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• W2912952992 abstract "Central MessageWe analyzed retrograde spiral turbulent flow in the aortic root during CF-LVAD support using CFD with accurate detailed anatomy.See Commentaries on pages e209 and e211. We analyzed retrograde spiral turbulent flow in the aortic root during CF-LVAD support using CFD with accurate detailed anatomy. See Commentaries on pages e209 and e211. Aortic insufficiency (AI) developed during continuous-flow left ventricular assist device (CF-LVAD) use occurs in 25% of patients within 1 year of CF-LVAD implantation.1Bouabdallaoui N. El-Hamamsy I. Pham M. Giraldeau G. Parent M.C. Carrier M. et al.Aortic regurgitation in patients with a left ventricular assist device: a contemporary review.J Heart Lung Transplant. 2018; 37: 1289-1297Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 2Toda K. Fujita T. Domae K. Shimahara Y. Kobayashi J. Nakatani T. Late aortic insufficiency related to poor prognosis during left ventricular assist device support.Ann Thorac Surg. 2011; 92: 929-934Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar Nonphysiologic retrograde flow in the ascending aorta and shear stress in the aortic valve have been suggested to induce valve-leaflet thinning, consequently, AI and its progression.3Hata H. Fujita T. Ishibashi-Ueda H. Nakatani T. Kobayashi J. Pathological analysis of the aortic valve after long-term left ventricular assist device support.Eur J Cardiothorac Surg. 2014; 46: 193-197Crossref PubMed Scopus (27) Google Scholar, 4Yoshida S. Fukushima S. Miyagawa S. Toda K. Sawa Y. Visualization of vortex flow and shear stress in the aortic root during left ventricular assist device support.J Thorac Cardiovasc Surg. 2017; 154: 877-878.e871Abstract Full Text Full Text PDF Scopus (5) Google Scholar Although blood flow analysis using vector flow mapping with 2-dimensional echocardiographic images or computational fluid dynamics (CFD) using the aortic mold without aortic root has been reported, blood flow and shear stress in the 3-dimensional aortic root with its complex anatomy are unknown.4Yoshida S. Fukushima S. Miyagawa S. Toda K. Sawa Y. Visualization of vortex flow and shear stress in the aortic root during left ventricular assist device support.J Thorac Cardiovasc Surg. 2017; 154: 877-878.e871Abstract Full Text Full Text PDF Scopus (5) Google Scholar, 5Karmonik C. Partovi S. Loebe M. Schmack B. Weymann A. Lumsden A.B. et al.Computational fluid dynamics in patients with continuous-flow left ventricular assist device support show hemodynamic alterations in the ascending aorta.J Thorac Cardiovasc Surg. 2014; 147: 1326-1333.e1321Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar To evaluate the 3-dimensional blood flow, CFD analysis with an accurate aortic root anatomy, including the aortic valve and coronary arteries, was performed in a 40-year-old woman in whom the aortic valve did not open after CF-LVAD (HeartMate II, Abbott, Chicago, Ill) implantation for ischemic dilated cardiomyopathy. First, the accurate flow rate was calculated using the arterial pressure waveform and cardiac output in the Swan-Ganz catheter (Figure 1, A and B), and a 3-dimensional patient-specific geometry was created using AZE Virtual Place (AZE, Tokyo, Japan) with electrocardiogram-gated computed tomography images (Figure 1, C). Subsequently, CFD analysis, using ANSYS-FLUENT 18.0 (ANSYS, Inc, Canonsburg, Pa), revealed retrograde spiral turbulence in the aortic root (Figure 2, A, Video 1), similar to a previous study that used echocardiography,4Yoshida S. Fukushima S. Miyagawa S. Toda K. Sawa Y. Visualization of vortex flow and shear stress in the aortic root during left ventricular assist device support.J Thorac Cardiovasc Surg. 2017; 154: 877-878.e871Abstract Full Text Full Text PDF Scopus (5) Google Scholar and demonstrated a low shear stress in the aortic root excluding the coronary arteries (Figure 2, B, and Video 2). Shear stress was similar in each aortic valve cusp, whereas it was relatively high in the commissures (Figure 2, C, and Video 3). The oscillatory shear index in the aortic root was low (Figure 2, D).Video 2Shear stress during 1 cardiac cycle from CFD simulation in a patient supported with a CF-LVAD, showing low shear stress in the aortic root except in the coronary arteries. Video available at: