Morphogenesis of the "immature symmetric embryonic aortic arches" into the "mature and asymmetric aortic arches" involves a delicate sequence of cell and tissue migration, proliferation, and remodeling within an active biomechanical environment. Both patient-derived and experimental animal model data support a significant role for biomechanical forces during arch development. The objective of the present study is to quantify changes in geometry, blood flow, and shear stress patterns (WSS) during a period of normal arch morphogenesis. Composite three-dimensional (3D) models of the chick embryo aortic arches were generated at the Hamburger-Hamilton (HH) developmental stages HH18 and HH24 using fluorescent dye injection, micro-CT, Doppler velocity recordings, and pulsatile subject-specific computational fluid dynamics (CFD). India ink and fluorescent dyes were injected into the embryonic ventricle or atrium to visualize right or left aortic arch morphologies and flows. 3D morphology of the developing great vessels was obtained from polymeric casting followed by micro-CT scan. Inlet aortic arch flow and cerebral-to-lower body flow split was obtained from 20 MHz pulsed Doppler velocity measurements and literature data. Statistically significant variations of the individual arch diameters along the developmental timeline are reported and correlated with WSS calculations from CFD. CFD simulations quantified pulsatile blood flow distribution from the outflow tract through the aortic arches at stages HH18 and HH24. Flow perfusion to all three arch pairs are correlated with the in vivo observations of common pharyngeal arch defect progression. The complex spatial WSS and velocity distributions in the early embryonic aortic arches shifted between stages HH18 and HH24, consistent with increased flow velocities and altered anatomy. The highest values for WSS were noted at sites of narrowest arch diameters. Altered flow and WSS within individual arches could be simulated using altered distributions of inlet flow streams. Thus, inlet flow stream distributions, 3D aortic sac and aortic arch geometries, and local vascular biologic responses to spatial variations in WSS are all likely to be important in the regulation of arch morphogenesis.
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http://dx.doi.org/10.1007/s10439-009-9682-5 | DOI Listing |
Ann Thorac Surg Short Rep
December 2024
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina.
Background: This study sought to determine the safety of primary and staged biventricular repair in neonates with interrupted aortic arch (IAA), ventricular septal defect (VSD), and severe left ventricular outflow tract obstruction (LVOTO).
Methods: Patients with a fundamental diagnosis of IAA and VSD between 2015 and 2020 were extracted from The Society of Thoracic Surgeons National Database by using a Participant User File. The objective was to compare outcomes for neonates undergoing primary and staged Yasui and Ross operations.
Ann Thorac Surg Short Rep
December 2024
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School Medicine, Chicago, Illinois.
Background: An anomalous left vertebral artery (aLVA) can complicate aortic arch surgery. We examined the safety of various aLVA revascularization strategies during open total arch replacement.
Methods: We retrospectively evaluated 92 patients undergoing total arch replacement from January 2018 to May 2023 and identified 11 patients with aLVA.
Ann Thorac Surg Short Rep
December 2024
Division of Cardiac Surgery, Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, Virginia.
Background: DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.
View Article and Find Full Text PDFAnn Thorac Surg Short Rep
December 2024
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas.
This report describes a patient with a thoracic aortic aneurysm who presented with chest pain and dyspnea. Preoperative studies revealed a massive cardiomediastinal silhouette. Within hours after the operation, a profound reduction in cardiomegaly was observed.
View Article and Find Full Text PDFAnn Thorac Surg Short Rep
December 2024
Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
We report on a successful thoracic endovascular aortic repair for perigraft seroma (PGS) after ascending aorta replacement (AAR). An 82-year-old man underwent AAR. Two years after the operation, computed tomography showed a 75-mm PGS around the ascending aorta.
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