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52. Case report: Personalized transcatheter approach to mid-aortic syndrome by in vitro simulation on a 3-dimensional printed model

Author

Giugno, Luca, Formato, Giovanni Maria, Chessa, Massimo, Votta, Emiliano, Carminati, Mario, and Sturla, Francesco

Subjects
Cardiology and Cardiovascular Medicine
Abstract

An 8-year-old girl, diagnosed with mid-aortic syndrome (MAS) at the age of 2 months and under antihypertensive therapy, presented with severe systemic hypertension (>200/120 mmHg). Computed tomography (CT) examination revealed aortic aneurysm between severe stenoses at pre- and infra-renal segments, and occlusion of principal splanchnic arteries with peripheral collateral revascularization. Based on CT imaging, preoperative three-dimensional (3D) anatomy was reconstructed to assess aortic dimensions and a dedicated in vitro planning platform was designed to investigate the feasibility of a stenting procedure under fluoroscopic guidance. The in vitro system was designed to incorporate a translucent flexible 3D-printed patient-specific model filled with saline. A covered 8-zig 45-mm-long Cheatham-Platinum (CP) stent and a bare 8-zig, 34-mm-long CP stent were implanted with partial overlap to treat the stenoses (global peak-to-peak pressure gradient > 60 mmHg), excluding the aneurysm and avoiding risk of renal arteries occlusion. Percutaneous procedure was successfully performed with no residual pressure gradient and exactly replicating the strategy tested in vitro. Also, as investigated on the 3D-printed model, additional angioplasty was feasible across the frames of the stent to improve bilateral renal flow. Postoperative systemic pressure significantly reduced (130/70 mmHg) as well as dosage of antihypertensive therapy. This is the first report demonstrating the use of a 3D-printed model to effectively plan percutaneous intervention in a complex pediatric MAS case: taking full advantage of the combined use of a patient-specific 3D model and a dedicated in vitro platform, feasibility of the stenting procedure was successfully tested during pre-procedural assessment. Hence, use of patient-specific 3D-printed models and in vitro dedicated platforms is encouraged to assist pre-procedural planning and personalize treatment, thus enhancing intervention success.

Published
2023
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54. Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant.

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Abstract

Purpose: Displacement forces ( DF s) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DF s merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. Materials and Methods: We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the "bovine" aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DF s within the aortic proximal landing zones. To quantify fast-approximate DF s, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction ( EST ). Results: Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a −1.1% and 0.7° bias in DF s magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. Conclusion: Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning. [ABSTRACT FROM AUTHOR]

Published
2023
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60. Lung anatomy, energy load, and ventilator-induced lung injury

Author

Protti, Alessandro, Andreis, Davide T., Milesi, Marta, Iapichino, Giacomo E., Monti, Massimo, Comini, Beatrice, Pugni, Paola, Melis, Valentina, Santini, Alessandro, Dondossola, Daniele, Gatti, Stefano, Lombardi, Luciano, Votta, Emiliano, Carlesso, Eleonora, and Gattinoni, Luciano

Published
2015
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64. Three-dimensional printing, holograms, computational modelling, and artificial intelligence for adult congenital heart disease care: an exciting future

Author

German Research Foundation, Ministry of Innovation, Science and Research of the State of North Rhine-Westphalia, Chessa, Massimo, Van De Bruaene, Alexander, Farooqi, Kanwal, Valverde, Israel, Jung, Christian, Votta, Emiliano, Sturla, Francesco, Diller, Gerhard Paul, Brida, Margarita, Sun, Zhonghua, Little, Stephen H., Gatzoulis, Michael A., German Research Foundation, Ministry of Innovation, Science and Research of the State of North Rhine-Westphalia, Chessa, Massimo, Van De Bruaene, Alexander, Farooqi, Kanwal, Valverde, Israel, Jung, Christian, Votta, Emiliano, Sturla, Francesco, Diller, Gerhard Paul, Brida, Margarita, Sun, Zhonghua, Little, Stephen H., and Gatzoulis, Michael A.

