Patient-specific computational models to support interventional procedures: a case study of complex aortic re-coarctation.
OBJECTIVE
We report the application of patient-specific computational models to plan the treatment of complex aortic re-coarctation (rCoA) with a proximal aberrant right subclavian artery in a patient who had previously undergone bare metal stenting.


RESULTS
Clinically acquired images were used to set up patient-specific computational models for finite element (FE) and fluid dynamics (CFD) analyses. The 3D geometry was reconstructed from computed tomography and echocardiography images. Computer-generated deployment of a CP covered stent (NuMED, Hopkinton, NY, USA) at different diameters was tested using FE simulations. CFD analyses based on preoperative magnetic resonance flow measurements allowed assessment of rCoA pressure relief and right subclavian artery perfusion in the different scenarios. The simulations suggested an expansion diameter for the CP stent (8 zigs, length=28 mm) of between 16 and 18 mm to relieve the obstruction, cover the aneurysm and maintain satisfactory flow to the right subclavian artery. Following the modelling study, a 16 mm CP covered stent was successfully implanted.


CONCLUSIONS
Patient-specific models can be successfully used to plan re-stenting of complex rCoA, showing the benefits of integrating computational techniques into patient management.
UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom.
Daria
D
Cosentino
Claudio
C
Capelli
Graham
G
Derrick
Sachin
S
Khambadkone
Vivek
V
Muthurangu
Andrew M
AM
Taylor
Silvia
S
Schievano
D000783:Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018376:Cardiovascular Abnormalities / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003198:Computer Simulation; D003680:Deglutition Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D004452:Echocardiography; D057510:Endovascular Procedures / Q000295:instrumentation; D020342:Finite Element Analysis; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008955:Models, Cardiovascular; D064847:Multimodal Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012008:Recurrence; D015607:Stents; D013348:Subclavian Artery / Q000002:abnormalities* / Q000503:physiopathology; D013813:Therapy, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult