Arq. Bras. Cardiol. 2022; 118(2): 448-460

Computational Fluid Dynamics to Assess the Future Risk of Ascending Aortic Aneurysms

Gabriela de C. Almeida , Bruno Alvares de Azevedo Gomes , Fabiula Schwartz de Azevedo , Karim Kalaun , Ivan Ibanez , Pedro S. Teixeira , Ilan Gottlieb , Marcelo M. Melo , Glaucia Maria Moraes de Oliveira , Angela O. Nieckele

DOI: 10.36660/abc.20200926

This Original Article is referred by the Short Editorial "Computational Fluid Dynamics (CFD) For Predicting Pathological Changes In The Aorta: Is It Ready For Clinical Use?".

Abstract

Background

A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined

Objetive

This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth.

Methods

Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients’ clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%.

Results

The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased.

Conclusion

This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.