Biomécanique de l aorte et paramètres extraits de l IRM 4D
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1 Biomécanique de l aorte et paramètres extraits de l IRM 4D Institut Mines-Télécom avril@emse.fr Prof. Stéphane AVRIL
2 MINES SAINT-ETIENNE First Grande Ecole outside Paris Founded in 1816 PARIS AUVERGNE RHONE-ALPES Institut Mines-Télécom
3 Computational mechanics in the OR for vascular surgery? Institut Mines-Télécom 3
4 Prediction of risk of rupture and dissection dissection Institut Mines-Télécom
5 Context More and more aneurysms are detected at an early stage (incidence >8% for males >65 years old). An intervention is recommended if the aneurysm grows more >1cm/year or it is >5.5cm. This represents >90000 interventions per year in Europe and USA BUT: 25% aneurysms <5.5cm rupture : deaths **! 60% of aneurysms >5.5 cm never experience rupture! In summary: very high rate of inappropriate decisions and misprogramed surgical interventions!! ** Pape et al, Aortic Diameter 5.5 cm Is Not a Good Predictor of Type A Aortic Dissection Observations From the International Registry of Acute Aortic Dissection (IRAD), Circulation, 2007
6 Bulge inflation test Romo et al. Journal of Biomechanics Circumferential Axial III) Inflation test device. Speckle pattern is made before starting the inflation test
7 Rupture risk estimation Rupture Stress Stretch/Stress Curve Cauchy Stress (MPa) E in-vitro = Tangent elastic modulus Physiological Stress Physiological Stretch Stretch Rupture Stretch
8 Correlation between the stretch-based rupture risk and the tangent elastic modulus Rupture risk E in-vitro (MPa) Duprey A, et al. Biaxial rupture properties of ascending thoracic aortic aneurysms. Acta Biomaterialia 2016.
9 Histological interpretation ATAA always manifests with damaged elastic fibers More and more collagen tends to be recruited biomechanically in the physiological range Patient with largest γ stretch elast coll Patient with smallest γ stretch M.R. Hill et al,, J. Biomech. 45 (2012)
10 RELATIONSHIP WITH HEMODYNAMICS? Preoperative dynamic imaging 4D MRI CAD Mesh Numerical Solution TAWSS Streamlines, velocity
11 Methodology Patients Age Aortic Valve Morphology Valvulopathy d (mm) 1 58 BAV AI grade TAV AI grade BAV AI grade TAV AI grade TAV Physiologic TAV AI grade TAV Physiologic BAV AS TAV AI grade TAV AI grade BAV= bicuspid aortic valve; TAV=tricuspid aortic valve; AI grade 4+= severe aortic insufficiency; AI grade 2+= moderate aortic insufficiency; AS= aortic stenosis; d= diameter in the region of the bulge.
12 Material and Methods- 4D MRI images Pre-processing Siemens 3T Prisma
13 MATERIAL AND METHODS- Patient Specific BCs Velocity profile mapping 4D MRI data Velocity Profile CFD Velocity Profile [m/s]
14 CFD - Numerical resolution
15 Validation of the computational model Flow eccentricity A B Flow eccentricity =0 Flow eccentricity =1 Sigovan, M., M.D. Hope, P. Dyverfeldt, D. Saloner. Comparison of four dimensional flow parameters for quantification of flow eccentricity in the ascending aorta. J Magn Reson Imaging. 34(5): , 2011.
16 Quantitative analysis of hemodynamics indices Localized Normalized Helicity h 2 =helicity intensity Morbiducci, U., R. Ponzini, G. Rizzo, M. Cadioli, A. Esposito, F.M. Montevecchi, A. Redaelli. Mechanistic insight into the physiological relevance of helical blood flow in the human aorta: an in vivo study. Biomech. Model. Mechanobiol. 10: , 2011.
17 Wall shear stress analysis Time averaged wall shear stress (WSS): Oscillatory Shear Index: where T is the period of the cardiac cycle and WSS is the instantaneous wall shear stress.
18 RESULTS Patient 1 (BAV) Patient 2 (TAV) Patient 3 (BAV)
19 RESULTS - OSI and TAWSS TAWSS [Pa]
20 Statistical Analysis-Spearman Rho: λ rupture vs. TAWSSmax [Pa] Spearman rho P-value 0.001
21 DISCUSSION Protective role of larger TAWSS, associated with low oscillatory wall shear stress? Controversial effects Guzzardi et al. JACC 2015
22 Summary 2 ways of defining rupture: PWS but unknown patient-specific strength γ stretch correlated with in vivo circumferential stiffness Higher stiffness less risk because the aneurysm can more easily withstand volume variation C. Martin et al., Acta Biomater. 9 (2013)
23 Acknowledgements Olfa Trabelsi Aaron Romo Jin Kim Pierre Badel Frances Davis Victor Acosta Jamal Mousavi Solmaz Farzeneh Francesca Condemi Cristina Cavinato Jérôme Molimard Baptiste Pierrat Joan Laubrie Claudie Petit Ambroise Duprey Jean-Pierre Favre Jean-Noël Albertini Salvatore Campisi Magalie Viallon Pierre Croisille Chiara Bellini Matthew Bersi Jay Humphrey Katia Genovese Funding: ERC-2014-CoG BIOLOCHANICS
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