Blood Flow Studies Research Articles

Recent Advances of PDMS In Vitro Biomodels for Flow Visualizations and Measurements: From Macro to Nanoscale Applications

Polydimethylsiloxane (PDMS) has become a popular material in microfluidic and macroscale in vitro models due to its elastomeric properties and versatility. PDMS-based biomodels are widely used in blood flow studies, offering a platform for improving flow models and validating numerical simulations. This review highlights recent advances in bioflow studies conducted using both PDMS microfluidic devices and macroscale biomodels, particularly in replicating physiological environments. PDMS microchannels are used in studies of blood cell deformation under confined conditions, demonstrating the potential to distinguish between healthy and diseased cells. PDMS also plays a critical role in fabricating arterial models from real medical images, including pathological conditions such as aneurysms. Cutting-edge applications, such as nanofluid hemodynamic studies and nanoparticle drug delivery in organ-on-a-chip platforms, represent the latest developments in PDMS research. In addition to these applications, this review critically discusses PDMS properties, fabrication methods, and its expanding role in micro- and nanoscale flow studies.

Study of renal blood flow in children with obstructive uropathies

Aim. To evaluate hemodynamic indicators of the kidneys in children with obstructive uropathies.Materials and Methods. The study was conducted at the Republican Scientific and Clinical Center of Pediatrics and Pediatric Surgery, involving 32 children aged 1 to 14 years, comprising 18 girls (56.3%) and 14 boys (43.7%). The children were divided into 3 groups: Group I with unilateral hydronephrosis - 14 (43.7%) children, Group II with bilateral hydronephrosis - 10 (31.3%) children, and Group III with ureterohydronephrosis - 8 (25%) children.Results and Discussion. Obstructive uropathy resulting from congenital kidney malformations, such as organic obstruction (hydronephrosis), causes dilation of the renal collecting system, increased ureteral pressure, reduced intrarenal blood flow, renal parenchyma atrophy, and progressive chronic renal failure.Conclusion. The above findings demonstrate that ultrasound using pulsed-wave Doppler and color Doppler mapping is an optimal non-invasive method for assessing renal hemodynamics.

Continuous measurements of respiratory muscle blood flow and oxygen consumption using noninvasive frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy.

Prior studies of muscle blood flow and muscle-specific oxygen consumption have required invasive injection of dye and magnetic resonance imaging, respectively. Such measures have limited utility for continuous monitoring of the respiratory muscles. Frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FD-NIRS & DCS) can provide continuous surrogate measures of blood flow index (BFi) and metabolic rate of oxygen consumption (MRO2). This study aimed to validate sternocleidomastoid FD-NIRS & DCS outcomes against electromyography (EMG) and mouth pressure (Pm) during incremental inspiratory threshold loading (ITL). Six female and six male healthy adults (means ± SD; 30 ± 7 yr, maximum inspiratory pressure 118 ± 61 cmH2O) performed incremental ITL starting at low loads (8 ± 2 cmH2O) followed by 50-g increments every 2 min until task failure. FD-NIRS & DCS continuously measured sternocleidomastoid oxygenated and deoxygenated hemoglobin + myoglobin (oxy/deoxy[Hb + Mb]), tissue saturation of oxygen (StO2), BFi, and MRO2. Ventilatory parameters including inspiratory Pm were also evaluated. Pm increased during incremental ITL (P < 0.05), reaching -47[-74 to -34] cmH2O (median [IQR: 25%-75%]) at task failure. Ventilatory parameters were constant throughout ITL (all P > 0.05). Sternocleidomastoid BFi and MRO2 increased from the start of the ITL (both P < 0.05). Deoxy[Hb + Mb] increased close to task failure, concomitantly with a constant increase in MRO2, and decreased StO2. Sternocleidomastoid deoxy[Hb + Mb], BFi, StO2, and MRO2 obtained during ITL via FD-NIRS & DCS correlated with sternocleidomastoid EMG (all P < 0.05). In healthy adults, FD-NIRS & DCS can provide continuous surrogate measures of respiratory BFi and MRO2. Increasing sternocleidomastoid oxygen consumption near task failure was associated with increased oxygen extraction and reduced tissue saturation.NEW & NOTEWORTHY This study introduces a novel approach, frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FD-NIRS & DCS), for noninvasive continuous monitoring of respiratory muscle blood flow and metabolic rate of oxygen consumption. Unlike prior methods involving invasive dye injection and magnetic resonance imaging, FD-NIRS & DCS offers the advantage of continuous measurement without the need for invasive procedures. It holds promise for advancing muscle physiology understanding and opens avenues for real-time monitoring of respiratory muscles.