Abstract

Congenital heart disease (CHD) is often comprised of complex three-dimensional (3D) anatomy that must be well understood to assess the pathophysiological consequences and guide therapy. Thus, detailed cardiac imaging for early detection and planning of interventional and/or surgical treatment is paramount. Advanced technologies have revolutionized diagnostic and therapeutic practice in CHD, thus playing an increasing role in its management. Traditional reliance on standard imaging modalities including echocardiography, cardiac computed tomography (CT) and magnetic resonance imaging (MRI) has been augmented by the use of recent technologies such as 3D printing, virtual reality, augmented reality, computational modelling, and artificial intelligence because of insufficient information available with these standard imaging techniques. This has created potential opportunities of incorporating these technologies into routine clinical practice to achieve the best outcomes through delivery of personalized medicine. In this review, we provide an overview of these evolving technologies and a new approach enabling physicians to better understand their real-world application in adult CHD as a prelude to clinical workflow implementation.

Published
2022

69. sj-docx-7-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-7-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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70. sj-docx-8-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-8-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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71. sj-docx-6-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-6-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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72. sj-docx-3-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-3-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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73. sj-docx-12-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-12-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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74. sj-docx-9-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-9-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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75. Three-dimensional printing, holograms, computational modelling, and artificial intelligence for adult congenital heart disease care: an exciting future

Author

Chessa, Massimo, Van De Bruaene, Alexander, Farooqi, Kanwal, Valverde, Israel, Jung, Christian, Votta, Emiliano, Sturla, Francesco, Diller, Gerhard Paul, Brida, Margarita, Sun, Zhonghua, Little, Stephen H., Gatzoulis, Michael A., German Research Foundation, and Ministry of Innovation, Science and Research of the State of North Rhine-Westphalia

Subjects
Adult, Heart Defects, Congenital, Artificial intelligence, Virtual Reality, Heart, 3D printing, Augmented reality, Congenital, Computational modelling, Three-Dimensional, Printing, Three-Dimensional, Printing, Adult with congenital heart defect, Humans, Heart Defects
Abstract

Congenital heart disease (CHD) is often comprised of complex three-dimensional (3D) anatomy that must be well understood to assess the pathophysiological consequences and guide therapy. Thus, detailed cardiac imaging for early detection and planning of interventional and/or surgical treatment is paramount. Advanced technologies have revolutionized diagnostic and therapeutic practice in CHD, thus playing an increasing role in its management. Traditional reliance on standard imaging modalities including echocardiography, cardiac computed tomography (CT) and magnetic resonance imaging (MRI) has been augmented by the use of recent technologies such as 3D printing, virtual reality, augmented reality, computational modelling, and artificial intelligence because of insufficient information available with these standard imaging techniques. This has created potential opportunities of incorporating these technologies into routine clinical practice to achieve the best outcomes through delivery of personalized medicine. In this review, we provide an overview of these evolving technologies and a new approach enabling physicians to better understand their real-world application in adult CHD as a prelude to clinical workflow implementation., We thank Dr. Carmelina Chiarello for her technical support. Christian Joung reports that institutional support has been received by the German Research Council (SFB 1116) as well as the State of North Rhine Westphalia (Giga for Health: 5GMedizincampus.NRW, Project number 005-2008-0055).

Published
2022

76. sj-docx-4-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-4-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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77. sj-docx-2-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-2-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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78. sj-docx-5-jet-10.1177_15266028221095403 – Supplemental material for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

Author

Sturla, Francesco, Caimi, Alessandro, Romarowski, Rodrigo M., Nano, Giovanni, Glauber, Mattia, Redaelli, Alberto, Votta, Emiliano, and Marrocco-Trischitta, Massimiliano M.

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110323 Surgery
Abstract

Supplemental material, sj-docx-5-jet-10.1177_15266028221095403 for Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant by Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta and Massimiliano M. Marrocco-Trischitta in Journal of Endovascular Therapy

Published
2022
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82. Comparison of Four‐Dimensional Magnetic Resonance Imaging Analysis of Left Ventricular Fluid Dynamics and Energetics in Ischemic and Restrictive Cardiomyopathies

Author

Riva, Alessandra, primary, Sturla, Francesco, additional, Pica, Silvia, additional, Camporeale, Antonia, additional, Tondi, Lara, additional, Saitta, Simone, additional, Caimi, Alessandro, additional, Giese, Daniel, additional, Palladini, Giovanni, additional, Milani, Paolo, additional, Castelvecchio, Serenella, additional, Menicanti, Lorenzo, additional, Redaelli, Alberto, additional, Lombardi, Massimo, additional, and Votta, Emiliano, additional

Published
2022
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91. Mitral valve finite element modeling: implications of tissues' nonlinear response and annular motion

Author

Stevanella, Marco, Votta, Emiliano, and Redaelli, Alberto

Subjects
Finite element method -- Models, Mitral valve -- Physiological aspects, Mitral valve -- Properties, Tissues -- Physiological aspects, Engineering and manufacturing industries, Science and technology
Abstract

