Matadial Ojha

Factors influencing blood flow patterns in the human right coronary artery.

AbstractEvidence suggests that atherogenesis is linked to local hemodynamic factors such as wall shear stress. We investigated the velocity and wall shear stress patterns within a human right coronary artery (RCA), an important site of atherosclerotic lesion development. Emphasis was placed on evaluating the effect of flow waveform and inlet flow velocity profile on the hemodynamics in the proximal, medial, and distal arterial regions. Using the finite-element method, velocity and wall shear stress patterns in a rigid, anatomically realistic model of a human RCA were computed. Steady flow simulations (ReD=500) were performed with three different inlet velocity profiles; pulsatile flow simulations utilized two different flow waveforms (both with Womersley parameter=1.82, mean ReD=233),1 as well as two of the three inlet profiles. Velocity profiles showed Dean-like secondary flow features that were remarkably sensitive to the local curvature of the RCA model. Particularly noteworthy was the “rotation” of these Dean-like profiles, which produced large local variations in wall shear stress along the sidewalls of the RCA model. Changes in the inlet velocity profiles did not produce significant changes in the arterial velocity and wall shear stress patterns. Pulsatile flow simulations exhibited remarkably similar cycle-average wall shear stress distributions regardless of waveform and inlet velocity profile. The oscillatory shear index was very small and was attributed to flow reversal in the waveform, rather than separation. Cumulatively, these results illustrate that geometric effects (particularly local three-dimensional curvature) dominate RCA hemodynamics, implying that studies attempting to link hemodynamics with atherogenesis should replicate the patient-specific RCA geometry.

Compliance mismatch may promote graft–artery intimal hyperplasia by altering suture-line stresses

The role of graft-artery compliance mismatch in the development of distal anastomotic intimal hyperplasia (DAIH) is not yet resolved. Although DAIH develops at all surgically created anastomoses, increased compliance mismatch does not lead to greater hyperplasia formation in end-to-end anastomoses, but in end-to-side anastomoses, it leads to a profound increase in hyperplasia. The current study was undertaken to determine whether suture-induced anastomotic stresses could explain these findings. A large strain finite element analysis of vascular wall mechanics was performed to compare the influence of compliance mismatch on intramural stresses in end-to-end versus end-to-side anastomoses. A novel modelling approach was implemented which includes suture-induced stress concentrations. End-to-end and end-to-side graft-artery simulations were executed using (1) artery (compliance = C = 0.44% kPa(-1)), (2) vein (C = 0.33% kPa(-1)), and (3) Dacron (C = 0.14% kPa(-1)) grafts. Residual stresses due to axial tension were included and the anastomoses were statically inflated to 13.3 kPa (100 mmHg). Elevated intramural stresses were found to exist at both the end-to-end and end-to-side graft-artery junctions; however, in the end-to-end anastomosis, the maximum anastomotic stress was not a function of the graft compliance, whereas in the end-to-side anastomosis, the maximum stress was a strong function of graft compliance. For the 45 degree end-to-side geometry considered in this study, the maximum anastomotic stress concentration obtained using a stiff Dacron graft was more than 40% greater than that obtained using a compliant artery graft. In the end-to-end anastomosis, the Dacron graft led to a less than 5% increase in maximum stress over the artery graft. Therefore, increased compliance mismatch increases stresses and promotes DAIH in end-to-side junctions, but, it has little influence on either stresses or DAIH in end-to-end junctions. Thus, the proliferative influence of increased compliance mismatch on suture-line hyperplasia in end-to-side anastomoses can be explained by the resulting increase in intramural stresses. In addition, since high stresses were found in both geometries, elevated suture-line intramural stresses may be an important proliferative stimulus for intimal hyperplasia formation in all vascular reconstructions.

Pulsatile flow through constricted tubes: an experimental investigation using photochromic tracer methods

A photochromic tracer method has been used to record pulsatile flow velocity profiles simultaneously at three axial locations along a flow channel. Two major advantages of this multiple-trace method are that it enables velocity data to be acquired in an efficient non-invasive manner and that it provides a detailed description of the spatial relationship of the flow field. The latter is found to be particularly useful in the investigation of transitional type flows; for example, in describing coherent flow structures. Studies of the flow patterns in tubes with mild to moderate degrees of vessel constriction were performed using a 2.9 Hz sinusoidal flow superimposed on a steady flow (frequency parameter of 7.5; mean and modulation Reynolds numbers of 575 and 360, respectively). With mild constrictions (

Spatial and temporal variations of wall shear stress within an end-to-side arterial anastomosis model