4D flow MRI: value and clinical perspectives in patients with pathology of the heart and great vessels (part 2): A review

The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow MRI in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.

A multi-site 99mTc-HMPAO SPECT study of cerebral blood flow in a community sample of patients with major depression

Prior regional Cerebral Blood Flow (rCBF) studies in Major Depressive Disorder (MDD) have been limited by small, highly selective, non-representative samples that have yielded variable and poorly replicated findings. The aim of this study was to compare rCBF measures in a large, more representative community sample of adults with MDD and healthy control participants. This is a cross-sectional, retrospective multi-site cohort study in which clinical data from 338 patients 18–65 years of age with a primary diagnosis of MDD were retrieved from a central database for 8 privately owned, private-pay outpatient psychiatric centers across the United States. Two 99mTc-HMPAO SPECT brain scans, one at rest and one during performance of a continuous performance task, were acquired as a routine component of their initial clinical evaluation. In total, 103 healthy controls, 18–65 years old and recruited from the community were also assessed and scanned. Depressed patients had significantly higher rCBF in frontal, anterior cingulate, and association cortices, and in basal ganglia, thalamus, and cerebellum, after accounting for significantly higher overall CBF. Depression severity associated positively with rCBF in the basal ganglia, hippocampus, cerebellum, and posterior white matter. Elevated rCBF was especially prominent in women and older patients. Elevated rCBF likely represents pathogenic hypermetabolism in MDD, with its magnitude in direct proportion to depression severity. It is brain-wide, with disproportionate increases in cortical and subcortical attentional networks. Hypermetabolism may be a reasonable target for novel therapeutics in MDD.

A comparative study of Newtonian and non-Newtonian blood flow through Bi-Leaflet Mechanical Heart Valve

The present study examines flow through Bi-Leaflet Mechanical Heart Valves (BMHV) at physiological conditions considering both Newtonian and non-Newtonian fluid models for blood rheology. It is well known that the non-Newtonian effects of blood are pronounced in small diameter arteries. Most of the earlier works on Mechanical Heart Valves (MHV) have considered blood as a Newtonian fluid as the flow involves large-diameter artery such as the aorta. In this work, we have reported the predicted parameters, such as leaflet kinematics, vortex structures, wall shear stress, and blood damage index for both blood models. It is found that the leaflet attributes smaller asynchronous motion in the case of non-Newtonian Carreau fluid model with slightly reduced angular velocity compared to the Newtonian assumption. Predictions on the blood damage index suggest a 21% higher damage while using non-Newtonian model than Newtonian model, which may be attributed to higher levels of mechanical stress within the fluid. However, vortex structures, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) are found to be similar in predictions using both the fluid models. We have used an in-house sharp interface immersed boundary method with fluid–structure interaction to simulate the coupled action of moving valves and pulsatile blood flow. Our findings suggest that the general consensus of using Newtonian model in large arteries may not be appropriate for prediction of leaflet kinematics and blood damage index in Mechanical heart valves.

