Virtual Planning and Simulation of Coarctation Repair in Hypoplastic Aortic Arches: Is Fixing the Coarctation Alone Enough?

Coarctation of aorta (CoA) is a congenital heart disease that may coexist with transverse arch hypoplasia (TAH). Infants who suffer from both conditions are often treated only for CoA at the initial repair if the degree of TAH is diagnosed as mild. In this study, we investigated the effect of virtually repairing the CoA of three patients (n=3) who also suffer from TAH. We repaired the CoA by using virtual stents that were modeled based on descending aorta diameters of the patients. Using computational fluid dynamics (CFD) simulations, we investigated the changes in time-averaged wall shear stress (TAWSS) after the virtual repair and calculated the peak systolic pressure drop (PSPD), which is the indicator of the performance of the repair. The magnitude of TAWSS was reduced in the repaired CoA regions in all the patients. The PSPD was improved in two patients, remaining above 20 mmHg in one of them. There was no significant change in PSPD for one patient after the virtual repair. The results may potentially help clinicians to gain better insights into whether the CoA repair alone in patients with existing TAH is sufficient.