Journal article
Modeling Outcomes: Modified Aortic Arch Advancement for Neonatal Hypoplastic Arch
Innovations (Philadelphia, Pa.), Vol.12(2), pp.109-115
03/2017
DOI: 10.1097/imi.0000000000000357
PMID: 28346262
Abstract
Objective Numerous surgical approaches regarding aortic arch advancement for neonatal arch hypoplasia have been described. These repairs can be classified into two categories: those that incorporate a patch and those that do not. The decision between repairs remains largely experiential, rather than empirical, because of the limited number of reported outcomes. We report early outcomes from neo-nates undergoing modified aortic arch advancement with an anterior patch and our experience using computational fluid dynamic modeling to better understand the hemodynamic consequences associated with this repair. Methods A retrospective review of neonates undergoing aortic arch advancement with anterior patch in 2014 at a single institution was performed. Anatomical, perioperative, and follow-up data were collected. Three-dimensional cardiac magnetic resonance images were used to generate computational fluid dynamic models of the modified anterior patch and direct end-to-side repairs. Cardiac waveform inputs were simulated and hemodynamic analyzed. Results Ten neonates underwent modified aortic arch advancement. No hemodynamically significant gradients were observed at a median follow-up of 0.77 (0.30–1.2) years. Asymmetrical flow was observed in the end-to-side repair, whereas more concentric laminar flow was observed throughout the modified model. Spatial variations in velocities immediately distal to the anastomosis were greater in the end-to-side model (0.35 vs 0.17 m/s, P < 0.001). Time-averaged variations in wall shear stress during systole were greater in the end-to-side model at the same location (3.44 vs 1.98 dynes/cm2, P <0.001). Conclusions Early outcomes after the use of an anterior patch for neonatal hypoplastic aortic arch repair show favorable hemodynamic outcomes.
Details
- Title: Subtitle
- Modeling Outcomes: Modified Aortic Arch Advancement for Neonatal Hypoplastic Arch
- Creators
- Joseph R Nellis - University of Iowa Carver College of Medicine, Iowa City, IA USATimothy K Chung - University of Iowa College of Engineering, Iowa City, IA USANandita Agarwal - Department of Radiology, University of Iowa Hospital, Iowa City, IA USAJose E Torres - Department of Cardiothoracic Surgery, Yavapai Regional Medical Center, Prescott, AZ USASarah E Holgren - Department of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa City, IA USAMadhavan L Raghavan - University of Iowa College of Engineering, Iowa City, IA USAJoseph W Turek - Department of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa City, IA USA
- Resource Type
- Journal article
- Publication Details
- Innovations (Philadelphia, Pa.), Vol.12(2), pp.109-115
- DOI
- 10.1097/imi.0000000000000357
- PMID
- 28346262
- ISSN
- 1556-9845
- eISSN
- 1559-0879
- Language
- English
- Date published
- 03/2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984064584202771
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