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      Hemodynamic Relevance Evaluation of Coronary Artery Anomaly During Stress Using FFR/IVUS in an Artificial Twin

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          Abstract

          Anomalous aortic origin of coronary artery can lead to ischemia. Due to the limitations of invasive catheterization dobutamine stress testing, an alternative noninvasive approach is desired. A 65-year-old woman with atypical chest pain was referred for coronary computed tomography angiography. Although coronary artery disease was excluded, a right anomalous aortic origin of coronary artery with an interarterial and intramural course was discovered. The patient underwent invasive coronary angiography with a dobutamine stress test, which revealed a pathologic fractional flow reserve (ie, dobutamine fractional flow reserve) of 0.76 (normal >0.8) and lateral ostial compression in dobutamine intravascular ultrasound. A physical replication, using a patient-specific 3-dimensional–printed phantom was created based on coronary computed tomography angiography and evaluated in a flow loop under the same hemodynamic rest and stress conditions. The 3-dimensional–printed phantom fractional flow reserve was similar with 0.78, and dobutamine intravascular ultrasound showed comparable lateral compression.

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          Patient-specific multiscale modeling of blood flow for coronary artery bypass graft surgery.

          Sethuraman Sankaran, Sandra L. Marsden, Chung-E Tseng … (2012)
          We present a computational framework for multiscale modeling and simulation of blood flow in coronary artery bypass graft (CABG) patients. Using this framework, only CT and non-invasive clinical measurements are required without the need to assume pressure and/or flow waveforms in the coronaries and we can capture global circulatory dynamics. We demonstrate this methodology in a case study of a patient with multiple CABGs. A patient-specific model of the blood vessels is constructed from CT image data to include the aorta, aortic branch vessels (brachiocephalic artery and carotids), the coronary arteries and multiple bypass grafts. The rest of the circulatory system is modeled using a lumped parameter network (LPN) 0 dimensional (0D) system comprised of resistances, capacitors (compliance), inductors (inertance), elastance and diodes (valves) that are tuned to match patient-specific clinical data. A finite element solver is used to compute blood flow and pressure in the 3D (3 dimensional) model, and this solver is implicitly coupled to the 0D LPN code at all inlets and outlets. By systematically parameterizing the graft geometry, we evaluate the influence of graft shape on the local hemodynamics, and global circulatory dynamics. Virtual manipulation of graft geometry is automated using Bezier splines and control points along the pathlines. Using this framework, we quantify wall shear stress, wall shear stress gradients and oscillatory shear index for different surgical geometries. We also compare pressures, flow rates and ventricular pressure-volume loops pre- and post-bypass graft surgery. We observe that PV loops do not change significantly after CABG but that both coronary perfusion and local hemodynamic parameters near the anastomosis region change substantially. Implications for future patient-specific optimization of CABG are discussed.
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            Diagnosis and Management of Anomalous Coronary Arteries with a Malignant Course

            Christoph Gräni, Philipp Kaufmann, Stephan Windecker … (2019)
            Although the prevalence of anomalous coronary artery from the opposite sinus (ACAOS) in the general population is low, more frequent use of invasive and non-invasive imaging to rule out coronary artery disease has seen an increase in absolute numbers of ACAOS. ACAOS are traditionally classified as malignant (with an interarterial course) and benign variants. Malignant variants have been recognised in autopsy studies to be an underlying cause of sudden cardiac death in young athletes. Conversely, it seems that older people with ACAOS are less predisposed to adverse cardiac events. Non-invasive anatomic imaging is complementary to invasive imaging and helps to further identify high-risk anatomic features. Using functional non-invasive perfusion imaging can assess potential ischaemia induced by dynamic compression of malignant ACAOS. Information gained from clinical imaging guides the management of these patients.
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              Relation of Distribution of Coronary Blood Flow Volume to Coronary Artery Dominance

              Shingo Sakamoto, Saeko Takahashi, Ahmet Coskun … (2013)
              Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, it is unknown whether coronary artery dominance also influences the distribution of coronary blood flow volume. The aim of this study was to evaluate volumetric coronary blood flow in 1,322 vessels from 496 patients in the Prediction of Progression of Coronary Artery Disease and Clinical Outcomes Using Vascular Profiling of Endothelial Shear Stress and Arterial Wall Morphology (PREDICTION) study. Patients were divided into 2 groups (right-dominant and left-dominant or balanced circulation). Coronary blood flow volume was calculated by coronary segment volume measurement using angiography and intravascular ultrasound and the contrast transit time through the segment. Coronary blood flow in the left circumflex coronary artery was significantly higher in left-dominant or balanced circulation than in right-dominant circulation (113 ± 43 vs 72 ± 37 ml/min, p <0.001), whereas flow in the right coronary artery was significantly lower in left-dominant or balanced circulation than in right-dominant circulation (56 ± 40 vs 113 ± 49 ml/min, p = 0.003). There was no significant difference in the left anterior descending coronary artery. In conclusion, coronary artery dominance has an impact on coronary blood flow volume in the left circumflex and right coronary arteries but not in the left anterior descending coronary artery. These findings suggest that the extent of myocardial perfusion area is associated with coronary blood flow volume.
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                Author and article information

                Contributors
                Christoph Gräni
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 04 December 2024
                Publication date Collection: 01 January 2025
                Publication date (Electronic): 04 December 2024
                Volume: 30
                Issue: 1
                Electronic Location Identifier: 102729
                Affiliations
                [a ]Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
                [b ]ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
                [c ]Translational Imaging Center, Sitem Center, University of Bern, Switzerland
                Author notes
                [∗ ] Address for correspondence: Dr Christoph Gräni, Department of Cardiology, University Hospital Bern–Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland. christoph.graeni@ 123456insel.ch
                Article
                Publisher Item ID: S2666-0849(24)00729-0 Publisher ID: 102729
                DOI: 10.1016/j.jaccas.2024.102729
                PMC ID: 11733583
                PubMed ID: 39822811
                SO-VID: 1922d306-5f0f-4df2-b7f2-c68d0d1c16d7
                Copyright © © 2025 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 14 June 2024
                Date revision received : 20 September 2024
                Date accepted : 25 September 2024
                Categories
                Subject: Mini-Focus Issue on Coronary, Peripheral, and Structural Interventions
                Subject: How We Do It

                Keywords: 3d-printed patient-specific phantom,3dpsp,aaoca,acaos,additive manufacturing,am,anomalous aortic origin of a coronary artery,artificial twin,ccta,coronary artery anomaly,dobutamine,ffr,fractional flow reserve,hemodynamic testing,intravascular ultrasound,ivus
                Data availability:
                Keywords: 3d-printed patient-specific phantom, 3dpsp, aaoca, acaos, additive manufacturing, am, anomalous aortic origin of a coronary artery, artificial twin, ccta, coronary artery anomaly, dobutamine, ffr, fractional flow reserve, hemodynamic testing, intravascular ultrasound, ivus

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