A doença valvar crônica de mitral (DVCM) é a principal cardiopatia adquirida dos cães e uma das suas complicações é a hipertensão arterial pulmonar (HAP), o que pode induzir a disfunção do ventriculo direito (VD). Assim, constituíram-se em objetivos do presente estudo identificar e descrever alterações de tamanho do VD, padrão de fluxo na artéria pulmonar (AP) e função sistólica ventricular direita nas diferentes fases da DVCM, além de correlacionar estas variáveis com índices de tamanho, volume, funções sistólica e diastólica do lado esquerdo do coração, bem como com a velocidade da insuficiência tricúspide (IT) e gradiente de pressão entre o ventrículo e átrio direitos nos cães que apresentavam regurgitação da valva tricúspide. Para tanto, foram incluídos 96 cães de diversas raças no estudo, que foram separados em quatro grupos de acordo com o estágio da DVCM: grupos ou estágios A, B1, B2 e C. Os cães com DVCM sintomáticos ou em estágio C apresentaram alterações no fluxo da artéria pulmonar (AP), bem evidenciadas pela redução das suas velocidades máxima e média, além da redução dos tempos de aceleração (TAC) e ejeção (TEJ) do fluxo sistólico da AP e correlação negativa com as variáveis de tamanho e funções sistólica e diastólica do coração esquerdo. O tamanho do VD foi estatisticamente maior nos animais do estágio C em comparação aos do estágio B1 e associou-se, negativamente, com os índices de função sistólica ventricular esquerda (VE). Os índices de função sistólica do VD como índice de excursão sistólica do plano anular tricúspide (iTAPSE) e variação fracional de área (FAC) foram maiores nos estágios mais avançados da DVCM e, juntamente com a velocidade de movimentação miocárdica sistólica do anel valvar tricúspide (onda Sm), correlacionou-se com índices de funções sistólica e diastólica do VE, seguindo o mesmo padrão de aumento de movimentação e estado hipercinético das variáveis do lado esquerdo do coração na evolução da DVCM. O padrão de fluxo sistólico da AP, bem caracterizado pelo TAC e TEJ, e o índice de área doVD foram os índices que mais alteraram com a evolução da hipertensão pulmonar na DVCM, enquanto que os índices de função do VD não apresentaram alterações significativas neste modelo de hipertensão arterial pulmonar em cão / Chronic mitral valvular disease (CMVD) is the most important acquired heart disease of dogs, and has as one of its complications, pulmonary arterial hypertension (PAH), which can lead to dysfunction of the right ventricle (RV). So, the objectives of the present study was to identify and describe changes in size, flow pattern in the pulmonary artery (PA) and RV systolic function at different stages of CMVD, and to correlate these variables with size, volume, systolic and diastolic function of left side of the heart, as well as the velocity of tricuspid insufficiency (TI) and pressure gradient between RV and right atrium in dogs thad had tricuspid valve regurgitation. For this purpose, 96 dogs of various breeds were included in the study, and they have been separated into 4 groups according to the stage of DVCM: group or stage A, B1, B2 and C. Dogs with symptomatic DVCM or stage C showed changes in the flow of PA, well evidenced by the reduction of the maximum and mean velocity flow of PA, besides the reduction of the acceleration (ACT) and ejection (EJT) times of systolic flow and negative correlation with the variables of size and systolic and diastolic function of the left heart. The RV size was statistically higher in the C stage of animals compared to stage B1; it was negatively associated with indices of left ventricular systolic function (LV). The systolic function indexes as index of tricuspide annular plane systolic excursion (ITAPSE) and fractional area change(FAC) were higher in more advanced stages of CMVD, and together with systolic myocardial movement of the tricuspid valve annulus velocity (wave Sm), correlated with indices of systolic and diastolic function of the left ventricle, following the same pattern of increase and hyperkinetic movement state variables of the left side of the heart in the evolution of DVCM. The pattern of systolic flow of the AP, well characterized by ACT and EJT, and RV area index are the variables that altered with the development of pulmonary hypertension in DVCM, while RV function indices showed no significant changes in this model of PAH in dogs

