Transient numerical simulation of the right coronary artery originating from the left sinus and the effect of its acute take-off angle on hemodynamics

Quantitative Imaging in Medicine and Surgery

article

Mengyang Cong¹  Huihui Zhao²  Shun Dai⁴  Chuanzhi Chen⁵  Xingming Xu¹  Jianfeng Qiu²  Shengxue Qin¹ 

[1] College of Mechanical and Electronic Engineering, Shandong University of Science and Technology;Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences;Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences;Department of Radiology, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine;Department of Radiology, East Hospital, Tongji University School of Medicine

关键词: Acute take-off angle;    anomalous right coronary artery;    fluid-structure interaction (FSI);    hemodynamic parameters;   

DOI  :  10.21037/qims-20-125

学科分类：外科医学

来源: AME Publications

【 摘 要 】

Background: An anomalous origin of the right coronary artery from the left coronary artery sinus is usually characterized by an acute take-off angle. Most affected patients have no clinical symptoms; however, some patients have decreased blood flow into the right coronary artery during exercise, which can lead to symptoms such as myocardial ischemia. Most researchers who have studied an anomalous origin of the right coronary artery from the left coronary artery sinus have done so through clinical cases. In this study, we used numerical simulation to evaluate the hemodynamics of this condition and the effect of an acute take-off angle on hemodynamic parameters. We expect that the results of this study will help in further understanding the clinical symptoms of this anomaly and the hemodynamic impact of an acute take-off angle. Methods: Three-dimensional models were reconstructed based on the computed tomography images from 16 patients with a normal right coronary artery and 26 patients with an anomalous origin of the right coronary artery from the left coronary artery sinus. A numerical simulation of a two-way fluid-structure interaction was executed with ANSYS Workbench software. The blood was assumed to be an incompressible Newtonian fluid, and the vessel was assumed to be an isotropic, linear elastic material. Hemodynamic parameters and the effect of an acute take-off angle were statistically analyzed. Results: During the systolic period, the wall pressure in the right coronary artery was significantly reduced in patients with an anomalous origin of the right coronary artery (t =1.32 s, P=0.0001; t =1.34–1.46 s, P<0.0001). The wall shear stress in the abnormal group was higher at the beginning of the systolic period (t =1.24 s, P=0.0473; t =1.26 s, P=0.0193; t =1.28 s, P=0.0441). The acute take-off angle was smaller in patients with clinical symptoms (27.81°±4.406°) than in patients without clinical symptoms (31.86°±2.789°; P=0.017). In the symptomatic group, pressure was negatively correlated with the acute take-off angle (P=0.0185–0.0341, r=−0.459 to −0.4167). Conclusions: This study shows that an anomalous origin of the right coronary artery from the left coronary artery sinus causes changes in hemodynamic parameters, and that an acute take-off angle in patients with this anomaly is associated with terminal ischemia of the right coronary artery.

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