Wall shear stress has been strongly implicated in the initiation of fibrous intimal hyperplasia that leads to arterial bypass graft failure. In this study, the photochromic tracer technique was used to determine the instantaneous value of the wall shear stress in order to provide a detailed description of its spatial and temporal variations within a 45 degrees end-to-side anastomosis model. At the heel and on the bed across from the heel, the shear stress was close to zero throughout the sinusoidal flow cycle. Flow separation was produced just beyond the toe where the peak phase-averaged shear stress was 6 dyn cm-2, whilst on the bed across from the toe it was 27 dyn cm-2. The stagnation point was seen to fluctuate quite sharply on the bed over a distance of about one tube radius upstream from the site across from the toe. This led to large spatial gradients of the wall shear stress with a peak value of 580 dyn cm-3. In addition, the sudden motion of the stagnation point around peak flow produced sharp temporal gradients of the wall shear stress with a peak absolute value of 3400 dyn cm-2 s-1. When compared to the sites where intimal hyperplasia tends to occur, a strong correlation is seen with low wall shear stress at the heel and toe, and with the sharp temporal variations of the magnitude and spatial gradient of the wall shear stress on the bed across from the junction.

The relationship between wall shear stress distributions and intimal thickening in the human abdominal aorta

PurposeThe goal of this work was to determine wall shear stress (WSS) patterns in the human abdominal aorta and to compare these patterns to measurements of intimal thickness (IT) from autopsy samples.MethodsThe WSS was experimentally measured using the laser photochromic dye tracer technique in an anatomically faithful in vitro model based on CT scans of the abdominal aorta in a healthy 35-year-old subject. IT was quantified as a function of circumferential and axial position using light microscopy in ten human autopsy specimens.ResultsThe histomorphometric analysis suggests that IT increases with age and that the distribution of intimal thickening changes with age. The lowest WSS in the flow model was found on the posterior wall inferior to the inferior mesenteric artery, and coincided with the region of most prominent IT in the autopsy samples. Local geometrical features in the flow model, such as the expansion at the inferior mesenteric artery (common in younger individuals), strongly influenced WSS patterns. The WSS was found to correlate negatively with IT (r2 = 0.3099; P = 0.0047).ConclusionLow WSS in the abdominal aorta is co-localized with IT and may be related to atherogenesis. Also, rates of IT in the abdominal aorta are possibly influenced by age-related geometrical changes.

In Vitro Hemodynamic Evaluation of a Simon Nitinol Vena Cava Filter: Possible Explanation of IVC Occlusion

PURPOSE To evaluate the local hemodynamics in the region of the Simon nitinol filter (SNF), used to prevent pulmonary emboli by capturing clot and promoting lysis. MATERIALS AND METHODS The hemodynamics of the Simon nitinol inferior vena cava (IVC) filter were evaluated under steady flow (Re = 600) in a 20-mm-diameter IVC model. The photochromic dye tracer technique was used to estimate the velocity and wall shear stress. These flow features were determined for the unoccluded and partially occluded (clot volume = 1,500 mm(3)) states of the SNF along its center plane. RESULTS A region of low velocities developed around the central axis of the filter extending from the leading edge of the central strut to the filter tip. This phenomenon was created by the strong redirection of flow toward the periphery of the filter. With the presence of the clot, these effects were enhanced, causing flow separation and recirculation. In addition, the shear stress on the hip of the clot was about 30 times that of the upstream value, and turbulence developed in the near-downstream region. CONCLUSIONS The extended region of almost-stagnant flow near the midsection of the umbrella region could lead to organization of thrombus and fibrin mesh network development. The presence of a simulated clot led to a significant increase in the size of the stagnant, thrombus-prone region as well as turbulence, which, overall, may contribute to caval occlusion.

Hemodynamics of a side-to-end proximal arterial anastomosis model

PURPOSE The purpose of this article was to analyze the fluid mechanical effects of a side-to-end proximal anastomosis and to compare the results with those from our earlier study on the end-to-side distal anastomosis. METHODS The photochromic tracer technique was used to determine the instantaneous wall shear stress and to visualize the overall flow field under pulsatile flow conditions. The flow consisted of a sinusoid plus a steady component with mean and modulation Reynolds numbers of 355 and 565, respectively, and a Womersley number of 7.9. RESULTS At the toe and heel of the junction, very high and positive wall shear stresses were seen together with substantial nonperiodic fluctuations. The peak wall shear stress was about four times higher at the toe and about seven times higher at the heel than the maximum values observed at about four tube diameters upstream from the junction. On the bed of the host vessel, nonperiodic fluctuations were also observed, but the shear stresses were mainly negative with magnitudes comparable to those seen upstream. With leakages of 11% and 28% of the mean flow through the blocked end of the host vessel, the shear stress pattern seemed to be significantly affected only at the toe for the higher leakage. Further, when the mean Reynolds number was reduced to 320, the magnitudes of the variations in the wall shear stress were reduced proportionately, except at the heel, where the reduction was much larger than expected. CONCLUSIONS It appears that the preferential development of intimal hyperplasia at the distal end-to-side anastomosis may be promoted by low wall shear stress at the toe and heel, and probably by high shear stresses or shear stress gradients on the bed.