Introdução: O acesso ao terceiro ventrículo constitui verdadeiro desafio ao neurocirurgião. Nesse contexto, estudos anatômicos e morfométricos são úteis para estabelecer as limitações e as vantagens de determinado acesso cirúrgico. O acesso transcorioideo é versátil e promove exposição adequada da região média e posterior do terceiro ventrículo. Entretanto, a coluna do fórnice limita a exposição da região anterior do terceiro ventrículo. Há evidências de que a secção ipsilateral da coluna do fórnice tenha pouca repercussão na função cognitiva. Esta tese compara a exposição anatômica proporcionada pelo acesso transforniceal transcorioideo com o do acesso transcorioideo e realiza avaliação morfométrica de estruturas relevantes e comuns aos dois acessos. Material e métodos: A exposição anatômica proporcionada pelos acessos transcaloso transcorioideo e transcaloso transforniceal transcorioideo foram comparadas em oito cadáveres não submetidos à conservação, utilizando o sistema de neuronavegação (Artis, Brasília, Brasil), para aferir a área de trabalho, a área de exposição microcirúrgica, a exposição angular no plano longitudinal e transversal de dois alvos anatômicos (túber cinéreo e aqueduto cerebral). Adicionalmente, foram quantificados a espessura do parênquima do lobo frontal direito, a espessura do tronco do corpo caloso, o diâmetro longitudinal do forame interventricular, a distância de trabalho da superfície cortical ao túber cinéreo e a distância de trabalho da superfície cortical até o aqueduto cerebral. Os valores obtidos foram submetidos a análise de estatística utilizando o teste de Wilcoxon. Resultados: Na avaliação quantitativa, o acesso transforniceal transcorioideo proporcionou maior área de trabalho (transforniceal transcorioideo = 150,299 +/- 11,147 mm2; transcorioideo = 121,421 +/- 7,698 mm2; p < 0,05), maior área de exposição microcirúrgica (transforniceal transcorioideo = 100,920 +/- 8,764 mm2; transcorioideo = 79,944 +/- 4,954 mm2; p < 0,05), maior área de exposição angular no plano longitudinal para o túber cinéreo (transforniceal transcorioideo = 70,898 +/- 6,598 graus; transcorioideo = 63,838 +/- 5,770 graus; p < 0,05) e maior área de exposição angular no plano longitudinal para o aqueduto cerebral (transforniceal transcorioideo = 61,806 +/- 6,406 graus; transcorioideo = 54,998 +/- 5,102 graus; p < 0,05) em comparação com o acesso transcorioideo. Nenhuma diferença foi observada na exposição angular ao longo do eixo transversal para os dois alvos anatômicos (túber cinéreo e aqueduto cerebral) (p > 0,05). A espessura média do lobo frontal direito foi de 34,869 +/- 3,439 mm, a espessura do tronco caloso foi 10,085 +/- 1,172 mm, o diâmetro do forame interventricular foi de 4,628 +/- 0,474 mm, a distância da superfície cortical ao túber cinéreo foi de 69,315 +/- 4,564 mm e a distância da superfície cortical ao aqueduto cerebral foi de 75,654 +/- 4,950 mm. Na avaliação qualitativa, observamos que o acesso transforniceal transcorioideo permitiu incremento da visualização das estruturas da região anteroinferior do terceiro ventrículo. Não houve diferença quanto à exposição das estruturas da região média e posterior em ambos os acessos. Conclusões: O acesso transforniceal transcorioideo propicia maior exposição cirúrgica da região anterior do terceiro ventrículo em comparação com aquela oferecida pelo acesso transcorioideo. O estudo morfométrico estabeleceu valores médios das estruturas anatômicas comuns aos dois acessos na população estudada / Introduction: Approaches to the third ventricle constitute a formidable challenge to the neurosurgeon and, in this context, anatomical and morphometric studies are useful to establish the limitations and advantages of certain surgical approaches. The transchoroidal approach is a versatile one that promotes adequate exposure of the middle and posterior regions of the third ventricle. However, the column of fornix limits the exposure of the anterior third ventricle region. There is evidence that the ipsilateral section of the column of fornix has little effect on the cognitive function. This thesis compares the anatomical exposure using the transchoroidal transforniceal technique with the transchoroidal approach, and performs morphometric assessment of relevant structures common to both approaches. Material and methods: The anatomical exposure achieved through the transchoroidal transcallosal approach and transchoroidal transforniceal transcallosal were compared in 8 fresh cadavers using the neuronavigation system (Artis, Brasilia, Brazil), to assess the working area, microsurgical exposure area, to quantify the angular exposure in the longitudinal and cross-sectional planes to two anatomical targets (tuber cinereum and cerebral aqueduct), to measure the thickness of the right frontal lobe parenchyma, corpus callosum body thickness, longitudinal diameter of the interventricular foramen, working distance from the cortical surface to the tuber cinereum and working distance from the cortical surface to the cerebral aqueduct. The values obtained were submitted to statistical analysis using Wilcoxon\'s test. Results: In the quantitative assessment, the transchoroidal transforniceal approach