Modelling cardiac mechanics of left ventricular noncompaction

Left ventricular noncompaction (LVNC) can be defined as a cardiomyopathy characterised by a pattern of prominent trabecular structure and deep intertrabecular recesses, that is thought to be caused by an arrest of normal endomyocardial morphogenesis. Using patient-specific computational modelling, we assessed the cardiac mechanics of five patients with LVNC and compared myocardial stress and pump performance to those of healthy controls. Findings shown that patients with LVNC have impaired left ventricular (LV) function, making it possible that the lack of fibre shortening of noncompacted layer can determine poor heart function. Pronounced end-systolic wall stress on left ventricular wall o…

STUDIO NUMERICO DELL'EMODINAMICA IN PAZIENTI CON DISSECAZIONE AORTICA DI TIPO B

The development of type B aortic dissection (AoD) is caused by altered haemodynamic forces exerted on false and true lumina of dissected aorta. This work aims to study haemodynamic and morphological proprieties, which influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on three patients with type B AoD, whose two presented an aneurysm evolution and one presented no further complication connected with dissection. Blood flow features showed that the true lumen flow was laminar and uniform while false lumen flow lost the laminar characteristic with consequent vorticity formation. The entry point zone proximal to the aortic arch showed both …

Computational analysis to predict false-lumen perfusion and outcome of type B aortic dissection.

We have attempted to identify potential predictors foracute and late aortic events starting from admission computed tomographic images.

Regional variation of wall shear stress in ascending thoracic aortic aneurysms.

The development of an ascending thoracic aortic aneurysm is likely caused by excessive hemodynamic loads exerted on the aneurysmal wall. Computational fluid-dynamic analyses were performed on patient-specific ascending thoracic aortic aneurysms obtained from patients with either bicuspid aortic valve or tricuspid aortic valve to evaluate hemodynamic and wall shear parameters, imparting aneurysm enlargement. Results showed an accelerated flow along the outer aortic wall with helical flow in the aneurysm center for bicuspid aortic valve ascending thoracic aortic aneurysms. In a different way, tricuspid aortic valve ascending thoracic aortic aneurysms exhibited normal systolic flow without su…

Evaluation of ventricular wall stress and cardiac function in patients with dilated cardiomyopathy

Dilated cardiomyopathy is a heart disease characterized by both left ventricular dilatation and left ventricular systolic dysfunction, leading to cardiac remodeling and ultimately heart failure. We aimed to investigate the effect of dilated cardiomyopathy on the pump performance and myocardial wall mechanics using patient-specific finite element analysis. Results evinced pronounced end-systolic wall stress on left ventricular wall of patients with dilated cardiomyopathy as compared to that of normal hearts. In dilated cardiomyopathy, both end-diastolic and end-systolic pressure–volume relationships of left ventricle and right ventricle were shifted to the right compared to controls, sugges…

AN IN-VITRO PHANTOM STUDY ON THE THORACIC AORTIC STENT GRAFT COLLAPSE RESULTING FROM A BIRD-BEAK CONFIGURATION INTO THE AORTIC ARCH

Cardiac Mechanics of Left Ventricular NonCompaction by Finite Element Modeling

Haemodynamic predictors of a penetrating atherosclerotic ulcer rupture using fluid-structure interaction analysis

We present preliminary data on the flow-induced haemodynamic and structural loads exerted on a penetrating atherosclerotic aortic ulcer (PAU). Specifically, one-way fluid-structure interaction analysis was performed on the aortic model reconstructed from a 66-year-old male patient with a PAU that evolved into an intramural haematoma and rupture of the thoracic aorta. The results show that elevated blood pressure (117 mmHg) and low flow velocity at the aortic wall (0.15 m/s(2)) occurred in the region of the PAU. We also found a low value of time-averaged wall shear stress (1.24 N/m(2)) and a high value of the temporal oscillation in the wall shear stress (oscillatory shear index = 0.13) in t…

POLYSACCHARIDE-BASED HYDROGELS FOR MYOCARDIUM REMODELING

Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair

Endografts placed in the aorta for thoracic endovascular aortic repair (TEVAR) may determine malappositioning to the lesser curvature of the aortic wall, thus resulting in a devastating complication known as endograft collapse. This premature device failure commonly occurs in young individuals after TEVAR for traumatic aortic injuries as a result of applications outside the physical conditions for which the endograft was designed. In this study, an experimentally-calibrated fluid-structure interaction (FSI) model was developed to assess the hemodynamic and stress/strain distributions acting on the excessive protrusion extension (PE) of endografts deployed in four young patients underwent TE…

Computational fluid dynamics simulation to evaluate aortic coarctation gradient with contrast-enhanced CT

Coarctation of aorta (CoA) is a narrowing of the aorta leading to a pressure gradient (Delta P) across the coarctation, increased afterload and reduced peripheral perfusion pressures. Indication to invasive treatment is based on values of maximal (systolic) trans-coarctation Delta P. A computational fluid dynamic (CFD) approach is herein presented for the non-invasive haemodynamic assessment of Delta P across CoA. Patient-specific CFD simulations were created from contrast-enhanced computed tomography (CT) and appropriate flow boundary conditions. Computed Delta P was validated with invasive intravascular trans-CoA pressure measurements. Haemodynamic indices, including pressure loss coeffic…

An In Vitro Phantom Study on the Role of the Bird-Beak Configuration in Endograft Infolding in the Aortic Arch.

