title: False Lumen Flow Patterns and their Relation with Morphological and Biomechanical Characteristics of Chronic Aortic Dissections. Computational Model Compared with Magnetic Resonance Imaging Measurements.
abstract: Aortic wall stiffness, tear size and location and the presence of abdominal side branches arising from the false lumen (FL) are key properties potentially involved in FL enlargement in chronic aortic dissections (ADs). We hypothesize that temporal variations on FL flow patterns, as measured in a cross-section by phase-contrast magnetic resonance imaging (PC-MRI), could be used to infer integrated information on these features. In 33 patients with chronic descending AD, instantaneous flow profiles were quantified in the FL at diaphragm level by PC-MRI. We used a lumped-parameter model to assess the changes in flow profiles induced by wall stiffness, tear size/location, and the presence of abdominal side branches arising from the FL. Four characteristic FL flow patterns were identified in 31/33 patients (94%) based on the direction of flow in systole and diastole: BA = systolic biphasic flow and primarily diastolic antegrade flow (n = 6); BR = systolic biphasic flow and primarily diastolic retrograde flow (n = 14); MA = systolic monophasic flow and primarily diastolic antegrade flow (n = 9); MR = systolic monophasic flow and primarily diastolic retrograde flow (n = 2). In the computational model, the temporal variation of flow directions within the FL was highly dependent on the position of assessment along the aorta. FL flow patterns (especially at the level of the diaphragm) showed their characteristic patterns due to variations in the cumulative size and the spatial distribution of the communicating tears, and the incidence of visceral side branches originating from the FL. Changes in wall stiffness did not change the temporal variation of the flows whereas it importantly determined intraluminal pressures. FL flow patterns implicitly codify morphological information on key determinants of aortic expansion in ADs. This data might be taken into consideration in the imaging protocol to define the predictive value of FL flows.
authors.affiliation: Physense, Universitat Pompeu Fabra, Barcelona, Spain.|University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Paula A
authors.identifier: http://orcid.org/0000-0003-0561-0193
authors.initials: PA
authors.lastname: Rudenick
authors.affiliation: Biofluid, Tissue and Solid Mechanics for Medical Applications, Institute Biomedical Technology, Ghent University, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.affiliation: University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Pineda
authors.affiliation: University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Hug
authors.initials: H
authors.lastname: Cuellar
authors.affiliation: University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
authors.affiliation: University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Physense, Universitat Pompeu Fabra, Barcelona, Spain.|ICREA, Barcelona, Spain.
authors.forename: Bart H
authors.identifier: http://orcid.org/0000-0003-3130-6937
authors.initials: BH
authors.lastname: Bijnens
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008955:Models, Cardiovascular; D059289:Vascular Stiffness / Q000502:physiology*