Computational modeling of blood flow in the aorta—insights into eccentric dilatation of the ascending aorta after surgery for coarctation Marcela Szopos,

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Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: 4D Flow CMR in Assessment of Valve-Related Ascending.

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Computational modeling of blood flow in the aorta—insights into eccentric dilatation of the ascending aorta after surgery for coarctation Marcela Szopos, PhD, Nicole Poussineau, PhD, Yvon Maday, PhD, Carla Canniffe, MD, David S. Celermajer, MBBS, PhD, FRACP, Damien Bonnet, MD, PhD, Phalla Ou, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 4, Pages 1572-1582 (October 2014) DOI: 10.1016/j.jtcvs.2013.11.055 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Postgadolinium magnetic resonance imaging 3-dimensional angiogram of the normal arch after coarctation repair. A, Cross-section measurements of the ascending aorta at the level of the pulmonary bifurcation (through line 1). Left, measurements of the 2 diameters (ie, anteroposterior diameter and left to right diameter) of the ascending aorta. Right, measurements of the corresponding area. B, Cross-section measurements of the horizontal aorta (through line 2). Left, Measurements of the 2 diameters (ie, superoinferior diameter and left to right diameter) of the horizontal aorta. Right, Measurements of the corresponding area. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Postgadolinium magnetic resonance imaging 3-dimensional angiogram of the gothic arch after coarctation repair. A, Cross-section measurements of the ascending aorta at the level of the pulmonary bifurcation (through line 1). Left, Measurements of the 2 diameters (ie, anteroposterior diameter and left–right diameter) of the ascending aorta. Right, Measurements of the corresponding area. B, Cross-section measurements of the horizontal aorta (through line 2). Left, Measurements of the 2 diameters (ie, superoinferior diameter and left- to right diameter) of the horizontal aorta. Right, Measurements of the corresponding area. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Aortic arch geometries showing 2 idealized geometries, corresponding to 2 extreme morphologies of the aortic arch after coarctation repair. Left, Normal arch. Right, Gothic arch. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Graph showing flow rate calculation plotted against time in the ascending aorta (red line) and descending aorta (green line). Note the reverse flow in the gothic arch in late systole (black arrow). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A and C, Velocity field, and (B and D) streamlines determined at the instant time ≈ 0.016 second. A and B, Normal arch; C and D, gothic arch. Note the recirculation zones in the ascending aorta in the gothic arch (D, black arrows). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Pressure wave propagation. Top, Drawings highlighting the moment when the pressure wave reaches the descending aorta (time ∼ 0.016 second) in the normal and gothic arch. Colors denote pressure values, from smallest (blue) to largest (yellow). Cross-section 1, pressure magnitude plotted against time at 4 points located at the anterior, posterior, and left and right wall in a cross section of the ascending aorta. Cross-section 2, pressure magnitude plotted against time at 4 points located at the superior, inferior, and left and right wall in a cross section of the horizontal aorta. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Wall shear stress (WSS) mapping and magnitude. Top, WSS distribution at an instant corresponding to the passage of the pressure wave (time ≈ 0.007 second) in the Left, normal and Right, gothic arch. Colors denote WSS values, from smallest (blue) to largest (red). Cross-section 1, magnitude of the WSS plotted against time at 4 points located at the anterior, posterior, and left and right wall in a cross section of the ascending aorta (Left, Romanesque arch; Right, gothic arch). Cross section 2, magnitude of the WSS plotted against time at 4 points located at the superior, inferior, and left and right wall in a cross section of the horizontal aorta (Left, Romanesque arch; Right, gothic arch). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1572-1582DOI: (10.1016/j.jtcvs.2013.11.055) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions