. During both experiments an increase in FLV (initial experiment: ΔFLV = 2.05 ml, p < 0.001, repeated experiment: ΔFLV = 1.08 ml, p = 0.005) and peak WSS (initial experiment: ΔWSS = 1.2 Pa, p = 0.004, repeated experiment: ΔWSS = 1.79 Pa, p = 0.016) was observed when HR increased from 60 to 80 bpm. Raising the HR from 80 to 100 bpm, no significant increase in FLV (p = 0.073, p = 0.139) was seen during both experiments. The false lumen mean WSS increased significant during initial (2.71 to 3.85 Pa; p = 0.013) and non-significant during repeated experiment (3.22 to 4.00 Pa; p = 0.320). 4D flow MRI provides insight into hemodynamic dimensions including WSS. Our ex-vivo experiments showed that an increase in HR from 60 to 80 bpm resulted in a significant increase of FLV and WSS of the false lumen. We suggest that strict heart rate control is of major importance to reduce the mean and peak WSS in uncomplicated acute TBAD. Because of the limitations of an ex-vivo study, 4D flow MRI will have to be performed in clinical setting to determine whether this imaging model would be of value to predict the course of uncomplicated TBAD.

Computational Fluid Dynamics Simulations to Predict False Lumen Enlargement After Surgical Repair of Type-A Aortic Dissection

We aim to use computational fluid dynamics to investigate the hemodynamic conditions that may predispose to false lumen enlargement in this patient population. Nine patients who received surgical repairs of their type-A aortic dissections between 2017-2018 were retrospectively identified. Multiple contrast-enhanced post-operative CT scans were used to construct 3D models of aortic geometries. Computational fluid dynamics simulations of the models were run on a high-performance computing cluster using SimVascular - an open-source simulation package. Physiological pulsatile flow conditions (4.9 L/min) were used at the aortic true lumen inlet, and physiological vascular resistances were applied at the distal vascular ends. Exploratory analyses showed no correlation between rate of false lumen growth and blood pressure, immediate post-op aortic diameter, or the number of fenestrations (p=0.2). 1-year post-operative CT scans showed a median false lumen growth rate of 4.31 (3.66, 14.67) mm/year Median (Interquartile range) peak systolic, mid-diastolic, and late diastolic velocity magnitudes were 0.90 (1.40); 0.10 (0.16); and 0.06 (0.06) cm/s respectively. Spearman's ranked correlations between fenestration velocity and 1-year false lumen growth rates were found to be statistically significant: Velocity magnitude at peak systolic (p=0.025; rho=0.75), mid diastolic (p=0.025; rho=0.75) and late diastolic phases of the cardiac cycle (p=0.006; rho=0.85). We have shown that false lumen growth is strongly correlated to fenestration flow velocity, which has potential implications for post-operative surveillance and risk stratification.

PIV Analysis of Haemodynamics Distal to the Frozen Elephant Trunk Stent Surrogate.

The Frozen Elephant Trunk (FET) stent is a hybrid endovascular device that may be implemented in the event of an aneurysm or aortic dissection of the aortic arch or superior descending aorta. A Type 1B endoleak can lead to intrasaccular flow during systole and has been identified as a known failure of the FET stent graft. The purpose was to develop in-vitro modelling techniques to enable the investigation of the known failure. A silicone aortic phantom and 3D printed surrogate stent graft were manufactured to investigate the haemodynamics of a Type 1B endoleak. Physiological pulsatile flow dynamics distal to the surrogate stent graft were investigated in-vitro using Particle Image Velocimetry (PIV). PIV captured recirculation zones and an endoleak distal to the surrogate stent graft. The endoleak was developed at the peak of systole and sustained until the onset of diastole. The endoleak was asymmetric, indicating a potential variation in the phantom artery wall thickness or stent alignment. Recirculation was identified on the posterior dorsal line during late systole. The identification of the Type 1B endoleak proved that in-vitro modelling can be used to investigate complex compliance changes and wall motions. The recirculation may indicate the potential for long term intimal layer inflammatory issues such as atherosclerosis. These results may aid future remediation techniques or stent design. Further development of the methods used in this experiment may assist with the future testing of stents prior to animal or human trial.

RAMP2-AS1 Regulates Endothelial Homeostasis and Aging.

The homeostasis of vascular endothelium is crucial for cardiovascular health and endothelial cell (EC) aging and dysfunction could negatively impact vascular function. Leveraging transcriptome profiles from ECs subjected to various stimuli, including time-series data obtained from ECs under physiological pulsatile flow vs. pathophysiological oscillatory flow, we performed principal component analysis (PCA) to identify key genes contributing to divergent transcriptional states of ECs. Through bioinformatics analysis, we identified that a long non-coding RNA (lncRNA) RAMP2-AS1 encoded on the antisense of RAMP2, a determinant of endothelial homeostasis and vascular integrity, is a novel regulator essential for EC homeostasis and function. Knockdown of RAMP2-AS1 suppressed RAMP2 expression and caused EC functional changes promoting aging, including impaired angiogenesis and increased senescence. Our study demonstrates an integrative approach to quantifying EC aging based on transcriptome changes, which also identified a number of novel regulators, including protein-coding genes and many lncRNAs involved EC functional modulation, exemplified by RAMP2-AS1.

