Predicting Outcome of Aortic Dissection with Patent False Lumen by Computational Flow Analysis
- 232 Downloads
Although Type B aortic dissection (AoD) has better in-hospital survival than Type A AoD, the short- and long term outcome for patients remains challenging, with 50–80% deaths at 5-years. Dissection-related complications include rapid aortic expansion, impending rupture, and malperfusion syndromes. We aimed to assess hemodynamic implications of patients with patent false lumen (FL) of dissected aorta. Computational fluid dynamic analyses were performed on patient-specific aortic geometries reconstructed from computed tomography scans of 25 patients with AoDs, who were admitted in our hospital from 2007 to 2013. We used the development of acute complications and chronic aneurysmal evolution as patient endpoints. Anatomical variables were correlated with hemodynamic variables, and regression was then performed to show independent determinants of FL flow. Velocity streamlines revealed helical, slower-moving flow in the FL of AoDs. Blood pressure and wall shear stress varied markedly between subjects, depending on AoD geometry. Lastly, linear regression shown that the height of entry tears was a significant predictor of blood flow through the patent FL. The greater the entry tear is, the greater the flow in the patent FL and thus the risk of dissection-related complications. Computational flow analysis may lead to more confident predictions of which patients will suffer adverse events and facilitate the clinical decision-making process related to the treatment of Type B AoDs.
KeywordsType B aortic dissection CFD False lumen Flow
This research was funded in part by a grant from Fondazione RiMED provided to Drs. Pasta. Mr. Rinaudo acknowledges the Italian Ministry of Education, University and Research for supporting his research.
Conflict of interest
Author A Rinaudo, Author G D’Ancona, Author JJ Lee, Author G Pilato, Author A Amaducci, Author R Baglini, Author F Follis, Author M Pilato, Author S Pasta declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for which identifying information is included in this article.
No animal studies were carried out by the authors for this article.
- 12.Gimbrone, Jr., M. A., J. N. Topper, T. Nagel, K. R. Anderson, and G. Garcia-Cardena. Endothelial dysfunction, hemodynamic forces, and atherogenesis. Ann. N Y Acad. Sci. 902:230–239, 2000; discussion 39–40.Google Scholar
- 14.Immer, F. F., E. Krahenbuhl, U. Hagen, M. Stalder, P. A. Berdat, F. S. Eckstein, et al. Large area of the false lumen favors secondary dilatation of the aorta after acute type A aortic dissection. Circulation 112:I249–I252, 2005.Google Scholar
- 17.Karmonik, C., S. Partovi, M. Muller-Eschner, J. Bismuth, M. G. Davies, D. J. Shah, et al. Longitudinal computational fluid dynamics study of aneurysmal dilatation in a chronic DeBakey type III aortic dissection. J. Vasc. Surg. 56(260–3):e1, 2012.Google Scholar
- 20.Moon, M. R., T. M. Sundt III, M. K. Pasque, H. B. Barner, C. B. Huddleston, R. J. Damiano, Jr., et al. Does the extent of proximal or distal resection influence outcome for type A dissections? Ann. Thorac. Surg. 71:1244–1249, 2001; discussion 49–50.Google Scholar
- 27.Rudenick, P. A., B. H. Bijnens, D. Garcia-Dorado, and A. Evangelista. An in vitro phantom study on the influence of tear size and configuration on the hemodynamics of the lumina in chronic type B aortic dissections. J. Vasc. Surg. 57(464–74):e5, 2013.Google Scholar
- 30.Suzuki, T., R. H. Mehta, H. Ince, R. Nagai, Y. Sakomura, F. Weber, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 108(Suppl 1):II312–II317, 2003.Google Scholar