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Computed Tomography-Based Patients’ Specific Biomechanical and Fluid Dynamic Study of Anomalous Coronary Arteries with Origin from the Opposite Sinus and Intramural Course

Published Online: December 23rd 2020 Heart International. 2020;14(2):Online ahead of journal publication
Authors: Gianluca Rigatelli, Marco Zuin
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Abstract:
Overview

Background: The anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) constitutes one of the most clinically relevant coronary artery anomalies in adults. Exact pathophysiology and the impact of intramural (IM) course segment stenting in ACAOS with IM course (ACAOS-IM) has not been clarified. We aimed to elucidate pathophysiology and impact of stenting applying biomechanical and computation fluid dynamics to computed tomography (CT) in patient-specific coronary vessel reconstruction. Methods: We separated coronary artery (Left or L-, Right or R-) ACAOS-IM into segments (proximal, mid and distal), based on coronary angiography and coronary CT angiography features, in 21 symptomatic patients (13 males, mean age 46.1 ± 8.1 years, L-ACAOS-IM in 9 and R-ACAOS-IM in 12 patients) collected at Rovigo General Hospital, Italy, between January 1, 2003 and January 1, 2018. Blood pressure gradient across the coronary circulation, calculated blood flow, vorticity magnitude, wall shear stress (WSS) and IM segment deformation were analysed by simulating exercise, before and after virtual stent implantation. Results: In both L- and R-ACAOS, computational fluid dynamic analysis demonstrated higher basal WSS values in the IM course (9.5 ± 0.2 and 8.6 ± 0.2 Pa for R- and L-ACAOS, respectively), than in the rest of the vessels. These values decreased after stenting. Vorticity magnitude significantly decreased after stenting as well, compared to baseline. Biomechanical deformation analysis revealed not only compression, but also a twisting of the IM segment with a mean distal pressure drop of 32% and 35% in R- and L-ACAOS, respectively, which was corrected by stent implantation. Conclusions: In both L- and R-ACAOS subtypes, the IM segment appeared to be phasically compressed and deformed with a degree of twisting that causes resting and exercise cross-sectional deformation and a drop in distal pressure. Stenting of the IM segment results in normalization of the flow profile, correction of the IM segment deformation and reverses the drop in pressure, for both variants of ACAOS.

Keywords

Coronary artery anomalies, sudden death, physiology, computed fluid dynamic

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**This manuscript has been accepted for publication, but may be subject to minor changes during the production process.**

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Disclosure

Gianluca Rigatelli and Marco Zuin have no financial relationships or non-financial relationships or activities to declare in relation to this article.

Compliance With Ethics

All procedures were followed in accordance with the responsible committee on human experimentation and with the Declaration of Helsinki of 1975 and subsequent revisions, and informed consent was received from all patients involved in this study.

Review Process

Double-blind peer review.

Authorship

The named authors meet the criteria of the International Committee of Medical Journal Editors for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval for the version to be published.

Correspondence

Gianluca Rigatelli, MD, PhD, EBIR, Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, 45100 Rovigo, Italy E: jackyheart@libero.it

Support

No funding was received for the publication of this article.

Open Access

This article is freely accessible at touchCARDIO.com © Touch Medical Media 2020.

Received

2020-09-10

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