Patient-Specific Analysis of Ascending Thoracic Aortic Aneurysm with the Living Heart Human Model

In ascending thoracic aortic aneurysms (ATAAs), aneurysm kinematics are driven by ventricular traction occurring every heartbeat, increasing the stress level of dilated aortic wall. Aortic elongation due to heart motion and aortic length are emerging as potential indicators of adverse events in ATAA...

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Bibliographic Details
Published in:Bioengineering (Basel) 2021-11, Vol.8 (11), p.175
Main Authors: Cutugno, Salvatore, Agnese, Valentina, Gentile, Giovanni, Raffa, Giuseppe M., Wisneski, Andrew D., Guccione, Julius M., Pilato, Michele, Pasta, Salvatore
Format: Article
Language:English
Subjects:
Adverse events
Angiography
Aorta
Aortic aneurysms
ascending aortic aneurysm
Biaxial tests
Bioengineering
Biomechanics
cardiac mechanics
Computed tomography
Coronary vessels
Dissection
Elongation
finite element analysis
Geometry
Heart
Kinematics
living heart human model
Mathematical models
Medical imaging
Mortality
Parameter estimation
Patients
Pulmonary arteries
Segmentation
Software
Stress distribution
Thorax
Ventricle
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Summary:In ascending thoracic aortic aneurysms (ATAAs), aneurysm kinematics are driven by ventricular traction occurring every heartbeat, increasing the stress level of dilated aortic wall. Aortic elongation due to heart motion and aortic length are emerging as potential indicators of adverse events in ATAAs; however, simulation of ATAA that takes into account the cardiac mechanics is technically challenging. The objective of this study was to adapt the realistic Living Heart Human Model (LHHM) to the anatomy and physiology of a patient with ATAA to assess the role of cardiac motion on aortic wall stress distribution. Patient-specific segmentation and material parameter estimation were done using preoperative computed tomography angiography (CTA) and ex vivo biaxial testing of the harvested tissue collected during surgery. The lumped-parameter model of systemic circulation implemented in the LHHM was refined using clinical and echocardiographic data. The results showed that the longitudinal stress was highest in the major curvature of the aneurysm, with specific aortic quadrants having stress levels change from tensile to compressive in a transmural direction. This study revealed the key role of heart motion that stretches the aortic root and increases ATAA wall tension. The ATAA LHHM is a realistic cardiovascular platform where patient-specific information can be easily integrated to assess the aneurysm biomechanics and potentially support the clinical management of patients with ATAAs.
ISSN:2306-5354
2306-5354
DOI:10.3390/bioengineering8110175