Propulsive study of blood flow with heat transfer enhancement connection to ferro copper magnetized nanoparticles in converging tapered stenosed arterial surface

To investigate the effects of magnetic fields and variously structured nanoparticles in narrowing, stenosed arteries, an arterial flow model is incorporated. The aim of this study here is to achieve more realistic results by modeling and simulating the arterial blood flow system with the nanoparticles and shape factor of the nanoparticles. The study of blood flow in tapered stenosed arteries with nanoparticles involves understanding the dynamics of blood circulation in vessels having application in drug delivery. Nanoparticles with specific shape factors can enhance imaging modalities like MRI, CT or ultrasound diagnosing tumor. Metallic nanoparticles in various shapes utilizing water as the base fluid have not yet been considered. Imagine a symmetrical radially but axially nonsymmetric constriction for the blood flow. Along with taking into account the regularity in the sequence of distributing the wall shear stress as well as resistance impedance, the study also takes into account a rise in these readings as the stenosis worsens. For speed, resistive impedance, wall shear and shearing forces at the stenosis throat, results have been computed in exact form. For various Cu-water-relevant parameters, the visual results of several types of converging tapering arteries have been assessed.

Uncertainty quantification of the lattice Boltzmann method focussing on studies of human-scale vascular blood flow

Uncertainty quantification is becoming a key tool to ensure that numerical models can be sufficiently trusted to be used in domains such as medical device design. Demonstration of how input parameters impact the quantities of interest generated by any numerical model is essential to understanding the limits of its reliability. With the lattice Boltzmann method now a widely used approach for computational fluid dynamics, building greater understanding of its numerical uncertainty characteristics will support its further use in science and industry. In this study we apply an in-depth uncertainty quantification study of the lattice Boltzmann method in a canonical bifurcating geometry that is representative of the vascular junctions present in arterial and venous domains. These campaigns examine how quantities of interest—pressure and velocity along the central axes of the bifurcation—are influenced by the algorithmic parameters of the lattice Boltzmann method and the parameters controlling the values imposed at inlet velocity and outlet pressure boundary conditions. We also conduct a similar campaign on a set of personalised vessels to further illustrate the application of these techniques. Our work provides insights into how input parameters and boundary conditions impact the velocity and pressure distributions calculated in a simulation and can guide the choices of such values when applied to vascular studies of patient specific geometries. We observe that, from an algorithmic perspective, the number of time steps and the size of the grid spacing are the most influential parameters. When considering the influence of boundary conditions, we note that the magnitude of the inlet velocity and the mean pressure applied within sinusoidal pressure outlets have the greatest impact on output quantities of interest. We also observe that, when comparing the magnitude of variation imposed in the input parameters with that observed in the output quantities, this variability is particularly magnified when the input velocity is altered. This study also demonstrates how open-source toolkits for validation, verification and uncertainty quantification can be applied to numerical models deployed on high-performance computers without the need for modifying the simulation code itself. Such an ability is key to the more widespread adoption of the analysis of uncertainty in numerical models by significantly reducing the complexity of their execution and analysis.

4D flow MRI: value and clinical perspectives in patients with pathology of the heart and great vessels. A review

The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow magnetic resonance imaging in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.

THE ANALYSIS OF THE FLOW OF BLOOD IN A STENOSED ARTERY THROUGH SIMULATION: A COMPARISON AMONG VARIOUS NON-NEWTONIAN MODELS

This paper focuses on the dual quality of blood, Newtonian and non-Newtonian, in particular by exploring the energy curves. Careful investigation of the dual property of blood has been made by considering two different geometries to represent a stenosed arterial segment. We present a cautious assessment of non-Newtonian blood rheology impacts in arterial stream simulations by coupling the Newtonian and non-Newtonian models. The flow of energy through the two flow dimensions is meticulously investigated using velocity (kinetic energy), pressure, and wall shear stress (pressure energy). Besides, the proper implementation of an interface boundary condition (IBC) was emphasized to ensure consistency with the flow conditions downstream of a backward-facing step. The integration of the Newtonian and non-Newtonian models adjoins the novelty of the current research. The energy curves are obtained by implementing five different non-Newtonian models to designate a suitable non-Newtonian model for blood flow investigations. The combination of the non-Newtonian models enforced in this research is novel and particular attention is paid to the energy curves obtained. The conclusion was to elect the Carreau model as a suitable non-Newtonian rheological model for the blood flow study. This study was able to finalize the fact that the coupling of Newtonian and non-Newtonian models is necessary to obtain accurate results. For the sinusoidal waveform considered for the velocity, Carreau and the Power law models yield better results, eliminating the other non-Newtonian models from the list. With a better inlet condition imposed in the form of the Fourier series for pressure and velocity, the Carreau model yields the best results.