provided: larger working area (transchoroidal transforniceal = 150.299 +/- 11.147 mm2; transchoroidal = 121.421 +/- 7.698 mm2; p < 0.05), larger area of microsurgical exposure (transforniceal transchoroidal = 100.920 +/- 8.764 mm2; transchoroidal = 79.944 +/- 4.954 mm2; p < 0.05), larger area of angular exposure in the longitudinal plane to the tuber cinereum (transchoroidal transforniceal = 70.898 +/- 6.598 degrees; transchoroidal = 63.838 + / - 5,770 degrees; p < 0.05) and larger area of angular exposure in the longitudinal plane to the cerebral aqueduct (transforniceal transchoroidal = 61.806 +/- 6.406 degrees; transchoroidal = 54.998 +/- 5.102 degrees; p < 0.05) when compared to the transchoroidal approach. No differences were observed in the angular exposure along the cross-sectional axis for both anatomical targets (tuber cinereum and cerebral aqueduct) (p > 0.05). The mean thickness of the right frontal lobe was 34.869 +/- 3.439 mm, the thickness of the corpus callosum body was 10.085 +/- 1.172 mm, the diameter of the interventricular foramen was 4,628 +/- 0,474 mm, the distance from the cortical surface to the tuber cinereum was 69.315 +/- 4.564 mm, and the distance from the cortical surface to the cerebral aqueduct was 75.654 +/- 4.950 mm. In the qualitative assessment, we observed that the transforniceal transchoroidal approach allowed better visualization of the structures in the anterior third ventricle region. There was no difference regarding exposure of structures in the middle and posterior regions with both access. Conclusions: The transforniceal transchoroidal approach provides greater surgical exposure of the anterior third ventricle region than that obtained with the transchoroidal approach. The morphometric study established mean values of anatomical structures that are common to both approaches in the assessed population

A avaliação do ventrículo esquerdo (VE) é uma das principais contribuições da ecocardiografia no estudo da função cardíaca e inclui a mensuração dos diâmetros da cavidade e espessura das paredes em diástole e sístole. O estudo por meio do modo M tem sido usado como padrão para a realização da mensuração e para o cálculo de índices sistólicos, mas o modo bidimensional também é utilizado para este fim. As medidas podem ser adquiridas a partir de dois planos de imagem: transversal e longitudinal. A definição de intervalos de confiança para valores normais de VE permite a identificação de remodelamento ventricular, concêntrico ou excêntrico, decorrente de doenças cardiovasculares ou sistêmicas. Assim sendo, o objetivo deste estudo foi comparar as medidas ecocardiográficas desta câmara obtidas pelos seguintes métodos: modo M em corte transversal, modo M em corte longitudinal, modo bidimensional em corte transversal e modo bidimensional em corte longitudinal. Adicionalmente, estudou-se o comportamento do efeito do peso e do sexo nos métodos mencionados. Foram selecionados 40 cães adultos da raça Pastor Alemão sem alterações cardiovasculares. A realização do ecocardiograma de cada animal inclui os quatro métodos descritos acima, de acordo com o recomendado pela literatura. Foram pesquisados os efeitos do corte e do método, bem como a influência do peso e do sexo, sobre cada medida estudada, linear ou derivada. O peso apresentou correlação com todas as medidas lineares de VE em pelo menos um dos métodos, mas não com fração de encurtamento (FE) e fração de ejeção (FEj). Utilizando-se a análise univariada, verificou-se que machos apresentaram todas as medidas estudadas significativamente maiores que fêmeas em pelo menos um dos métodos, exceto FE e FEj, cujos valores não foram diferentes entre os sexos. Observou-se efeito isolado do corte apenas sobre diâmetro diastólico final do ventrículo esquerdo (DdFVE), com medidas maiores obtidas no corte transversal, e mudança de comportamento do sexo nos cortes com influência significativa do peso sobre septo interventricular em diástole (SIVd). Houve efeito isolado do modo sobre os índices de função sistólica FE e FEj, com valores maiores fornecidos pelo modo M. O peso teve efeito isolado positivo sobre parede livre de ventrículo esquerdo em diástole (PLVEd), exceto no modo M em corte transversal e (diâmetro sistólico final de ventrículo esquerdo (DsFVE). O sexo, retirada a influência do peso, teve efeito isolado apenas sobre DdFVE, com machos apresentando valores significativamente maiores que fêmeas em ambos os cortes no modo bidimensional. Os resultados Os resultados mostram que há risco de erro de interpretação quando valores normais de referência, gerados a partir de determinado método, são utilizados para a avaliação de um paciente examinado por técnica de mensuração diversa, especialmente quando se obtém resultados nos limites superior ou inferior de