Computational fluid dynamics simulation to evaluate aortic coarctation gradient with contrast-enhanced CT

Coarctation of aorta (CoA) is a narrowing of the aorta leading to a pressure gradient (Delta P) across the coarctation, increased afterload and reduced peripheral perfusion pressures. Indication to invasive treatment is based on values of maximal (systolic) trans-coarctation Delta P. A computational fluid dynamic (CFD) approach is herein presented for the non-invasive haemodynamic assessment of Delta P across CoA. Patient-specific CFD simulations were created from contrast-enhanced computed tomography (CT) and appropriate flow boundary conditions. Computed Delta P was validated with invasive intravascular trans-CoA pressure measurements. Haemodynamic indices, including pressure loss coefficient (PLc), time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI), were also quantified. CFD-estimated Delta P values were comparable to the invasive ones. Moreover, the aorta proximal to CoA was exposed to altered TAWSS and OSI suggesting hypertension. PLc was found as a further geometric marker of CoA severity. Finally, CFD-estimated Delta P confirmed a significant reduction after percutaneous balloon dilatation and stenting of the CoA in one patient (e.g. from Delta P similar to 52mmHg to Delta P similar to 3mmHg). The validation of the Delta P computations with catheterisation measurements suggests that CFD simulation, based on CT-derived anatomical data, is a useful tool to readily quantify CoA severity.