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Hostile Hemodynamics in Distal Stent Graft–Induced New Entry Prior to Aortic Rupture: A Comparison of Transient versus Steady-State CFD Simulations

血流动力学 计算流体力学 湍流 主动脉 机械 湍流动能 剪应力 血流 稳态(化学) 心脏病学 材料科学 医学 物理 化学 物理化学
作者
Anja Oßwald,Konstantinos Tsagakis,Ender Demircioğlu,Alexander Weymann,Alina Zubarevich,Arjang Ruhparwar,Christof Karmonik
出处
期刊:Thoracic and Cardiovascular Surgeon [Georg Thieme Verlag]
卷期号:72 (02): 134-141
标识
DOI:10.1055/s-0043-1771357
摘要

Abstract Background Computational fluid dynamics (CFD) simulations model blood flow in aortic pathologies. The aim of our study was to understand the local hemodynamic environment at the site of rupture in distal stent graft–induced new entry (dSINE) after frozen elephant trunk with a clinically time efficient steady-flow simulation versus transient simulations. Methods Steady-state simulations were performed for dSINE, prior and after its development and prior to aortic rupture. To account for potential turbulences due geometric changes at the dSINE location, Reynolds-averaged Navier–Stokes equations with the realizable k-ε model for turbulences were applied. Transient simulations were performed for comparison. Hemodynamic parameters were assessed at various locations of the aorta. Results Post-dSINE, jet-like flow due to luminal narrowing was observed which increased prior to rupture and resulted in focal neighbored regions of high and low wall shear stress (WSS). Prior to rupture, aortic diameter at the rupture site increased lowering WSS at the entire aortic circumference. Concurrently, WSS and turbulence increased locally above the entry tear at the inner aortic curvature. Turbulent kinetic energy and WSS elevation in the downstream aorta demonstrated enhanced stress on the native aorta. Results of steady-state simulations were in good qualitative agreement with transient simulations. Conclusion Steady-flow CFD simulations feasible at clinical time scales prior to aortic rupture reveal a hostile hemodynamic environment at the dSINE rupture site in agreement with lengthy transient simulations. Consequently, our developed approach may be of value in treatment planning where a fast assessment of the local hemodynamic environment is essential.
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