Purpose: To assess endograft infolding for excessive bird-beak configurations in the aortic arch in relation to hemodynamic variables by quantifying device displacement and rotation of oversized stent-grafts deployed in a phantom model. Methods: A patient-specific, compliant, phantom pulsatile flow model was reconstructed from a patient who presented with collapse of a Gore TAG thoracic endoprosthesis. Device infolding was measured under different flow and pressure conditions for 3 protrusion extensions (13, 19, and 24 mm) of the bird-beak configuration resulting from 2 TAG endografts with oversizing of 11% and 45%, respectively. Results: The bird-beak configuration with the greatest protr…

Predicting Outcome of Aortic Dissection with Patent False Lumen by Computational Flow Analysis

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 a…

COMPUTATIONAL FLUID DYNAMICS OF TYPE B AORTIC DISSECTION

Type B aortic dissection (AoD) is a disease connected to high blood load on the aortic wall and to a reduced aortic wall resistance. Nowadays, prognosis on type B AoD results to be particularly difficult with an high incidence of patients treated with medical therapy which manifest complication connected with dissection and which should have been treated with surgical repair immediately. This work aims to study those haemodynamical and morphological proprieties of dissected aorta, which can influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on twenty-five patients with type B AoD, whose nine presented an aneurysm evolution and sixteen p…

Difference in hemodynamic and wall stress of ascending thoracic aortic aneurysms with bicuspid and tricuspid aortic valve.

The aortic dissection (AoD) of an ascending thoracic aortic aneurysm (ATAA) initiates when the hemodynamic loads exerted on the aneurysmal wall overcome the adhesive forces holding the elastic layers together. Parallel coupled, two-way fluid–structure interaction (FSI) analyses were performed on patient-specific ATAAs obtained from patients with either bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) to evaluate hemodynamic predictors and wall stresses imparting aneurysm enlargement and AoD. Results showed a left-handed circumferential flow with slower-moving helical pattern in the aneurysm's center for BAV ATAAs whereas a slight deviation of the blood flow toward the anterolater…

Influenza della Morfologia Funzionale della Valvola Aortica sull'Emodinamica di Pazienti con Aneurisma Toracico dell'Aorta Ascendente

Il presente lavoro si propone di studiare le differenze emodinamiche e i carichi di parete che si sviluppano in pazienti con aneurisma toracico dell'aorta ascendente (ATAA) con differente morfologia della valvola aortica. Sono stati identificati 5 pazienti con ATAA sottoposti a scansione TC per il controllo del diametro dell'aneurisma presso l'Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione. In particolare, tre pazienti presentano valvola aortica di tipo tricuspide(TAV) mentre due valvola aortica di tipo bicuspide (BAV) generalmente associata alla formazione di ATAA. Sono state ricostruite le geometrie dei ATAA includendo anche la ricostruzione delle valvole aortich…

Predicting Outcome of Type B Aortic Dissection with Patent False Lumen by Computational Flow Analysis

Mechanics of pericardial effusion: A simulation study

Pericardial effusion is a pathological accumulation of fluid within pericardial cavity, which may compress heart chambers with hemodynamic impairment. We sought to determine the mechanics underlying the physiology of the hemodynamic impairment due to pericardial effusion using patient-specific computational modeling. Computational models of left ventricle and right ventricle were based on magnetic resonance images obtained from patients with pericardial effusion and controls. Myocardial material parameters were adjusted, so that volumes of ventricular chambers and pericardial effusion agreed with magnetic resonance imaging data. End-diastolic and end-systolic pressure–volume relationships …

Development of a self-pumping extracorporeal blood oxygenation device characterized by a rotating shaft with embedded fiber packages.

Introduction: To offer respiratory support for patients with lung disease, a novel technological solution for blood pumping and oxygenation is being developed. The pump–lung system was designed to integrate fiber membranes into six packages radially embedded in a rotating hollow shaft placed along the longitudinal axis of the device. Fiber packages are inclined with respect to the rotation axis so that the rotational motion of the rotating shaft allows a self-pumping system to be obtained. Method: Both hemodynamic and gas transfer performances were investigated using both in vitro experiments and in silico flow analyses. Results: The predicted flow velocity in the pump chamber was smooth an…