https://www.jtcvs.org/article/S0022-5223(19)30284-3/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Video 3Shear stress in the aortic valve during 1 cardiac cycle from CFD simulation in a patient supported with a CF-LVAD, showing that shear stress is similar in each aortic valve cusp and is relatively high in the commissures. Video available at: https://www.jtcvs.org/article/S0022-5223(19)30284-3/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 1A, Graph representing the time-dependent change in the arterial pressure during 1 cardiac cycle in patients with ischemic cardiomyopathy under CF-LVAD support. B, Graph representing the time-dependent change in the flow rate from the LVAD during 1 cardiac cycle, which was calculated using the arterial pressure waveform and mean cardiac output (4.0 L/min) in the Swan-Ganz catheter. C, Images showing a 3-dimensional patient-specific geometry of the aorta, the coronary and cervical arteries, and the outflow graft of the LVAD from the anterior (left), lateral (middle), and inferior (right) view.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 2The results of CFD simulation in a patient supported with a CF-LVAD. A, Streamline shows retrograde spiral turbulence in the aortic root. B, Shear stress is low in the aortic root except in the coronary arteries. C, Shear stress is similar in each aortic valve cusp and relatively high in the commissures. D, Oscillatory shear index in the aortic root is low.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Elucidation of the difference in blood flow pattern and shear stress between patients with and without de novo AI might allow preoperative CFD to predict AI occurrence after CF-LVAD implantation. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4MjE1YTRmOWU0YzJmNjU4ZjAzMjg1YzYzZWM5OTBmMiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjQ2NTIwNjYyfQ.pMbMnXyYi4iD3_8VjWyjeA_5s2Au8PWBRo0rpWbHgTYYceXqH9CbBFAHyCxoI601GUjlEHOFZoQ_MNZ-n-FKZ1tD0UkJ8dYPGVk4Bz_elVNRJMdYLJaOM-qcq1D5aGwuR7NFtq--Howhl-thSvfH95fAxBsrVukqe7WUhjZbTrnk96QlVxLeQ_SVrnO0grJHKZm5vdgLaa_EmJJcLnNy_zRLc2lCpurU6bteJOoEtjqJsDhVun9qwwu5DG0WagSQUMhTipalCv6b2d0Pfk0IIQdfgqchUDJgRTFoOFgtr1Jg4u-E0mSFzwzjjhEkdrflGT54yfo7WuxAcmF--CwAcQ Download .mp4 (0.58 MB) Help with .mp4 files Video 1Streamline during 1 cardiac cycle from CFD simulation in a patient supported with a CF-LVAD showing retrograde spiral turbulence in the aortic root. Video available at: https://www.jtcvs.org/article/S0022-5223(19)30284-3/fulltext.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxNDFkZGI3NDJhYTUzZDAxN2Y1ZTliM2FjNzZiNjY1ZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjQ2NTIwNjYyfQ.KkTTD5Q4DOv_OzKDOpMx92D06uLgcJkpy6Px61UVYAHUKBdi7MNzTwVurzLtZnJC0-wnTPuyLxBb08SQDoHaAbDWtE9V2DA1HByxG1cziSDYJkHjuOGU85-tSEbI3NLKrUurg509wiGCUb5kq4h9PiAztlgRhBHp6_VQhNoNa_KEqVYdqgycK_N7Kl9xKoX12q0s-NTLQHCFJ9SyYnOYPNGNqIOQIm588NJqNIzm1MYFLlqWncUFBdeGqArotC6ZlRDxYb-JHjzKStfy_OOnK4oGXBuWy9HSsc7_X5K8hr0hND2Cgt_2mntB37BmVGGWpQAeJnrml3XH0yz9r-coEw Download .mp4 (0.43 MB) Help with .mp4 files Video 2Shear stress during 1 cardiac cycle from CFD simulation in a patient supported with a CF-LVAD, showing low shear stress in the aortic root except in the coronary arteries. Video available at: https://www.jtcvs.org/article/S0022-5223(19)30284-3/fulltext.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5MWQ3ZDUzZjQwNjQ5MmMzOGVkYzA1MTBiMjg1MzI1MSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjQ2NTIwNjYyfQ.KZsfWxnt9LLOOR0AVva_xyNBvunR1ipxYZfBe5eKI8Zcneyz2xfYt42fHg3zXB-_sfKipHW1yzd0fmDcGgQTDEJX6M2pO747DqItRS4Twn4b6MrPQwfU9F_bzLp70BZykNP7FQk4j6KvLjp7ugCok7Yu9V_bVBTNIFu_WQkxXaQGK-JtsgEfodgfuHvDCkDaGdNJX8ePsbvian7LTq5hAVRa19OiBhAdnmdxW3ZGZcqe1nTxzBvWH5WmaRf4FUwJM3T67BXRJdHMyTbOxPqjV4npA9IaqbYHkxz72c3cBk1A2CmPaYVT9hOmSiI_9-QfRtK4dRbYLifjM42p-Tk-4w Download .mp4 (0.57 MB) Help with .mp4 files Video 3Shear stress in the aortic valve during 1 cardiac cycle from CFD simulation in a patient supported with a CF-LVAD, showing that shear stress is similar in each aortic valve cusp and is relatively high in the commissures. Video available at: https://www.jtcvs.org/article/S0022-5223(19)30284-3/fulltext." @default.
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• W2912952992 title "Computational fluid dynamics visualizes turbulent flow in the aortic root of a patient under continuous-flow left ventricular assist device support" @default.
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