Computational fluid dynamic simulations investigating the diagnosis, treatment, and long term outcomes associated with aortic coarctation
Abstract/Contents
- Abstract
- Coarctation of the aorta is a congenital heart defect where a narrowing occurs in the thoracic aorta. Aortic coarctation accounts for approximately 5-10% of all congenital heart defects, affecting approximately 1 in 3000 newborns. While the condition has been recognized for over 70 years, many clinical questions still remain about the management of patients with aortic coarctation. There exists a need to investigate the complex hemodynamics associated with this disease using computational fluid dynamics to improve the diagnosis, treatment, and long-term management of these patients. First, computational simulations were used to determine the hemodynamic significance of various aortic arch obstructions, specifically to determine the significance of aortic hypoplasia, defined as long segment aortic narrowing, compared with aortic coarctation, defined as discrete narrowing. Ventricular workload was used as a metric for the degree of significance imposed by the narrowing. Results indicated that aortic hypoplasia was more significant that aortic coarctation when the same percent narrowing was considered. In addition, the simulations revealed that aortic hypoplasia consisting of 25-50% narrowing is not likely to be hemodynamically significant under resting conditions. Next, various treatment options were investigated by using simulations to compare surgical and stent-based treatment. In particular, stents placed in the aorta create a compliance mismatch because the stent is rigid and the aorta is deformable, so computational simulations were used to determine the significance of the mismatch. The results showed that the compliance mismatch associated with a rigid stent did not produce a clinically significant change in the required ventricular workload. This study refuted the claim that the compliance mismatch associated with stenting in aortic coarctation patients negatively impacts patient hemodynamics. Finally, patients with corrected aortic coarctation often suffer from hypertension and associated cardiovascular problems in the coronary and cerebral vessels. Computational simulations were used to determine the hemodynamics in the aorta, coronary, and cerebral vessels associated with hypertension and subsequent vascular remodeling. The results showed that hypertension induced with aortic coarctation is associated with nearly equal increases in mean pressure but different increases in pulse pressure throughout the model. This study revealed interesting and important information related to the hemodynamics in a large vascular model under the effects of hypertension and vascular wall remodeling. These studies showed the power of computational simulations to aid in the investigation of clinical questions regarding aortic coarctation.
Description
| Type of resource | text |
|---|---|
| Form | electronic; electronic resource; remote |
| Extent | 1 online resource. |
| Publication date | 2011 |
| Issuance | monographic |
| Language | English |
Creators/Contributors
| Associated with | Coogan, Jessica Shih |
|---|---|
| Associated with | Stanford University, Department of Bioengineering. |
| Primary advisor | Feinstein, Jeffrey A |
| Primary advisor | Taylor, Charles A. (Charles Anthony) |
| Thesis advisor | Feinstein, Jeffrey A |
| Thesis advisor | Taylor, Charles A. (Charles Anthony) |
| Thesis advisor | Chan, Frandics |
| Thesis advisor | Pelc, Norbert J |
| Advisor | Chan, Frandics |
| Advisor | Pelc, Norbert J |
Subjects
| Genre | Theses |
|---|
Bibliographic information
| Statement of responsibility | Jessica Shih Coogan. |
|---|---|
| Note | Submitted to the Department of Bioengineering. |
| Thesis | Thesis (Ph.D.)--Stanford University, 2011. |
| Location | electronic resource |
Access conditions
- Copyright
- © 2011 by Jessica Shih Coogan
- License
- This work is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported license (CC BY-NC).
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