In-silico Model to Study the Role of Anomalous Origin of Coronary Artery in Sudden Cardiac Death

Seyyed Mahmoud Mousavi1, Meri Gjika2, Gianluca Zitti2, Maurizio Brocchini2
1Department of Construction, Civil Engineering, and Architecture, Polytechnic University of Marche, Ancona, Italy, 2Università Politecnica delle Marche


Abstract

Sudden cardiac death in athletes is often related to anomalies in coronary-arteries origin, which involves the first part of the coronary path and may affect the coronary perfusion. However, these anomalies have not been associated with the processes inducing the sudden cardiac death. This is because coronary perfusion is governed by both the aortic pressure and the coronary autoregulation, and no symptoms are observed even during intense physical activities. To analyze the role of anomalous coronary artery origins an experimental setup had been proposed by Mousavi 2024 [1], reproducing the human ascending aorta, aortic sinuses of Valsalva, left, and right coronary arteries, including a first-hand trileaflet bioprosthetic aortic valve. To understand accurately the hydrodynamic processes, aortic pressures, coronary pressures, and coronary flows had been measured simultaneously allowing us to compare the coronary flow with the driving pressure, to evaluate coronary resistance and to setup numerical simulations useful for the modeling of the fluid dynamics in the whole coronary arteries. Piecewise-constant resistance parametrization is used in Windkessel-type models to derive coronary outflow. A unique mean value, equal to 2.17 mmHg/(ml/min) is considered to model the right coronary artery resistance. The left coronary artery resistance is assumed to be equal to its mean value out of the contraction (1.35 mmHg/(ml/min)) and to its peak value during the contraction (2400 mmHg/(ml/min)). An optimization process is used to determine the model compliance. To test the capability of this approach, it is used to define the boundary conditions for numerical simulations, showing that it is capable of modeling accurately some hydrodynamics structure in the Valsalva Sinuses and in the coronary arteries, supporting the use of Windkessel-type outflow boundary conditions, based on pressure measurements.