Study Of Morphologic And Surgical Computational Fluid Dynamics On Aortic Coarctation With Hypoplastic Aortic Arch

Objective The spectrum of coarctation of the aorta with arch hypoplasia is broad,the anatomy of individual is different from each other,the current surgical treatment remains controversial,long-term postoperative complication rate and survival rate is still unsatisfactory.The first part of this study explores the changes of aortic coarctation with arch hypoplasia pathology spectrum,trying to clarify the relationship between the shape of aortic arch segments and whole arch;the second part of this study attempts to compare the two aortic coarctation with arch hypoplasia after correction of the difference in the aortic arch hemodynamics;the third part of this study tries to compare three types of virtual correction of aortic coarctation associated with adverse postoperative hemodynamic differences in the aortic arch.Method Part I: according to the aortic arch hypoplasia occurrence of aortic arch hypoplasia coarctation,all cases were grouped with the four full-arch shape in each group the number of cases recorded;Comparison on Four kinds total arch shape in isolated coarctation group with coarctation with arch hypoplasia differences between groups arch development;comparison on Four kinds of whole arch shape differences between the subtypes in the aortic arch hypoplasia.Part II: Two patients of coarctation of the aorta with arch hypoplasia underwent end-to-side anastomosis and patch aortoplasty,respectively.Computed tomography scan before and after surgery were obtained to reconstruct a three-dimensional structure of the aortic arch,and then the structure were been meshing and numerical simulation.Part III: Select one case of distal + isthmus arch hypoplasia,its imaging data line reconstruction,re-use computer-aided design software,its virtually correction by end to side anastomosis,extend end to end anastomosis and patch aortoplasty,aortic arch three-dimensional structure of the virtual surgery before and after meshing parallel numerical simulation.Results Part I: 424 cases of aortic coarctation cases,137 cases with arch hypoplasia,which included 67 cases of isthmus arch hypoplasia,39 cases of isthmus + distal arch hypoplasia,15 cases of isthmus + distal + proximal arch hypoplasia,11 cases of distal arch hypoplasia,5 cases of distal + proximal arch hypoplasia;simple coarctation of the aorta and aortic coarctation with arch hypoplasia significantly different(P <0.05)in whole arch morphology;simple isthmus arch hypoplasia and isthmus + distal arch hypoplasia there are significant differences(P <0.05)in the arch morphology.Part II: end to side anastomosis and patch aortoplasty could well relieve constriction and expansion of hypoplasitic aortic arch;two kinds of correction of the aortic arch area after the pressure distribution is more uniform than before surgery,and descending aortic pressure increased significantly,innominate artery,left common carotid artery and left subclavian artery pressure decreased significantly;two kinds of correction of the aortic arch area after high-velocity zone disappeared,the blood flow velocity distribution is more uniform;end to side anastomosis,the descending aorta entrance to the blood flow paths form a more obvious acute notch;patch aortoplasty,distal arch form a clear spiral blood flow turbulent.Part III: Three virtual aortic coarctation with arch hypoplasia correction of postoperative hemodynamics within the aortic arch were improved to some extent;expand anastomosis can better reduce the innominate artery side wall shear force;end to side anastomosis edge presence in anastomosis after high wall shear stress;energy loss of the end to side anastomosis is the least in one cardiac cycle;patch aortoplasty shows better on the velocity distribution.Conclusion Part I: The coarctation of the aorta with arch hypoplasia involving each of the segments,the incidence in the order of the isthmus,distal and proximal arch;aortic arch hypoplasia sections in this study were observed or five aortic coarctation with arch hypoplasia subtypes;hypoplastic aortic arch segments will impact the whole arch shape;children respond to each segment of the aortic arch and the whole shape of the arch should fully understand before surgery,to choose their individual anatomical characteristics of surgical options to build ideal postoperative aortic arch morphology and improve their short and long term effects of surgery.Part II: end to side anastomosis and patch aortoplasty can relieve constriction and expansion of hypoplastic aortic arch,descending aorta perfusion recovery,so that all hemodynamic parameters improved to a certain extent;end to side anastomosis is easier the formation of the Gothic aortic arch;patch aortoplasty after aortic arch shape is relatively optimal.Part III: Three virtual Surgical Corrections respective advantages,they should be selected for the correction of the anatomical characteristics of patients according to their own children in order to build the ideal postoperative aortic arch shape,to obtain a satisfactory outcome.