Image-based modeling of hemodynamics in coronary artery aneurysms caused by Kawasaki disease

• Published in: Biomechanics and modeling in mechanobiology Vol. 11; no. 6; pp. 915 - 932
• Main Authors: Sengupta, Dibyendu, Kahn, Andrew M., Burns, Jane C., Sankaran, Sethuraman, Shadden, Shawn C., Marsden, Alison L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.07.2012; Springer Nature B.V
• Subjects: Aneurysms; Biological and Medical Physics; Biomechanics; Biomedical Engineering and Bioengineering; Biophysics; Blood Flow Velocity - physiology; Blood Pressure - physiology; Boundary conditions; Cardiovascular diseases; Child; Child, Preschool; Computed tomography; Computer Simulation; Coronary Aneurysm - diagnostic imaging; Coronary Aneurysm - etiology; Coronary Aneurysm - physiopathology; Coronary Angiography; Coronary vessels; Coronary Vessels - physiopathology; Engineering; Hemodynamics - physiology; Humans; Imaging, Three-Dimensional - methods; Male; Models, Cardiovascular; Mucocutaneous Lymph Node Syndrome - complications; Myocardial infarction; Original Paper; Quantitative research; Shear stress; Stress, Mechanical; Theoretical and Applied Mechanics; Thromboembolism; Kawasaki disease; Wall shear stress; Residence time; Aneurysm
• DOI: 10.1007/s10237-011-0361-8
• ISSN: 1617-7959; 1617-7940

Kawasaki Disease (KD) is the leading cause of acquired pediatric heart disease. A subset of KD patients develops aneurysms in the coronary arteries, leading to increased risk of thrombosis and myocardial infarction. Currently, there are limited clinical data to guide the management of these patients, and the hemodynamic effects of these aneurysms are unknown. We applied patient-specific modeling to systematically quantify hemodynamics and wall shear stress in coronary arteries with aneurysms caused by KD. We modeled the hemodynamics in the aneurysms using anatomic data obtained by multi-detector computed tomography (CT) in a 10-year-old male subject who suffered KD at age 3 years. The altered hemodynamics were compared to that of a reconstructed normal coronary anatomy using our subject as the model. Computer simulations using a robust finite element framework were used to quantify time-varying shear stresses and particle trajectories in the coronary arteries. We accounted for the cardiac contractility and the microcirculation using physiologic downstream boundary conditions. The presence of aneurysms in the proximal coronary artery leads to flow recirculation, reduced wall shear stress within the aneurysm, and high wall shear stress gradients at the neck of the aneurysm. The wall shear stress in the KD subject (2.95–3.81 dynes/sq cm) was an order of magnitude lower than the normal control model (17.10–27.15 dynes/sq cm). Particle residence times were significantly higher, taking 5 cardiac cycles to fully clear from the aneurysmal regions in the KD subject compared to only 1.3 cardiac cycles from the corresponding regions of the normal model. In this novel quantitative study of hemodynamics in coronary aneurysms caused by KD, we documented markedly abnormal flow patterns that are associated with increased risk of thrombosis. This methodology has the potential to provide further insights into the effects of aneurysms in KD and to help risk stratify patients for appropriate medical and surgical interventions.