title: Finite element modeling of the pulmonary autograft at systemic pressure before remodeling.
abstract: OBJECTIVE
  Pulmonary autograft dilatation requiring reoperation is an Achilles' heel of the Ross procedure, as exposure to systemic pressure increases autograft wall stress, which may in turn lead to tissue remodeling and aneurysmal pathology. However, the magnitude of autograft wall stress with the Ross procedure is unknown. The study aim was to develop a realistic finite element (FE) model of the autograft, and to perform simulations at systemic pressure to determine wall stress distribution immediately after the Ross operation.
  
  
  METHODS
  The porcine pulmonary root geometry was generated from high-resolution microcomputed tomography (microCT) images to create a mesh composed of hexahedral elements. Previously defined constitutive equations were used to describe the regional material properties of the native porcine pulmonary root. The anterior and posterior pulmonary arteries, and each of the pulmonary sinuses, were best described by non-linear, anisotropic Fung strain energy functions, and input individually into the model. Autograft dilatation and wall stress distribution during pulmonary and systemic loading prior to remodeling were determined using explicit FE analysis in LS-DYNA.
  
  
  RESULTS
  The autograft was highly compliant in the low-strain region, and the majority of dilation occurred with < 30 mmHg of pressurization. During pulmonic loading, a typical inflation/deflation was observed between systole and diastole, but the autograft remained almost completely dilated throughout the cardiac cycle at systemic pressure. Although the systolic blood pressure was 380% greater in the aortic than in the pulmonary position, the peak systolic diameter was increased by only 28%. The maximum principal wall stress increased approximately 10-fold during systole and 25-fold during diastole, and was greater in the sinus than the distal artery for all simulations.
  
  
  CONCLUSIONS
  Under systemic loading conditions, the pulmonary autograft remained fully dilated and experienced large wall stresses concentrated in the sinus. The future correlation of this model with explanted autografts may lead to an improved understanding of tissue remodeling following the Ross procedure.
authors.affiliation: Department of Surgery, University of California at San Francisco Medical Center, San Francisco, CA 94103-0118, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Matthews
authors.forename: Choon-Sik
authors.initials: CS
authors.lastname: Jhun
authors.forename: Stephanie
authors.initials: S
authors.lastname: Yaung
authors.forename: Ali N
authors.initials: AN
authors.lastname: Azadani
authors.forename: Julius M
authors.initials: JM
authors.lastname: Guccione
authors.forename: Liang
authors.initials: L
authors.lastname: Ge
authors.forename: Elaine E
authors.initials: EE
authors.lastname: Tseng
mesh_terms: D000818:Animals; D001014:Aortic Aneurysm / Q000209:etiology / Q000503:physiopathology; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003187:Compliance; D003198:Computer Simulation; D004108:Dilatation, Pathologic; D020342:Finite Element Analysis; D008955:Models, Cardiovascular; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D011652:Pulmonary Circulation; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D013314:Stress, Mechanical; D013552:Swine; D014182:Transplantation, Autologous; D055114:X-Ray Microtomography