Patient-specific hemodynamic assessment using experimental and computational approaches in anomalous aortic origin of the coronary artery: Case study

Abstract

Objective

To develop and demonstrate the feasibility of a patient-specific framework combining experimental and computational modeling for noninvasive hemodynamic evaluation of anomalous aortic origin of coronary artery (AAOCA) anatomy derived from coronary computed tomography angiography.

Methods

A patient with a left AAOCA who experienced aborted sudden cardiac death underwent an unroofing procedure and later required coronary reimplantation after recurrent aborted sudden cardiac death was studied. Patient-specific models were generated at 3 stages: preoperative, postunroofing, and postreimplantation. Experimental assessment used 3-dimensional–printed aortocoronary models integrated with a pulsatile flow loop, whereas computational simulations were performed using computational fluid dynamics. Fractional flow reserve (FFR) and flow velocities were evaluated at rest and under simulated stress and compared with clinical stress FFR obtained during cardiac catheterization.

Results

Clinical cardiac catheterization-derived FFR under dobutamine stress was 0.77 postunroofing and 0.99 after reimplantation. Experimental testing demonstrated similar stress FFR of 0.7 in native left AAOCA (with short intramural course), 0.8 after unroofing (compression from the intercoronary pillar), and 0.9 postreimplantation. Computational FFR agreed with both experimental and clinical measurements: lowest values were 0.74 preoperatively, 0.8 post unroofing, and 0.87 post reimplantation. Flow patterns and pressure gradients corresponded with surgical and anatomical observations, showing improved coronary perfusion after reimplantation.

Conclusions

This hybrid experimental-computational workflow enables patient-specific assessment of AAOCA hemodynamics across sequential surgical stages. The approach provides accurate evaluation of coronary anatomy, cross-validation of model results, and preliminary mechanistic insight into ischemia, supporting the feasibility of this hybrid approach for patient-specific hemodynamic evaluation and motivating future investigation in larger cohorts.