Ultrasound Duplex Scanning of Vessels in the Diagnosis of Limb Length Discrepancy in Pediatric Patients with Congenital Vascular Malformations

Ultrasound Duplex Scanning of Vessels in the Diagnosis of Limb Length Discrepancy in Pediatric Patients with Congenital Vascular Malformations

Ultrasound Flow Imaging Study on Rat Brain with Ultrasound and Light Stimulations.

Functional ultrasound (fUS) flow imaging provides a non-invasive method for the in vivo study of cerebral blood flow and neural activity. This study used functional flow imaging to investigate rat brain's response to ultrasound and colored-light stimuli. Male Long-Evan rats were exposed to direct full-field strobe flashes light and ultrasound stimulation to their retinas, while brain activity was measured using high-frequency ultrasound imaging. Our study found that light stimuli, particularly blue light, elicited strong responses in the visual cortex and lateral geniculate nucleus (LGN), as evidenced by changes in cerebral blood volume (CBV). In contrast, ultrasound stimulation elicited responses undetectable with fUS flow imaging, although these were observable when directly measuring the brain's electrical signals. These findings suggest that fUS flow imaging can effectively differentiate neural responses to visual stimuli, with potential applications in understanding visual processing and developing new diagnostic tools.

Evaluation of blood supply and metabolism in tumor, axillary lymph node and normal breast tissue with F-18 FDG PET/CT in breast cancer: comparison with pathological prognostic factors

Background and purposePerfusion parameters obtained in F-18 FDG PET/CT performed for staging purposes in breast cancers may provide additional information about tumor biology as well as glucose metabolism. The aim of this study was to evaluate throughout F-18 FDG PET/CT the relationship between blood flow and glucose metabolism and histological parameters of the primary tumor, normal mammary gland, and axillary lymph nodes in breast cancer patients.Materials and methodsSixty six female patients (mean age 51 y ± 12,81) were prospectively included to this study. We performed dynamic blood flow (f) study that started with 296–444 MBq (8–12 mCi) F-18 FDG injection and lasted for 10 minutes, and glucose metabolism (m) imaging one hour later. On each frame, mean activity concentration (AC) values (Bq/mL) were recorded on a spherical volume of interest (VOI) having a volume of ~ 1 cm3 on the hottest voxel of primary tumor (T), across normal breast gland (NG) and ipsilaterally axillary lymph nodes (iLN). Correlations among PET parameters and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (c-erbB2) and Ki67 index were analyzed.ResultsT volume (TV) ranged from 1.1 to 85.28 cm3 [median (IR): 6.44 (11.78)]. There were positive correlations between c-erbB2 and TACf and between c-erbB2 and iLNACf (p = 0.045, r = + 0.248; p = 0.050, r = + 0.242). In the ER positive (ERP) patients, TV and TACm were significantly lower than those of ER negative (ERN) (respectively p = 0.044 and p = 0.041). In patients with two positive Ki-67 indices, iLN-SUVmax was significantly higher than one-positive patients (p = 0.020). There was a negative correlation between NGACm and histological grade of tumor (p = 0.005, r = − 0.365).ConclusionsBreast cancer shows differences in progression, metastasis and survival due to its diversity in terms of molecular, biological and angiogenesis. High glucose metabolism in breast cancers is associated with tumor aggressiveness. Being able to examine tumor tissue characteristics such as blood flow and glucose metabolism with a single diagnostic technique and to reveal its relationship with histological parameters can provide a reliable pretherapeutic evaluation in breast cancers.

Development of an in vitro setup for flow studies in a stented carotid artery bifurcation.

