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Abstract Coronary Artery Bypass Grafts (CABG) are asso- (SVG). After 10 years from the surgery 40% 50% of grafts
ciated to many diseases such as atherosclerosis, atherogene- are occluded and only 25% show no angiographic evidence
sis and Intimal Hyperplasia (IH), which in time may reduce of atherosclerosis. Internal Mammary Artery grafts (IMAs)
the graft patency and cause a new occlusion and the need of usually are patent for more years postoperatively (10-year
a new surgery. In this work we studied the effects of CABG patency > 90%). Previous study showed a relation between
on blood flow in a patient specific 3D framework, studying anastomotic Intimal Hyperplasia (IH) and haemodynamic
the physical parameters that are connected to the develop- factors LoGerFo and also the mismatch between graft and
ment of coronary artery diseases. host artery Loth. More specifically Ojha analyzed the rela-
tion between low and oscillatory Wall Shear Stress (WSS)
Keywords CABG CFD LIMA SVG patient specific
and the rise of IH in end to side anastomoses. It was shown
that region of oscillatory WSS are zones of Low Density
Lipopotrein accumulation, which are the one responsible of
1 Introduction atherosclerosis soulis2011oscillating. Hughes have shown
that intimal hyperplasia occurs in regions of flow separation
Coronary artery bypass graft surgery (CABG) is a proce- at the toe and the heel, and that flow-stagnation is observed
dure used to treat coronary artery diseases in some circum- on the floor of the anastomosis. It has been noticed the im-
stances. The most common Coronary Artery Disease (CAD) portance of the effect of the geometry on the development
is the narrowing of the coronary arteries, caused by a build- of the flow, in particular the local three dimensional curva-
up of fatty material within the walls of the arteries, so CABG ture Meyers-Moore, this study implyies that studies attempt-
is one of the most frequent heart related surgery. One of ing to link hemodynamics with atherogenesis should repli-
the biggest issue with CABG surgery is the development cate the patient-specific geometry. We spent a lot of effort in
of atherosclerosis in the implanted graft and consequent re- our work to obtain an accurate reconstruction of the patient
occlusion of the vessels. The study of [1] show how long coronaries, and developed tools that allowed us to extrapo-
time patency is a big issue in case of Saphenous Vein Grafts late the geometry in case of imperfection in the data.
F. Ballarin
MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza
Leonardo da Vinci 32, 20133 Milano, Italy
E-mail: francesco.ballarin@polimi.it
2 Materials and methods
E. Faggiano
MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza
Leonardo da Vinci 32, 20133 Milano, Italy
2.1 Patients and datasets
E-mail: elena.faggiano@mail.polimi.it
R. Ferrero
Our initial materials were the CTs provided by the hospital.
Politecnico di Torino, Corso Duca degli Abruzzi 24, 10100, Torino, We conducted our study on four patients of different ages
Italy that underwent CABG surgery. For each patient we run a to-
E-mail: s180122@studenti.polito.it tal of four simulations, three with different degrees of steno-
ci saranno anche i clinici tra gli autori, completiamo dopo tutti i nomi sis ( 60%, 80%, 90%) and one where the stenosis were
e affiliazioni, ora non e un problema removed.
2 Francesco Ballarin et al.
zone, cut it away and re-interpolate the surface taking in ac- 2.400
LCA
the cut. With those scripts we were able to select the de-
mm3/s
face preserving the curvature and torsion of the vessel. We 1.000
adaptive mesh.
0
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
time s
mm3/s
that using modified version of the script allowed us to re- 1000
build the ghost vessels coherently with the coronary vessel 800
400
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
time s
2.7 Model For each outlet we prescribed the usual zero stress condi-
tion wellnhofer 504367 For the Coronary Artery (CA) in-
Two unsteady numerical simulations were performed for each let it was proved that the shape of the inlet profile on the
patient described above one with the stenosis and one where developed flow patterns, and especially on the WSS distri-
the stenosis where removed, by using the finite element li- butions is not dramatically significant [6]. The difficulty to
brary LifeV (http://www.lifev.org). Blood was considered as determine in practice the velocity profile developed in the
Newtonian, homogeneous, and incompressible. Blood vis- coronary artery of interest for a given patient, due in part
cosity was set equal to 0.035 Poise and the density equal to to the complex nature of flow especially in proximity of the
1.0 g/cm3 (O.K. Baskurt, M. Hardeman, M.W. Rampling, ostium and the great intra-patient variability of coronary ge-
H.J.). Being a preliminary study we decided to neglect the ometry, and to the absence of a non-invasive technique for
Fluid Structure Interaction (FSI), so we supposed to be un- its measurement in clinic practice, led us to choose a time
der the hypothesis of rigid and impervious wall and to ne- dependent flat velocity profile normal to the inlet surface.
glect thermal effects. We are able to describe the blood flow For each patients the velocity profile of the Left Coronary
with the incompressible Navier-Stokes equations. Artery (LCA) and Right Coronary Artery (RCA) was com-
puted starting from a medium flow we researched in the ex-
u (2D(u)) + (u )u + p = f, x , t > 0
isting literature [7] dividing it by the inlet area.
t
6000
mm3/s
4000
3 Results
2000
0
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
4 Conclusions
time s