title: Computational study of haemodynamic effects of entry- and exit-tear coverage in a DeBakey type III aortic dissection: technical report.
abstract: OBJECTIVE
  Outcome prediction in DeBakey Type III aortic dissections (ADs) remains challenging. Large variations in AD morphology, physiology and treatment exist. Here, we investigate if computational fluid dynamics (CFD) can provide an initial understanding of pressure changes in an AD computational model when covering entry and exit tears and removing the intra-arterial septum (IS).
  
  
  METHODS
  A computational mesh was constructed from magnetic resonance images from one patient (one entrance and one exit tear) and CFD simulations performed (scenario #1). Additional meshes were derived by virtually (1) covering the exit tear (false lumen (FL) thrombus progression) (scenario #2), (2) covering the entrance tear (thoracic endovascular treatment, TEVAR) (scenario #3) and (3) completely removing the IS (fenestration) (scenario #4). Changes in flow patterns and pressures were quantified relative to the initial mesh.
  
  
  RESULTS
  Systolic pressures increased for #2 (300 Pa increase) with largest inter-luminal differences distally (2500 Pa). In #3, false lumen pressure decreased essentially to zero. In #4, systolic pressure in combined lumen reduced from 2400 to 800 Pa.
  
  
  CONCLUSIONS
  CFD results from computational models of a DeBakey type III AD representing separate coverage of entrance and exit tears correlated with clinical experience. The reported results present a preliminary look at a complex clinical problem.
authors.affiliation: Methodist DeBakey Heart & Vascular Center, the Methodist Hospital, Houston, TX 77030, USA. ckarmonik@tmhs.org
authors.forename: C
authors.initials: C
authors.lastname: Karmonik
authors.forename: J
authors.initials: J
authors.lastname: Bismuth
authors.forename: D J
authors.initials: DJ
authors.lastname: Shah
authors.forename: M G
authors.initials: MG
authors.lastname: Davies
authors.forename: D
authors.initials: D
authors.lastname: Purdy
authors.forename: A B
authors.initials: AB
authors.lastname: Lumsden
mesh_terms: D000784:Aortic Dissection / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D003198:Computer Simulation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012039:Regional Blood Flow; D013526:Surgical Mesh; D016896:Treatment Outcome