Main Logo
Logo

Society for Pediatric Radiology – Poster Archive

  186
  0
  0
 
 


Final ID: Paper #: 043

Hemodynamic Assessment of Anomalous Aortic Origin of a Coronary Artery (AAOCA) in Children Using Patient-Specific Flow Models

Purpose or Case Report: AAOCA is the second leading cause of sudden cardiac death in the young which typically occurs with exertion. With in-vitro patient-specific modeling the study aims to assess the differences in fractional flow reserve(FFR)with hyperemia(high-flow)in a patient with AAOCA with a confirmed ischemic event and compare it to a patient with normal coronaries
Methods & Materials: Patient-specific flow models were created after segmenting CT data and 3D printed using Agilus a flexible material whose compliance was matched to native aortic tissue from 2 subjects:1)11 year old male with anomalous right coronary artery(RCA)with a 12.3mm intramural course, slit-like ostium and confirmed ischemia on stress testing; 2)16 year old male with normal coronary artery anatomy. The two models were placed in a left heart duplicator under exercise conditions of 90bpm, cardiac output of 5L/min and mean aortic pressure of 100mmHg. RCA flow at baseline was set to account for 30% of 4-5% of the cardiac output. Pressure waveforms were recorded using a Millar catheter starting in the aorta, through ostium and intramural segment into RCA mediastinal segment. FFR was computed as the ratio of distal to aortic pressure. A simulated stress test was performed, increasing the aortic pressure from 100 to 240mmHg to observe effects of pressure-driven anatomical deformation on coronary flow
Results: In normal RCA, FFR measurements from the aortic position to the mediastinal segment showed no sign of ischemia(FFR>0.8). In the anomalous RCA, FFR measurements under exercise conditions showed a significant drop in FFR in the middle of the intramural course to<0.6, indicating conditions for ischemia. FFR recovered distal to the intramural segment, but remained<0.8. Exposing the models to the simulated stress illustrated an unhindered increase in coronary flow in response to aortic pressure with the normal model compared with the ischemic AAOCA model, with the latter showing a slope on the flow-pressure curve that was 2.2 times lower than that obtained with the normal coronary
Conclusions: Ischemia in AAOCA patients may manifest through dynamic biomechanically driven flow resistance related to the morphological substrate like ostial stenosis and intramural course. In AAOCA with clinically documented ischemia, FFR significantly decreases at the ostium and intramural course, and resistance to flow with increasing aortic pressure increases(absent in normal coronaries). These findings may highlight the mechanisms leading to sudden death in AAOCA
Session Info:

Scientific Session II-B: Cardiovascular

Cardiovascular

SPR Scientific Papers

More abstracts on this topic:
Coronary Arteries Evaluation in Congenital Heart Disease in Children: Diagnostic Comparison of ECG Gated and Non-ECG Gated CT Cardiac Angiography

Sodhi Kushaljit, Bhatia Anmol, Rana Pratyaksha, Farook Shameema, Saxena Akshay, Singh Harkant, Mishra Anand, Manoj Rohit

Chest CT with iterative reconstuction technique in youngest children - review of pathology and dose consideration

Barczuk Marzena, Roik Danuta, Ostapska Zofia, Biejat Agnieszka, Brzewski Michal

More abstracts from these authors:
3D Printed Patient Specific Surgical Guides for Pediatric Orthopedic Tumor Resection

Parthasarathy Jayanthi, Scharschmidt Thomas, Rees Mitchell, Selvaraj Bhavani

Patient specific 3D-printed Modeling for Risk-stratification in Anomalous Aortic Origin of a Coronary Artery (AAOCA): Material Selection, Model Creation and Validation

Parthasarathy Jayanthi, Hatoum Hoda, Flemister Dorma, Mery Carlos, Molossi Silvana, Dasi Lakshmi Prasad, Krishnamurthy Rajesh

Due to circumstances surrounding the coronavirus pandemic, this final ePoster exhibit was not submitted.
You have to be authorized to contact abstract author. Please, Login or Signup.

Please note that this is a separate login, not connected with your credentials used for the SPR main website.

Not Available

Comments

We encourage you to join the discussion by posting your comments and questions below.

Presenters will be notified of your post so that they can respond as appropriate.

This discussion platform is provided to foster engagement, and stimulate conversation and knowledge sharing.

Please click here to review the full terms and conditions for engaging in the discussion, including refraining from product promotion and non-constructive feedback.

 

You have to be authorized to post a comment. Please, Login or Signup.

Please note that this is a separate login, not connected with your credentials used for the SPR main website.


   Rate this abstract  (Maximum characters: 500)