Finite element modeling represents an established method for the comprehension of the mitral function and for the simulation of interesting clinical scenarios. However, current models still do not include all the key aspects of the real system. We implemented a new structural finite element model that considers (i) an accurate morphological description of the valve, (ii) a description of the tissues' mechanical properties that accounts for anisotropy and nonlinearity, and (iii) dynamic boundary conditions that mimic annulus and papillary, muscles' contraction. The influence of such contraction on valve biomechanics was assessed by comparing the computed results with the ones obtained through an auxiliary model with fixed annulus and papillary muscles. At the systolic peak, the leaflets' maximum principal stress contour showed peak values in the anterior leaflet at the strut chordae insertion zone (300 kPa) and near the annulus (200-250 kPa), while much lower values were detected in the posterior leaflet. Both leaflets underwent larger tensile strains in the longitudinal direction, while in the circumferential one the anterior leaflet experienced nominal tensile strains up to 18% and the posterior one experienced compressive strains up to 23% associated with the folding of commissures and paracommissures, consistently with tissue redundancy. The force exerted by papillary muscles at the systolic peak was equal to 4.11 N, mainly borne by marginal chordae (76% of the force). Local reaction forces up to 45 mN were calculated on the annulus, leading to tensions of 89 N/m and 54 N/m for its anterior and posterior tracts, respectively. The comparison with the results of the auxiliary model showed that annular contraction mainly affects the leaflets' circumferential strains. When it was suppressed, no more compressive strains could be observed and peak strain values were located in the belly of the anterior leaflet. Computational results agree to a great extent with experimental data from literature. They provided insight into some of the features characterizing normal mitral function, such as annular contraction and leaflets' tissue anisotropy and nonlinearity. Some of the computed results may be useful in the design of surgical devices and techniques. In particular, forces applied on the annulus by the surrounding tissues could be considered as an indication for annular prostheses design. [DOI: 10.1115/1.4000107] Keywords: mitral valve, finite element modeling

Published
2009

93. List of Contributors

Author

Andreassen, Steen, primary, Bassingthwaighte, James B., additional, Bellazzi, Riccardo, additional, Bequette, B. Wayne, additional, Bertoldo, Alessandra, additional, Burattini, Roberto, additional, Carson, Ewart, additional, Caumo, Andrea, additional, Cobelli, Claudio, additional, Cona, Filippo, additional, Dalla Man, Chiara, additional, De Nicolao, Giuseppe, additional, Di Camillo, Barbara, additional, Doyle, Francis J, additional, Ferrazzi, Fulvia, additional, Karbing, Dan S., additional, Kjærgaard, Søren, additional, Kovatchev, Boris, additional, Magni, Paolo, additional, Magosso, Elisa, additional, Pasotti, Lorenzo, additional, Patek, Stephen, additional, Pedersen, Morten Gram, additional, Pia Saccomani, Maria, additional, Pillonetto, Gianluigi, additional, Poggesi, Italo, additional, Redaelli, Alberto, additional, Rees, Stephen E., additional, Rocchetti, Maurizio, additional, Rodriguez-Fernandez, Maria, additional, Sambo, Francesco, additional, Sawacha, Zimi, additional, Schrefler, Bernhard, additional, Simeoni, Monica, additional, Sparacino, Giovanni, additional, St. John, Peter C., additional, Toffolo, Gianna, additional, Ursino, Mauro, additional, Vicini, Paolo, additional, Votta, Emiliano, additional, Yang, Ruoting, additional, and Zucca, Susanna, additional

Published
2014
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99. Trends in biomedical engineering: focus on Patient Specific Modeling and Life Support Systems

Author

Dubini, Gabriele, Ambrosi, Davide, Bagnoli, Paola, Boschetti, Federica, Caiani, Enrico G., Chiastra, Claudio, Conti, Carlo A., Corsini, Chiara, Costantino, Maria Laura, DʼAngelo, Carlo, Formaggia, Luca, Fumero, Roberto, Gastaldi, Dario, Migliavacca, Francesco, Morlacchi, Stefano, Nobile, Fabio, Pennati, Giancarlo, Petrini, Lorenza, Quarteroni, Alfio, Redaelli, Alberto, Stevanella, Marco, Veneziani, Alessandro, Vergara, Christian, Votta, Emiliano, Wu, Wei, and Zunino, Paolo

Published
2011
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