normalidade. / Left ventricle (LV) evaluation is one of the most important contributions of echocardiography in the assessment of cardiac function. It includes measurements of internal diameter and wall thickness at end-diastole and end-sistole of this chamber. M Mode echocardiography has been widely used for measuring linear dimensions and quantifying systolic function, but bidimensional mode is also used with the same purpose. The LV measurement can be derived from transverse or longitudinal images of the heart. The establishment of normal confidence intervals of LV dimensions allows identification of concentric or excentric ventricular remodeling process secondary to cardiovascular and systemic diseases. The aim of this study was to compare LV measurements obtained from four methods: M mode in short-axis, M mode in long-axis, bidimensional mode in short-axis and bidimensional mode in long-axis view of the heart. In addition the effect of weight and gender over measures was studied in the methods mentioned above. Forty adult German Shepherds without cardiovascular diseases were selected. The echocardiogram of each animal included the four described methods, according previous referenced recommendations. The effects of axis and mode as well as weight and gender were studied for each linear or derived LV measure. Weight correlated with all linear LV measures at least in one method, but not with ejection fraction (EF) and shortening fraction (SF). All LV measures of males were greater than those of females at least in one method, except for EF and SF, which did not differ between sexes. Isolated effect of the axis was observed only for LV end diastolic diameter (LVEDD), with greater values obtained from short-axis views. The combined effect of axis, gender and weight was identified in interventricular septal end diastolic thickness. There was isolated effect of mode over EF and SF, with greater measures derived from bidimensional mode methods. Weight had isolated significant positive effect over LV enddiastole posterior wall thickness in all methods, except from M mode performed in short axis, and LV end-sistolic diameter. Gender had isolated effect only over LVEDD, males showing greater values than females in bidimensional mode in short and long axis. Professionals should be aware of the possibility of erroneous interpretation when using data obtained by a different method of that used in the patient exam as reference, mainly for the values situated in inferior and superior limits of confidence intervals.

La LVNC est une cardiomyopathie rare, caractérisée par une hypertrabéculation et de profonds replis du ventricule gauche. A ce jour, nous ne savons toujours pas si la LVNC résulte d'un défaut se produisant durant le développement cardiaque et si sa gravité dépend du stade embryonnaire auquel l'arrêt de la compaction se produit. Notre objectif a été d'étudier l'évolution pathologique de la LVNC en caractérisant les défauts fonctionnels et en identifiant les mécanismes moléculaires dans des modèles de souris présentant un développement anormal des trabécules ventriculaires. Pour établir un modèle de LVNC, nous avons généré des souris KO conditionnel pour Nkx2.5 grâce au système Flox/loxP inductible par injection de tamoxifène qui active la recombinaison Cre. Nous avons ainsi supprimé l'allèle Nkx2.5 dans l'oreillette et les cardiomyocytes dérivant des trabécules. Nous avons choisi de sipprimé Nkx2.5 au stade embryonnaire E10 quand le trabécule s'accroît, au stade E14 quand il se compacte, ou juste après la naissance quand le cœur a terminé son processus de compaction. En résumé, nous avons réussi à générer différents modèles de LVNC, dans lesquelles nous avons pu étudier cette pathologie, en supprimant le facteur de transcription Nkx2.5 dans les oreillettes et les cardiomyocytes dérivés des trabécules. Nous avons également confirmé que la sévérité de la LVNC dépend du stade de développement du trabécule auquel le défaut se produit. Peu de publications décrivent à ce jour les mécanismes responsables de l'état inflammatoire observé dans la LVNC, nos résultats sont donc prometteurs pour de futures recherches dans cette voie. / LVNC is a rare cardiomyopathy, characterized by hypertrabeculation and deep trabecular recesses in the left ventricle. It is still unclear whether LVNC results from a defect occurring during cardiac development. One hypothesis to consider is that the severity of LVNC depends on which embryonic stage the arrest of myocardial compaction occurs. Our aim was to study the pathological evolution of LVNC by characterizing functional defects and identifying molecular mechanisms in mouse models with abnormal ventricular trabeculae development. To establish a LVNC mouse model, we generated specific Nkx2.5 conditional knockout mice