A summary of the steps conducted for patient-specific computational analysis of AACOA in the current investigation included model reconstruction from cardiac magnetic resonance imaging (CMR) data, mesh generation with local refinements on the ostial region and left main coronary artery (LMCA) bifurcation, assigning multiscale boundary conditions, and postprocessing of resulting hemodynamics to visualize and quantify changes in coronary artery velocity and indices of wall shear stress (WSS). Six AAOCA patients (3 left, 3 right) status post unroofing (median = 13.5 years) underwent CMR. Timing of post-MRI ranged from 3 months-6 years (mean 2.9 years). Computational fluid dynamics (CFD) models were created from pre (n = 2) and postunroofing (n = 6) CMR data. Mesh generation was performed and locally refined until it was properly representative of the geometry. Parameters of the boundary conditions were determined so that physiologic pressure and flow waveforms were achieved. Results showed that: (1) time averaged wall shear stress (TAWSS) was higher preoperatively due to more skewed velocity profiles along the length of the angulated anomalous arteries, (2) unroofing may normalize WSS, and (3) changes in AO led to significant alterations in the local flow patterns and hemodynamics. These findings suggest that acute AO creates abnormal coronary flow patterns and hemodynamics that could leave patients more susceptible to the early onset and progression of atherosclerosis and ultimately may help explain myocardial morbidity associated with intramural AAOCA. Future studies with a larger cohort will allow for a correlation analysis between hemodynamic indices and patient outcomes to predict the patients’ future risk for ischemia or morbidity.
Abstract A case of aortopulmonary window associated with anomalous origin of the right coronary artery from the pulmonary artery in a four-month-old boy is reported in this paper with a different method of repair. In this patient, surgical repair was done by transferring the right coronary artery from the pulmonary artery to the aorta at the aortopulmonary window side. The defect at the pulmonary artery was repaired by a pericardial patch, so no other secondary opening was used for the aorta in order to reimplant the coronary artery . 相似文献
