False Lumen Flow Patterns and their Relation with Morphological and Biomechanical Characteristics of Chronic Aortic Dissections. Computational Model Compared with Magnetic Resonance Imaging Measurements
Rudenick, Paula A. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Segers, Patrick (Ghent University)
Pineda, Victor (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Cuellar-Calabria, Hug (Hospital Universitari Vall d'Hebron. Institut de Recerca)
García-Dorado, David (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Evangelista Masip, Arturo (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bijnens, Bart H. (Institució Catalana de Recerca i Estudis Avançats)
Universitat Autònoma de Barcelona

Date:	2017
Abstract:	Aortic wall stiffness, tear size and location and the presence of abdominal side branches arising from the false lumen (FL) are key properties potentially involved in FL enlargement in chronic aortic dissections (ADs). We hypothesize that temporal variations on FL flow patterns, as measured in a cross-section by phase-contrast magnetic resonance imaging (PC-MRI), could be used to infer integrated information on these features. In 33 patients with chronic descending AD, instantaneous flow profiles were quantified in the FL at diaphragm level by PC-MRI. We used a lumped-parameter model to assess the changes in flow profiles induced by wall stiffness, tear size/location, and the presence of abdominal side branches arising from the FL. Four characteristic FL flow patterns were identified in 31/33 patients (94%) based on the direction of flow in systole and diastole: B = systolic biphasic flow and primarily diastolic antegrade flow (n = 6); B = systolic biphasic flow and primarily diastolic retrograde flow (n = 14); M = systolic monophasic flow and primarily diastolic antegrade flow (n = 9); M = systolic monophasic flow and primarily diastolic retrograde flow (n = 2). In the computational model, the temporal variation of flow directions within the FL was highly dependent on the position of assessment along the aorta. FL flow patterns (especially at the level of the diaphragm) showed their characteristic patterns due to variations in the cumulative size and the spatial distribution of the communicating tears, and the incidence of visceral side branches originating from the FL. Changes in wall stiffness did not change the temporal variation of the flows whereas it importantly determined intraluminal pressures. FL flow patterns implicitly codify morphological information on key determinants of aortic expansion in ADs. This data might be taken into consideration in the imaging protocol to define the predictive value of FL flows.
Grants:	European Commission 611823 Instituto de Salud Carlos III PI108/0608 Instituto de Salud Carlos III PI11/01709
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	PloS one, Vol. 12 (january 2017) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0170888
PMID: 28125720

20 p, 3.8 MB

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