STUDIO NUMERICO DELL'EMODINAMICA IN PAZIENTI CON DISSECAZIONE AORTICA DI TIPO B

The development of type B aortic dissection (AoD) is caused by altered haemodynamic forces exerted on false and true lumina of dissected aorta. This work aims to study haemodynamic and morphological proprieties, which influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on three patients with type B AoD, whose two presented an aneurysm evolution and one presented no further complication connected with dissection. Blood flow features showed that the true lumen flow was laminar and uniform while false lumen flow lost the laminar characteristic with consequent vorticity formation. The entry point zone proximal to the aortic arch showed both high blood velocity and pressure connected with peaks of maximum WSS value. A negative pressure gradient between the false lumen entry and re-entry points was observed. This promotes the blood to flow towards the abdominal aorta reducing the risk of retrograde flow during systole. We concluded that fluid dynamics study of patients with type B AoD is a valid tool to identify the risk of aortic dissection progression as well as the formation of aortic dissection connected pathology

Comparing different solutions for testing resistive defects in low-power SRAMs

Low-power SRAM architectures are especially sensitive to many types of defects that may occur during manufacturing. Among these, resistive defects can appear. This paper analyzes some types of such defects that may impair the device functionalities in subtle ways, depending on the defect characteristics, and that may not be directly or easily detectable by traditional test methods, such as March algorithms. We analyze different methods to test such defects and discuss them in terms of complexity and test time

Regional variation of wall shear stress in ascending thoracic aortic aneurysms

The development of an ascending thoracic aortic aneurysm is likely caused by excessive hemodynamic loads exerted on the aneurysmal wall. Computational fluid-dynamic analyses were performed on patient-specific ascending thoracic aortic aneurysms obtained from patients with either bicuspid aortic valve or tricuspid aortic valve to evaluate hemodynamic and wall shear parameters, imparting aneurysm enlargement. Results showed an accelerated flow along the outer aortic wall with helical flow in the aneurysm center for bicuspid aortic valve ascending thoracic aortic aneurysms. In a different way, tricuspid aortic valve ascending thoracic aortic aneurysms exhibited normal systolic flow without substantial secondary pattern. Analysis of wall shear parameters evinced a high and locally varying wall shear stress on the outer aortic wall and high temporal oscillations in wall shear stress (oscillatory shear index) on either left or right side of aneurysmal aorta. These findings may explain the asymmetric dilatation typically observed in ascending thoracic aortic aneurysms. Simulations of a hypertensive scenario revealed an increase in wall shear stress upon 44% compared to normal systemic pressure models. Computational fluid-dynamics-based analysis may allow identification of wall shear parameters portending aneurysm dilatation and hence guide preventative intervention

Impact Of Pericardial Effusion On Cardiac Mechanics In Patients With Dilated Cardiomyopathy

Dilated cardiomyopathy (CDM) is a degenerative disease of the myocardium accompanied by left ventricular (LV) remodeling, resulting in an impaired pump performance. Differently, pericardial effusion(PE) is a liquid accumulation in the pericardial cavity, which may inhibit blood filling of heart chambers. Clinical evidence show that PE may improve pump performance in patients with CDM. Therefore, this study aims to assess wall stress and global function of patients with CDM, PE as compared to healthy patient. These findings suggests that CDM has an important implication in the mechanical changes of LV and right ventricle by increasing wall stress and reducing pump function. Conversely, PE determines lowering myocardial fiber stress and improves global function as compared to those of CD

COMPUTATIONAL FLUID DYNAMICS OF TYPE B AORTIC DISSECTION

Type B aortic dissection (AoD) is a disease connected to high blood load on the aortic wall and to a reduced aortic wall resistance. Nowadays, prognosis on type B AoD results to be particularly difficult with an high incidence of patients treated with medical therapy which manifest complication connected with dissection and which should have been treated with surgical repair immediately. This work aims to study those haemodynamical and morphological proprieties of dissected aorta, which can influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on twenty-five patients with type B AoD, whose nine presented an aneurysm evolution and sixteen presented no further complication connected with dissection. Blood flow features showed that the true lumen flow was laminar and uniform while false lumen flow was less homogeneous with a consequent recirculating path. We found that entry point zone proximal to the aortic arch showed both high blood velocity and pressure connected with peaks of maximum WSS value. Moreover, a negative pressure gradient between the false lumen entry and re-entry points was observed. This promotes the blood to flow towards the abdominal aorta reducing the risk of retrograde flow during systole. We concluded that fluid dynamics study of patients with type B AoD is a valid tool to identify the risk of aortic dissection progression as well as the formation of pathology connected with aortic dissection

