Late false-lumen expansion predicted by preoperative blood flow simulation in a patient with chronic type B aortic dissection Chikara Ueki, MD, Hiroshi.

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Presentation transcript:

Late false-lumen expansion predicted by preoperative blood flow simulation in a patient with chronic type B aortic dissection Chikara Ueki, MD, Hiroshi Tsuneyoshi, MD, PhD The Journal of Thoracic and Cardiovascular Surgery DOI: 10.1016/j.jtcvs.2018.09.108 Copyright © 2018 Terms and Conditions

Figure 1 Three-dimensional computed tomographic angiography and axial images at the sites of primary entry and multiple reentry sites. Lt., Left. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure 2 Computational fluid dynamics simulation derived from preoperative computed tomographic imaging data showed high wall shear stress at the most dilated site of the false lumen. A, Stream line. B, Wall shear stress. C, Oscillatory shear index. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure 3 Computational fluid dynamics simulation of the model in which a primary entry was closed virtually showed high wall shear stress at the level of the celiac trunk. A, Stream line. B, Wall shear stress. C, Use of computational fluid dynamics studies in predicting aneurysmal degeneration of acute type B aortic dissections Oscillatory shear index. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure 4 Comparison of early postoperative (A1 and B1) and follow-up (A2 and B2) computed tomographic images demonstrates shrinkage of the false lumen at the level of the pulmonary artery bifurcation and enlargement of the false lumen at the level of the celiac trunk (arrowhead). The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure E1 Three-dimensional computed tomographic angiography after primary entry closure with thoracic endovascular aortic repair. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure E2 Preoperative 3-dimensional patient-specific geometry (A) and 3-dimensional computed tomographic angiography (B) after primary entry closure in a patient without late false-lumen expansion after thoracic endovascular aortic repair. Lt., Left; Rt., right. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure E3 Preoperative computational fluid dynamics simulation in a patient without late false-lumen expansion after thoracic endovascular aortic repair showed high wall shear stress at the most dilated site of the false lumen. A, Stream line. B, Wall shear stress. C, Oscillatory shear index. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Figure E4 Computational fluid dynamics simulation of the model in which the primary entry was closed virtually in a patient without late false-lumen expansion after thoracic endovascular aortic repair showed no marked wall shear stress elevation. A, Stream line. B, Wall shear stress. C, Oscillatory shear index. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions

Extremely high wall shear stress is present at the eventual site of false-lumen expansion. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.09.108) Copyright © 2018 Terms and Conditions