Patient-Specific Numerical Analysis of Coronary Blood Flow in Children with Intramural Anomalous Aortic Origin of Coronary Arteries
Intramural anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect where the origin of a coronary artery originates from the wrong sinus of Valsalva with an acute angle (angle of origin) and follows a course within the aortic wall. A surgical technique, known as “unroofing”, addresses this pathology by removing the intramural coronary segment and opening the potentially restrictive anomalous coronary orifice with the creation of a large neoorifice designed to arise perpendicularly from appropriate aortic sinus. Recent reports of sudden cardiac arrest after surgical unroofing have raised questions about the long-term consequences of this treatment, but the exact mechanism of ischemia and morbidity in these patients is unclear. Although abnormal angle of origin has been assumed to be a contributing factor in changing coronary artery blood flow patterns (i.e. hemodynamics), the effects of this anatomic feature on resulting hemodynamics have not been investigated in detail. The objectives of this study are to 1) analyze morphology and coronary blood flow patterns in AAOCA patients pre-operatively as well as post-unroofing, and 2) determine the effect of angle of origin on indices related to ischemia in a virtually manipulated model. The results of this study will characterize hemodynamic parameters previously linked to morbidity in AAOCA patients for the first time and determine the altered hemodynamics for risk stratification after unroofing surgery.