Pulsatile Flow-Induced Fatigue-Resistant Photopolymerizable Hydrogels for the Treatment of Intracranial Aneurysms.

An alternative intracranial aneurysm embolic agent is emerging in the form of hydrogels due to their ability to be injected in liquid phase and solidify in situ. Hydrogels have the ability to fill an aneurysm sac more completely compared to solid implants such as those used in coil embolization. Recently, the feasibility to implement photopolymerizable poly(ethylene glycol) dimethacrylate (PEGDMA) hydrogels in vitro has been demonstrated for aneurysm application. Nonetheless, the physical and mechanical properties of such hydrogels require further characterization to evaluate their long-term integrity and stability to avoid implant compaction and aneurysm recurrence over time. To that end, molecular weight and polymer content of the hydrogels were tuned to match the elastic modulus and compliance of aneurysmal tissue while minimizing the swelling volume and pressure. The hydrogel precursor was injected and photopolymerized in an in vitro aneurysm model, designed by casting polydimethylsiloxane (PDMS) around 3D printed water-soluble sacrificial molds. The hydrogels were then exposed to a fatigue test under physiological pulsatile flow, inducing a combination of circumferential and shear stresses. The hydrogels withstood 5.5 million cycles and no significant weight loss of the implant was observed nor did the polymerized hydrogel protrude or migrate into the parent artery. Slight surface erosion defects of 2–10 μm in depth were observed after loading compared to 2 μm maximum for non-loaded hydrogels. These results show that our fine-tuned photopolymerized hydrogel is expected to withstand the physiological conditions of an in vivo implant study.

Parametric Sequential Method for MRI-Based Wall Shear Stress Quantification.

Wall shear stress (WSS) has been suggested as a potential biomarker in various cardiovascular diseases and it can be estimated from phase-contrast Magnetic Resonance Imaging (PC-MRI) velocity measurements. We present a parametric sequential method for MRI-based WSS quantification consisting of a geometry identification and a subsequent approximation of the velocity field. This work focuses on its validation, investigating well controlled high-resolution in vitro measurements of turbulent stationary flows and physiological pulsatile flows in phantoms. Initial tests for in vivo 2D PC-MRI data of the ascending aorta of three volunteers demonstrate basic applicability of the method to in vivo.

Glycoprotein VI (GPVI)-functionalized nanoparticles targeting arterial injury sites under physiological flow

Thrombus formation at athero-thrombotic sites is initiated by the exposure of collagen followed by platelet adhesion mediated by the platelet-specific collagen receptor glycoprotein VI (GPVI). Here, dimeric GPVI was used as a targeting motif to functionalize polymeric nanoparticle-based drug carriers and to show that with proper design, such GPVI-coated nanoparticles (GPNs) can efficiently and specifically target arterial injury sites while withstanding physiological flow. In a microfluidic model, under physiological shear levels (1-40 dyne/cm2), 200 nm and 2 μm GPNs exhibited a >60 and >10-fold increase in binding to collagen compared to control particles, respectively. In vitro experiments in an arterial stenosis injury model, subjected to physiological pulsatile flow, showed shear-enhanced adhesion of 200 nm GPNs at the stenosis region which was confirmed in vivo in a mice ligation carotid injury model using intravital microscopy. Altogether, our results illustrate how engineering tools can be harnessed to design nano-carriers that efficiently target cardiovascular disease sites.

The Influence of Aortic Wall Elasticity on the False Lumen in Aortic Dissection: An In Vitro Study.

Hemodynamics, dissection morphology, and aortic wall elasticity have a major influence on the pressure in the false lumen. In contrast to aortic wall elasticity, the influence of hemodynamics and dissection morphology have been investigated often in multiple in vitro and ex vivo studies. The purpose of this study was to evaluate the influence of aortic wall elasticity on the diameter and pressure of the false lumen in aortic dissection. An artificial dissection was created in 3 ex vivo porcine aortas. The aorta models were consecutively positioned in a validated in vitro circulatory system with physiological pulsatile flow. Each model was imaged with ultrasound on 4 positions along the aorta and the dissection. At these 4 locations, pressure measurement was also performed in the true and false lumen with an arterial catheter. After baseline experiments, the aortic wall elasticity was adjusted with silicon and the experiments were repeated. The aortic wall elasticity was decreased in all 3 models after siliconizing. In all 3 siliconized models, the diameters of the true and false lumen increased at proximal, mid, and distal location, while the mean arterial pressure did not significantly change. In this in vitro study, we showed that aortic wall elasticity is an important parameter altering the false lumen. An aortic wall with reduced elasticity results in an increased false lumen diameter in the mid and distal part of the false lumen. These results can only be transferred to corresponding clinical situations to a limited extent.