To investigate flow conditions in a double-layered carotid artery stent, a bench-top in vitro flow setup including a bifurcation phantom was designed and fabricated. The geometry of the tissue-mimicking phantom was based on healthy individuals. Two identical phantoms were created using 3D-printing techniques and molding with PVA-gel. In one of them, a clinically available CGuard double-layer stent was inserted. Measurements were performed using both continuous and pulsatile flow conditions. Blood flow studies were performed using echoPIV: a novel ultrasound-based technique combined with particle image velocimetry. A maximum deviation of 3% was visible between desired and measured flow patterns. The echoPIV measurements showed promising results on visualization and quantification of blood flow in and downstream the stent. Further research could demonstrate the effects of a double-layered stent on blood flow patterns in a carotid bifurcation in detail.

Elasticity Amelioration in transporting blood flow within curved stenotic tubes

AbstractIn biomechanical devices, blood can be transfused through small, curved walls. Accordingly, this research highlights the study of blood flow in cases of stenosis of the elastic artery with curvature. The effects of bending on the shear and resistance through this elastic tube have been investigated. The moderate stenosis case has been used to simulate the governing equations for an incompressible and steady non‐Newtonian fluid, or “tangent hyperbolic fluid”. A perturbation technique has been used to obtain an analytical solution. The Rubinow &amp; Keller model [24] simulates the flexibility of the stenosis artery walls. The results showed that increasing the parameters linked to the walls' flexibility made it easier for blood to flow through the stenosis area, which emphasizes the need for a thorough investigation of non‐Newtonian fluid flow phenomena. One of the most important threats facing humanity is blood stenosis. In microvasculature, there are many conditions in which the blood vessels are curved or twisted, especially in the case of disease.

Mechanical study of blood flow through a permeable capillary with slippery wall

This research presents the mechanical behavior of blood flow through capillary having smooth inner surface. In this study modelling of blood flow via permeable and lubricated capillary caused by nutrients re-absorption has been done by the help of laws of momentum and mass. The nutrients re-absorption is assumed to be constant and inner walls of the capillary are smooth and slippery therefore slip condition on the velocity and constant rate in vertical direction at the wall has considered. The Kelvin Voigt model is employed to simulate blood flow via capillaries, and results for pressure, blood flow pattern, and shear force necessary for blood flow are discovered by recursive approach. Numerical results for nutrient re-absorption from the blood and impact of smooth and slippery surfaces on blood flow are shown through graphs. The novelty of the research invents that the smoothness and slickness of capillary wall is a crucial presumption to examine the blood as non-Newtonian fluid via capillary.

Endothelial Hemoglobin Alpha Mediates Iron Regulation of Endothelial Nitric Oxide

Iron deficiency is associated with heart failure, chronic kidney disease, and chronic inflammation. All of these pathologies are associated with endothelial dysfunction and impaired nitric oxide (NO) signaling. Previous clinical studies have found iron deficiency anemia (IDA) increases endothelial NO signaling and attributed this change to the reduction in circulating hemoglobin. However, while free hemoglobin is a potent scavenger of NO, it has been shown in ex vivo preparations that endothelial NO signaling is unaffected by the presence of erythrocytes suggesting changes in circulating hemoglobin do not alter NO signaling. For these reasons we focused on endothelial iron regulation. Using single cell RNA sequencing data of isolated mesenteric and adipose endothelial cells generated by our lab, we have observed arterial endothelial cells have higher transferrin receptor expression compared to capillary, veinous, and lymphatic endothelial cells. This suggests that the arterial endothelium, which controls blood flow and is especially susceptible to endothelial dysfunction, may be particularly sensitive to changes in iron status. Additionally, our lab has previously shown the alpha chain of hemoglobin (Hbα) is expressed in the endothelium of small arteries and scavenges NO. We therefore hypothesized endothelial Hbα, rather than blood hemoglobin is responsible for the increased NO signaling in IDA. We first tested this hypothesis in a mouse model of IDA in which we were able to replete vascular iron stores. C57BL/6 mice were fed an iron deficient (2-6 ppm Fe) or nutrient matched control diet (48 ppm Fe) beginning at weaning. IDA mice underwent phlebotomies (10% blood volume) at 9 and 11 weeks old to aid in the progression of anemia. To restore vascular iron stores, a subset of IDA mice received a single i.p. injection of iron dextran (FeDex; 20 mg/kg) at 12 weeks. One week later complete blood counts were assessed, tissues were collected, and blood flow studies were performed. As expected, IDA mice had low blood hemoglobin (Con: 15.54 ± 0.43 vs. IDA: 6.04 ± 0.35 g/dL; p &amp;lt; 0.0001). FeDex did not rescue the anemia (8.55 ± 0.74 g/dL; p &amp;lt; 0.0001 vs. Con), but did rescue vascular iron stores as measured by ferritin light chain protein. To investigate NO signaling, we used laser speckle contrast imaging to measure changes in in vivo blood flow in response to the NO synthase inhibitor L-NAME. The magnitude of the response to L-NAME is an indicator of NO signaling. IDA mice exhibited an exaggerated response to L-NAME indicating increased NO signaling. Rescuing vascular iron stores with FeDex restored the L-NAME response back to control levels suggesting vascular iron stores, rather than the anemia itself increased NO signaling. In order to investigate the role of endothelial Hbα, we repeated these studies in endothelial specific Hbα knockout mice (Hba1 fl/fl-Cdh5-CreER T2+) developed by us. Lack of endothelial Hbα did not prevent the increased response to L-NAME in IDA mice, but did prevent the rescue by FeDex. These data suggest a model in which endothelial Hbα participates in regulating NO in response to iron, but not the increased NO in IDA.

