Computational fluid dynamics-based prediction of aortic aneurysm rupture in a patient with chronic aortic dissection

The indication of additional aortic arch surgery for residual aortic dissection remains controversial as some patients experience aneurysm rupture at a smaller diameter of 55 mm. An 84-year-old woman, who underwent total arch replacement for chronic dissection, developed rupture of a residual aneurysm of with a diameter of 48 mm. