Assessment of wall stress distribution in thoracic ascending aortic aneurysm: Simulation, prediction, and prevention

AbstractAscending aortic aneurysms often include the sinotubular junction (STJ) and extend into the root portion of the aorta. The novel surgery of the V-shape resection of the noncoronary sinus of the aortic root has been shown to be a simpler procedure, comparing with traditional surgeries such as full aortic root replacement, for patients with moderate ascending aortic aneurysm and aortic root ectasia. This novel surgery could reduce the diameter and cross-sectional area of the aortic root. However, the detailed effect on the stress field and the rupture risk of the aortic root and aneurysm has not been fully investigated. In this study, we performed patient-specific finite element (FE) analysis based on the 3D geometries of the aortic root and ascending aortic aneurysm, reconstructed directly from the clinical computed tomographic (CT) images. By comparing the pre- and post-surgery results, we investigated the influence of the V-shape surgery on the stress field and rupture risk of the aortic root, ascending aortic aneurysm and aortic arch. It was found that the surgery could significantly reduce the wall stress of the aortic root, ascending aortic aneurysm, as well the aortic arch, and hence lower the rupture risk.

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On the severity of aortic stenosis in ascending aortic aneurysm: A computational tool to examine ventricular-arterial interaction and aortic wall stress

Mechanics Research Communications ◽

10.1016/j.mechrescom.2020.103621 ◽

2020 ◽

Vol 110 ◽

pp. 103621

Author(s):

Federica COSENTINO ◽

Marzio DI GIUSEPPE ◽

Valentina AGNESE ◽

Giovanni GENTILE ◽

Giuseppe M RAFFA ◽

...

Keyword(s):

Aortic Aneurysm ◽

Aortic Stenosis ◽

Aortic Wall ◽

Wall Stress ◽

Computational Tool ◽

Ascending Aortic Aneurysm

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Pulsatile flow measurements and wall stress distribution in a patient specific abdominal aortic aneurysm phantom

ZAMM ‐ Journal of Applied Mathematics and Mechanics / Zeitschrift für Angewandte Mathematik und Mechanik ◽

10.1002/zamm.201700281 ◽

2018 ◽

Vol 98 (12) ◽

pp. 2258-2274 ◽

Cited By ~ 5

Author(s):

T. Ahamed ◽

R. A. Peattie ◽

L. Dorfmann ◽

E. M. Cherry Kemmerling

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stress Distribution ◽

Pulsatile Flow ◽

Wall Stress ◽

Patient Specific ◽

Flow Measurements ◽

Abdominal Aortic

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Wall stress distribution on three-dimensionally reconstructed models of human abdominal aortic aneurysm

Journal of Vascular Surgery ◽

10.1067/mva.2000.103971 ◽

2000 ◽

Vol 31 (4) ◽

pp. 760-769 ◽

Cited By ~ 252

Author(s):

M.L. Raghavan ◽

David A. Vorp ◽

Michael P. Federle ◽

Michel S. Makaroun ◽

Marshall W. Webster

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stress Distribution ◽

Wall Stress ◽

Abdominal Aortic

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A simulation framework for estimating wall stress distribution of abdominal aortic aneurysm

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society ◽

10.1109/iembs.2011.6090201 ◽

2011 ◽

Author(s):

Jing Qin ◽

Jing Zhang ◽

Chee-Kong Chui ◽

Wei-Min Huang ◽

Tao Yang ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stress Distribution ◽

Wall Stress ◽

Simulation Framework ◽

Abdominal Aortic

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Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

The Heart Surgery Forum ◽

10.1532/hsf.1284 ◽

2015 ◽

Vol 18 (4) ◽

pp. 124

Author(s):

Mehmet Kaplan ◽

Bahar Temur ◽

Tolga Can ◽

Gunseli Abay ◽

Adlan Olsun ◽

...

Keyword(s):

Aortic Aneurysm ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Distal Anastomosis ◽

Ascending Aortic Aneurysm ◽

Aortic Aneurysm Surgery ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Background: This study aimed to report the outcomes of patients who underwent proximal thoracic aortic aneurysm surgery with open distal anastomosis technique but without cerebral perfusion, instead under deep hypothermic circulatory arrest.Methods: Thirty patients (21 male, 9 female) who underwent ascending aortic aneurysm repair with open distal anastomosis technique were included. The average age was 60.2±11.7 years. Operations were performed under deep hypothermic circulatory arrest and the cannulation for cardiopulmonary bypass was first done over the aneurysmatic segment and then moved over the graft. Intraoperative and early postoperative mortality and morbidity outcomes were reported.Results: Average duration of cardiopulmonary bypass and cross-clamps were 210.8±43 and 154.9±35.4 minutes, respectively. Average duration of total circulatory arrest was 25.2±2.4 minutes. There was one hospital death (3.3%) due to chronic obstructive pulmonary disease at postoperative day 22. No neurological dysfunction was observed during the postoperative period.Conclusion: These results demonstrate that open distal anastomosis under less than 30 minutes of deep hypothermic circulatory arrest without antegrade or retrograde cerebral perfusion and cannulation of the aneurysmatic segment is a safe and reliable procedure in patients undergoing proximal thoracic aortic aneurysm surgery.

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Epigenetic Profiling Identifies Novel Genes for Ascending Aortic Aneurysm Formation with Bicuspid Aortic Valves

The Heart Surgery Forum ◽

10.1532/hsf.1247 ◽

2015 ◽

Vol 18 (4) ◽

pp. 134 ◽

Cited By ~ 12

Author(s):

Asad A Shah

Keyword(s):

Gene Expression ◽

Aortic Aneurysm ◽

Methylation Status ◽

Aortic Aneurysms ◽

Aortic Valves ◽

Ascending Aortic Aneurysm ◽

Novel Genes ◽

Aneurysm Formation ◽

Aortic Replacement ◽

Bicuspid Aortic Valves

Background: Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized. We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients.Methods: Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves. Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays. Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test. Results: Twenty-seven probes in 9 genes showed significant differential methylation and expression (P<5.5x10-4). The top gene was protein tyrosine phosphatase, non-receptor type 22 (PTPN22), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10-5) in bicuspid patients, as compared to tricuspid patients. Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including ACTA2 (4 probes, delta beta range: -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissectionsConclusions: Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms. The top gene was PTPN22, which is involved in T-cell receptor signaling and associated with various immune disorders. These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.

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