RELATION OF THE FLOW FIELD DISTAL TO A MODERATE STENOSIS TO THE DOPPLER POWER

An experimental investigation was undertaken to establish how different flow regimes affect the Doppler signal. A rigid tube model consisting of a 70% asymmetric area stenosis was used with steady and pulsatile flow conditions. The characteristics of the flow field at various sites was determined using a photochromic flow visualization method. Continuous-wave Doppler measurements were made using a 41% suspension of human red blood cells (RBCs) in saline as well as a dilute suspension of 4% fixed RBCs. For steady flow, the photochromic results indicated that for Reynolds numbers (Re) of 545 and 1410, turbulence was generated and the length of the turbulent region was found to increase with increasing Re. Under pulsatile flow conditions, turbulence was triggered around peak systole and began to dissipate in late deceleration, and by the end of diastole the flow field almost relaminarized. During the turbulent phase of the flow cycle, the poststenotic flow field was seen to consist of four distinct flow regimes similar to those observed for steady flow. For higher Womersley parameters and Reynolds numbers the turbulent zone was found to be larger and to occupy a greater fraction of the flow cycle. These flow visualization results were compared with the Doppler power measurements made at the same locations and under similar flow conditions. At physiological hematocrits (41%) the onset of turbulence for both steady and pulsatile flow increased the backscattered Doppler power. The location of the peak Doppler power coincided with the region of maximum turbulence observed using the photochromic technique.

Histology and morphology of 59 internal thoracic artery grafts and their distal anastomoses

BACKGROUND The left internal thoracic artery (LITA) is accepted as a superior graft for the left coronary system because of its better long-term patency rate than saphenous grafts. The postsurgical histomorphometric changes at the distal anastomosis of LITA grafts are not well documented. METHODS The cellular changes within the intima of 59 LITA grafts were analyzed by light microscopy. RESULTS Grafts implanted 1 week or less (n = 34) showed no postsurgical tissue proliferation. Of the 7 grafts implanted 1 to 8 weeks, only the suture sites exhibited intimal thickening (6 of 7 grafts, 0.08 +/- 0.07 mm). The remaining grafts (n = 18), aged 2 months to 10 years, showed significant intimal thickening at the suture sites (0.39 +/- 0.17 mm) and on the hood (0.29 +/- 0.25 mm), with variable thickening on the floor (10 of 18 left anterior descending coronary arteries, 0.11 +/- 0.12 mm). The graft body showed insignificant intimal changes (10 of 18, 0.03 +/- 0.04 mm), with mild focal atherosclerotic lesions in 2 of 18 late LITA grafts. CONCLUSIONS Left internal thoracic artery grafts develop fibromuscular intimal hyperplasia primarily around the anastomosis. The response on the hood appears to be a hemodynamic response, secondary to that of the suture sites.

Distribution of intimal and medial thickening in the human right coronary artery: a study of 17 RCAs.

OBJECTIVE To quantify the distribution of intimal and medial thickening in human right coronary arteries (RCAs) obtained at autopsy. BACKGROUND The shear and tensile stresses created by arterial bifurcation are believed to result in eccentric fibromuscular intimal thickening that leads to atherosclerosis. Vascular curvature has been cited as a cause of atherosclerosis; however, details of the location and extent of intimal and medial thickness in the largely curved human RCA are not adequately documented. METHODS The right coronary arteries were obtained from 40 postmortem hearts and cut into 20-30 segments, each being 3-4 mm in length. Microscopic sections from the proximal, acute margin, and distal regions of the RCA were digitized around the circumference of the vessel. Seventeen arteries showed insignificant stenosis (<50%) and were selected for detailed examination. RESULTS Seventy-one percent (12/17) of proximal sections displayed eccentric intimal thickening. Normalized ensemble averaging revealed a preferential thickening on the myocardial side of the artery. At the acute margin region where curvature is most pronounced and at the distal region, 51% (8/17) of the samples showed eccentric thickening, but the ensemble average thickening in these regions showed no preferential location. In these mildly diseased arteries, the thickened intima comprised of mainly smooth muscle cells with an extracellular matrix of collagen and some elastin. A relatively uniform medial smooth muscle layer was seen at all three locations. CONCLUSIONS The proximal region of the RCA appears to be a site of intrinsic eccentric intimal thickening with maximum thickness on the myocardial side of the artery. Eccentric thickening does occur in the acute margin and distal regions; however, no distinct pattern or location was evident.