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Hemodynamic Modeling of Surgically Repaired Coarctation of the Aorta

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Abstract

Late morbidity of surgically repaired coarctation of the aorta includes early cardiovascular and cerebrovascular disease, shortened life expectancy, abnormal vasomodulator response, hypertension and exercise-induced hypertension in the absence of recurrent coarctation. Observational studies have linked patterns of arch remodeling (Gothic, Crenel, and Romanesque) to late morbidity, with Gothic arches having the highest incidence. We evaluated flow in native and surgically repaired aortic arches to correlate respective hemodynamic indices with incidence of late morbidity. Three dimensional reconstructions of each remodeled arch were created from an anatomic stack of magnetic resonance (MR) images. A structured mesh core with a boundary layer was generated. Computational fluid dynamic (CFD) analysis was performed assuming peak flow conditions with a uniform velocity profile and unsteady turbulent flow. Wall shear stress (WSS), pressure and velocity data were extracted. The region of maximum WSS was located in the mid-transverse arch for the Crenel, Romanesque and Native arches. Peak WSS was located in the isthmus of the Gothic model. Variations in descending aorta flow patterns were also observed among the models. The location of peak WSS is a primary difference among the models tested, and may have clinical relevance. Specifically, the Gothic arch had a unique location of peak WSS with flow disorganization in the descending aorta. Our results suggest that varied patterns and locations of WSS resulting from abnormal arch remodeling may exhibit a primary effect on clinical vascular dysfunction.

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Acknowledgments

This work is supported by National Institutes of Health/National Heart, Lung and Blood Institute Grant HL67622.

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Authors and Affiliations

  1. Division of Cardiology, Children’s National Medical Center, West Wing, W3-200, 111 Michigan Avenue, Washington, DC, 20010, USA

    Laura J. Olivieri, Kanishka Ratnayaka & Russell R. Cross

  2. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Diane A. de Zélicourt, Christopher M. Haggerty & Ajit P. Yoganathan

Authors
  1. Laura J. Olivieri
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  2. Diane A. de Zélicourt
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  3. Christopher M. Haggerty
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  4. Kanishka Ratnayaka
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  5. Russell R. Cross
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  6. Ajit P. Yoganathan
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Correspondence to Laura J. Olivieri.

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Associate Editor Pedro del Nido oversaw the review of this article.

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Olivieri, L.J., de Zélicourt, D.A., Haggerty, C.M. et al. Hemodynamic Modeling of Surgically Repaired Coarctation of the Aorta. Cardiovasc Eng Tech 2, 288–295 (2011). https://doi.org/10.1007/s13239-011-0059-1

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  • DOI: https://doi.org/10.1007/s13239-011-0059-1

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