A hybrid RSA-IPA optimizer for designing an artificial neural network to study the Jeffery-Hamel blood flow with copper nanoparticles: Application to stenotic tapering artery

In this study, the effects of copper nanoparticles are taken into account to create a new hybrid metaheuristic for solving the nonlinear MHD Jeffery-Hamel blood flow problem. Since copper nanoparticles are effective in lowering the hemodynamics of stenosis, the subject has scientific and biological implications. The coupled partial differential equations are converted to ordinary differential equations using suitable transformations. Considering an artificial neural network as a solution, the error function has been formed for the differential equations. A hybrid of the reptile search algorithm (RSA) and the interior point algorithm (IPA) is used to minimise the error function (≤10−05). The initial weights are first updated using the RSA algorithm (maximum 20 iterations), which is used as a tool for global search; later, IPA is used for quick local convergence. To validate the proposed technique’s accuracy, comparison studies are conducted using the fourth-order Runge-Kutta method and the hybrid PSO-IPA algorithm. Statistical analysis is provided using multiple performance indices to demonstrate the suggested approach’s precision, efficiency, and reliability. The research findings indicate that the outcomes achieved by the developed RSA-IPA technique exhibit superior performance compared to previously established methodologies, with an accuracy level of 10−04. The findings indicate that a rise in the volume fraction of cu-nanoparticles results in a decrease in the rate of blood flow. The research advances studies of blood flow in the medical sciences.

A mathematical approach for modeling the blood flow containing nanoparticles by employing the Buongiorno’s model

Abstract A mathematical model has been suggested for the numerical study of blood flow in a vessel due to the pumping action of the heart. Blood is assumed to contain some impurities in the form of chemically reactive species (undergoing a first-order irreversible reaction) and, being a hybrid nanofluid, also contains the nano-sized solid particles, thus forming a homogeneous mixture which is subjected to a pressure gradient (of trigonometric nature) in the horizontal direction. Human vessel is subjected to a transverse magnetic field and is presumed to be filled with plaque which is considered as a porous medium, and is mathematically modeled by applying the Darcy–Forchheimer theory. The nonlinear nature of the governing equations steered toward the decision of using the numerical approach to obtain the solution of the governing system, which led to the discovery of a linear concentration variation across the vessel at higher values of the Reynolds number. Finally, a 38% rise in the heat transfer has been noted due to the presence of solid particles in the human blood.

Retracted: Verifying the Usefulness of Pulmonary Blood Flow Studies in the Correction of Pulmonary Atresia and Ventricular Septal Defect with Major Aortopulmonary Collateral Arteries.

[This retracts the article DOI: 10.1155/2021/3483976.].