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Blood flow analysis with computational fluid dynamics in the left atrium after left atrial plication: a prospective study

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Abstract

Objective

This study aimed to evaluate blood flow stagnation in an enlarged left atrium (LA) and prove that left atrial plication (LAP) could alleviate the stagnation.

Methods

Five patients with chronic atrial fibrillation who underwent mitral valve surgery followed by LAP for an enlarged LA with a ≥ 60-mm diameter were included. We performed computational fluid dynamics (CFD) analysis using preoperative and postoperative computed tomography and four-dimensional flow magnetic resonance imaging. Additionally, computer graphics were used to create virtual left atrial appendage resection (LAAR) images. We performed CFD analysis to assess blood flow stagnation in the LA for three groups: preoperative, LAAR, and LAP.

Results

When the average and constant stagnation volumes were both set to 100 preoperatively, the average stagnation volumes of the LAAR and LAP groups were 67.42 ± 18.64 and 35.88 ± 8.20, respectively. The constant stagnation volumes of these groups reduced to 45.01 ± 7.43 and 21.14 ± 7.70, respectively. The LAP group also had significantly lower average and constant stagnation volumes than those in the LAAR group (p = 0.006 and p = 0.033, respectively).

Conclusions

Blood flow stagnation was noted in the LAA and enlarged LA. CFD analysis revealed that LAP for the enlarged LA improved blood flow stagnation more than the virtual LAAR alone.

Clinical trial registry number

UMIN000049923.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing. We are thankful for Cardio Flow Design Ltd for their assistance in conducting this study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Takashi Enomoto, Takehito Mishima & Masanori Tsuchida

Authors
  1. Takashi Enomoto
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  2. Takehito Mishima
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  3. Masanori Tsuchida
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Corresponding author

Correspondence to Takashi Enomoto.

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Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

Studies with human subjects: The Niigata University Institutional Ethics Committee approved this study (approval number 2021-0097; date July 30, 2021), and it was conducted in accordance with the Declaration of Helsinki (UMIN CTR identifier: UMIN000049923). Written informed consent was obtained from all patients before their participation in the study. Studies with animals: Not applicable.

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Supplementary Information

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Supplementary file1 Video 1 The blood flow streamlines in the left atrium during one cardiac cycle in Case 4. The velocities ranged from 0 to 0.2 m/s (MP4 17001 KB)

Supplementary file2 Video 2 The stagnation area of the left atrium during one cardiac cycle in Case 4. The velocities ranged from 0 to 0.01 m/s (MP4 6980 KB)

Supplementary file3 (DOCX 393 KB)

Supplementary file4 (DOCX 22 KB)

Supplementary file5 (DOCX 13 KB)

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Enomoto, T., Mishima, T. & Tsuchida, M. Blood flow analysis with computational fluid dynamics in the left atrium after left atrial plication: a prospective study. Gen Thorac Cardiovasc Surg 72, 209–215 (2024). https://doi.org/10.1007/s11748-023-01963-2

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