OBJECTIVES: To obtain predictive information regarding aortic disease, we evaluated how blood flow inside the aortic arch was influenced by thoracic aortic aneurysms. In addition, to reveal the optimal intraoperative management in these cases, we examined blood flow during right subclavian arterial (rSCA) perfusion using computational fluid dynamics (CFD). METHODS: Patient-specific models of the aortic arch were made with six different patterns based on the computed tomographic images. CFD models with finite volume methods were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow stream patterns, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated during one cardiac cycle. Furthermore, flow streamlines during rSCA perfusion were simulated under different perfusion flows. RESULTS: Aortic dilatation caused vortical disturbed flow in a dilated space, resulting in turbulent flow not only inside the aneurysm but also in the proximal and/or distal normal aortic portion. In patients with a dilated thoracic aorta, there was a helical spiral flow with a circumferential vortex in systole. In patients with an arch aneurysm, turbulent flow inside the aneurysm caused a high OSI at the tip of the aneurysm. A high OSI was detected at the orifice of the supra-aortic branches, sinotubular junction, posterior lateral side of the ascending aorta and lesser curvature of the proximal descending aorta. rSCA perfusion revealed that the right common carotid artery was perfused by blood flow from rSCA throughout the cardiac cycle. With 75% of the flow from the rSCA, blood flow from the heart reached the left common carotid and subclavian artery only during a short period during the peak of systole. CONCLUSIONS: A dilated aorta causes a turbulent flow pattern in the aortic arch. The high OSI site was similar to the favourite entry site for acute aortic dissection, indicating the causal relationship between mechanical stress and acute aortic dissection. rSCA cannulation might be cerebroprotective from ascending aortic plaque.
OBJECTIVES: To obtain predictive information regarding aortic disease, we evaluated how blood flow inside the aortic arch was influenced by thoracic aortic aneurysms. In addition, to reveal the optimal intraoperative management in these cases, we examined blood flow during right subclavian arterial (rSCA) perfusion using computational fluid dynamics (CFD). METHODS:Patient-specific models of the aortic arch were made with six different patterns based on the computed tomographic images. CFD models with finite volume methods were created to simulate the physiological pulsatile flow including the peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow stream patterns, wall shear stress (WSS) and the oscillatory shear index (OSI) were calculated during one cardiac cycle. Furthermore, flow streamlines during rSCA perfusion were simulated under different perfusion flows. RESULTS: Aortic dilatation caused vortical disturbed flow in a dilated space, resulting in turbulent flow not only inside the aneurysm but also in the proximal and/or distal normal aortic portion. In patients with a dilated thoracic aorta, there was a helical spiral flow with a circumferential vortex in systole. In patients with an arch aneurysm, turbulent flow inside the aneurysm caused a high OSI at the tip of the aneurysm. A high OSI was detected at the orifice of the supra-aortic branches, sinotubular junction, posterior lateral side of the ascending aorta and lesser curvature of the proximal descending aorta. rSCA perfusion revealed that the right common carotid artery was perfused by blood flow from rSCA throughout the cardiac cycle. With 75% of the flow from the rSCA, blood flow from the heart reached the left common carotid and subclavian artery only during a short period during the peak of systole. CONCLUSIONS: A dilated aorta causes a turbulent flow pattern in the aortic arch. The high OSI site was similar to the favourite entry site for acute aortic dissection, indicating the causal relationship between mechanical stress and acute aortic dissection. rSCA cannulation might be cerebroprotective from ascending aortic plaque.