to delete Nkx2.5 allele in atria and trabecular derived cardiomyocytes at embryonic stages when trabeculae arise (at around E10), or start to compact (at around E14), or at neonatal stages (after birth) when the heart is almost finish compaction step. After all, we were successful in generating several LVNC mouse models by the conditional deletion of Nkx2.5 transcription factor in atria and trabecular derived cardiomyocytes. These mouse models are suitable for studying LVNC pathology. We also confirmed the hypothesis that the severity of LVNC depends on stages when disturbances in the trabecular development occur. Hypertrabeculation, cardiac conduction defects, decreased ejection fraction, and existence of fibrosis are robustly observed following deletion at E10.5/11.5 meaning that the deletion at early stage of trabecular development causes the most severe pathological phenotype of LVNC. There had been just a few publications showing inflammation in LVNC heart, which could be a very good finding for future researches.

No description available.

This study investigated whether acute myocardial ischemia of the anterior left ventricular wall induced an increase in cardiac sympathetic efferent nerve activity and thereby affected regional myocardial blood flow and contractile function.

Bakgrund: Uträkning av vänsterkammarens (VK) volymer (Enddiastolisk volym, EDV; Endsystolisk volym, ESV; Slagvolym, SV) och ejektionsfraktion (EF) går att göra med elektrokardiografi (EKG)-styrd gating vid positronemissionstomografi (PET) med spårämnet 15O-vatten. Metoden behöver utredas noggrannare och optimeras för att kunna introduceras i klinisk rutinverksamhet. Syfte: Syftet med denna studie var att undersöka bildanalys av PET-rekonstruktioner med olika spatial och temporal upplösning i samband med 15O-vatten-PET utförd med EKG-gating, samt jämföra analysutfallen av VK-volymer och EF mot CMR och sinsemellan, för att utreda möjligheten att optimera metoden. Metod: Totalt 25 patienter som genomgått en 15O-vatten-PET, varav n=11 hade undersökts med CMR samma dag, inkluderades. Olika gating-rekonstruktioner med varierande upplösning utfördes retrospektivt och analyserades automatiskt samt manuellt. Analysutfallen för VK-volymer och EF för PET och CM jämfördes statistiskt. Resultat: I studien fanns en stark till mycket stark korrelation mellan PET och CMR för EDV, stark korrelation för ESV, medel till stark korrelation för SV och svag till medel korrelation för EF. Rekonstruktion med 12 gating-bins och 256x256 matrisstorlek hade starkast korrelation för SV och EF. Samtliga PET-rekonstruktioner korrelerade starkt-till mycket starkt med varandra för VK-volymer och EF. Bland-Altman-analyser visade på en god repeterbarhet, framförallt vid manuell analys, för beräkning av EF med 15O-vatten-PET. Slutsats: VK-volymer och EF kan beräknas med 15O-vatten-PET med en repeterbarhet liknande den för andra, mer använda modaliteter. Att använda en högre upplösning än vad som tidigare testats gav högre värden för EF, och starkare korrelation i jämförelse mot CMR. / Background: Calculation of left ventricle (LV)-volumes (End Diastolic Volume, EDV; End Systolic Volume, ESV; Stroke Volume, SV) and ejection fraction (EF) is possible with electrocardiography (ECG)-gated Positron Emission Tomography (PET) using 15O-water, but the method needs to be further investigated and optimized before clinical routine implementation. Purpose: The purpose of this study was to investigate how altered image resolution affects the analysis and values of LV-volumes and ejection fraction on 15O-water-PET and compare the results against Cardiac Magnetic Resonance imaging (CMR) to enable optimization of the PET-method.  Method: In total, 25 patients who previously underwent a 15O-water-PET, where n=11 also performed CMR on the same day were included in the study. Different gating-reconstructions with varying resolution were performed retrospectively and underwent analysis, both automatically and manually.  Results: Correlation analysis found a strong to very strong correlation comparing PET against CMR for EDV, a strong correlation for ESV, a moderate to strong correlation for SV and a weak to moderate correlation for EF. The reconstruction containing 12 gating-bins and a 256x256 matrix size showed the strongest correlation for SV and EF. All PET-reconstructions correlated strong to very strong against each other for all LV-volumes and EF. Bland-Altman-plots showed good repeatability, especially for manual analysis, when calculating EF on 15O-water-PET.  Conclusion: LV-volumes and EF can be calculated on 15O-water-PET, with repeatability close to that of other modalities. Using an increased resolution than previously tested resulted in higher EF and stronger correlation in comparison with CMR.