Evaluation of ventricular wall stress and cardiac function in patients with dilated cardiomyopathy

Dilated cardiomyopathy is a heart disease characterized by both left ventricular dilatation and left ventricular systolic dysfunction, leading to cardiac remodeling and ultimately heart failure. We aimed to investigate the effect of dilated cardiomyopathy on the pump performance and myocardial wall mechanics using patient-specific finite element analysis. Results evinced pronounced end-systolic wall stress on left ventricular wall of patients with dilated cardiomyopathy as compared to that of normal hearts. In dilated cardiomyopathy, both end-diastolic and end-systolic pressure-volume relationships of left ventricle and right ventricle were shifted to the right compared to controls, suggesting reduced myocardial contractility. We hereby propose that finite element analysis represents a useful tool to assess the myocardial wall stress and cardiac work, which are responsible for progressive left ventricular deterioration and poor clinical course

An in vitro phantom study on the role of the bird-beak configuration in endograft infolding in the aortic arch

Purpose: To assess endograft infolding for excessive bird-beak configurations in the aortic arch in relation to hemodynamic variables by quantifying device displacement and rotation of oversized stent-grafts deployed in a phantom model. Methods: A patient-specific, compliant, phantom pulsatile flow model was reconstructed from a patient who presented with collapse of a Gore TAG thoracic endoprosthesis. Device infolding was measured under different flow and pressure conditions for 3 protrusion extensions (13, 19, and 24 mm) of the bird-beak configuration resulting from 2 TAG endografts with oversizing of 11% and 45%, respectively. Results: The bird-beak configuration with the greatest protrusion extension exhibited the maximum TAG device displacement (1.66 mm), while the lowest protrusion extension configuration led to the minimum amount of both displacement and rotation parameters (0.25 mm and 0.6°, respectively). A positive relationship was found between the infolding parameters and the flow circulating in the aorta and left subclavian artery. Similarly, TAG device displacement was positively and significantly (p<0.05) correlated with the pulse pressure for all bird-beak configurations and device sizes. However, no collapse was observed under chronic perfusion testing maintained for 30 days and pulse pressure of 100 mm Hg. Conclusion: These findings suggest that endograft infolding depends primarily on the amount of aortic pulsatility and flow rate and that physiological flows do not necessarily engender hemodynamic loads on the proximal bird-beak segment sufficient to cause TAG collapse. Hemodynamic variables may allow for identification of patients at high risk of endograft infolding and help guide preventive intervention to avert its occurrence

Difference in hemodynamic and wall stress of ascending thoracic aortic aneurysms with bicuspid and tricuspid aortic valve

The aortic dissection (AoD) of an ascending thoracic aortic aneurysm (ATAA) initiates when the hemodynamic loads exerted on the aneurysmal wall overcome the adhesive forces holding the elastic layers together. Parallel coupled, two-way fluid–structure interaction (FSI) analyses were performed on patient-specific ATAAs obtained from patients with either bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) to evaluate hemodynamic predictors and wall stresses imparting aneurysm enlargement and AoD. Results showed a left-handed circumferential flow with slower-moving helical pattern in the aneurysm's center for BAV ATAAs whereas a slight deviation of the blood flow toward the anterolateral region of the ascending aorta was observed for TAV ATAAs. Blood pressure and wall shear stress were found key hemodynamic predictors of aneurysm dilatation, and their dissimilarities are likely associated to the morphological anatomy of the aortic valve. We also observed discontinues, wall stresses on aneurysmal aorta, which was modeled as a composite with two elastic layers (i.e., inhomogeneity of vessel structural organization). This stress distribution was caused by differences on elastic material properties of aortic layers. Wall stress distribution suggests AoD just above sinotubular junction. Moreover, abnormal flow and lower elastic material properties that are likely intrinsic in BAV individuals render the aneurysm susceptible to the initiation of AoD