L’insuffisance cardiaque droite est la première cause de morbi-mortalité chez les patients atteints d’hypertension pulmonaire. Améliorer le phénotypage de l’adaptation du coeur droit en imagerie non-invasive est essentiel afin de mieux comprendre les mécanismes favorisant la transition d’un état adapté à un état maladapté.Le premier chapitre a démontré la fiabilité de l’échographie cardiaque pour la détection de l’hypertension pulmonaire, fournissant des conseils méthodologiques pratiques.Le second chapitre a permis d’identifier les indices télé-systoliques de remodelage du ventricule droit comme les plus puissants paramètres pronostiques en imagerie chez les patients atteints d’hypertension artérielle pulmonaire (HTAP), en association avec la classe NYHA et le taux de NT-proBNP.Le troisième chapitre est dédié à l’étude des biomarqueurs immunitaires en hypertension pulmonaire, en mettant en utilisant la méthode de phénotypage approfondi du coeur droit pour déterminer le profile circulant protéomique associé à la défaillance droite chez les patiens atteints d’HTAP. Cette étude a permis de montrer que des taux élevés plasmatiques d’hepatic growth factor, de nerve grwoth factor et de stem cell growth factor beta sont associés à la défaillance droite dans deux cohortes d’HTAP. Le rôle direct de ces biomarqueurs dans le ventricule droit reste à être élucidé. / Right heart failure is the major cause of morbi-mortality in patients with pulmonary hypertension (PH). Improving right heart adaptive phenotyping using non-invasive imaging is needed in order to better understand the transition from right ventricular (RV) adaptation to maladaptation in PH.The first chapter of this thesis has been dedicated to demonstrate the reliability of echocardiography to detect PH in patients with group 1 or 3 PH, providing methodology pearls and pitfalls.The second chapter has enabled to identify, among the multiple right heart non-invasive imaging metrics, RV end-systolic remodeling indices as the strongest prognostic biomarkers in patients with pulmonary arterial hypertension (PAH), combined with the NYHA class and NT-proBNP levels.The third chapter has explored the role of immune biomarkers in PH, providing a practical application of right heart deep phenotyping to determine the circulating immune proteomic profile associated with right heart failure in patients with PAH. This screening proteomics study has identified high plasmatic levels of hepatic growth factor, nerve growth factor and stem cell growth factor beta to be associated with right heart maladaptation in two cohorts with PAH. The role of these biomarkers within the right ventricle itself remains to be fully explored.

Ventricle Assist Devices (VADs), which are typically either axial or centrifugal flow pumps implanted on the aortic arch, have been used to support patients who are awaiting cardiac transplantation. Success of the apparatus in the short term has led to long term use. Despite anticoagulation measures, blood clots (thrombi) have been known to form in the device itself or inside of the heart. The Ventricle Assist Devices supply blood flow via a conduit (cannula) implanted on the ascending aorta. Currently, the implantation angle of the VAD cannula is not taken into consideration. Since the VADs supply a significant amount of blood flow to the aorta, the implantation angle can greatly affect the trajectory of the formed thrombi as well as the cardiac flow field inside of the aortic arch. This study aims to vary the implantation angle of a pediatric Left Ventricle Assist Device (LVAD) through a series of computational fluid dynamics (CFD) software simulations focusing on the aortic arch and its branching arteries of a 20 kg pediatric patient in order to reduce the occurrence of stroke.

No description available.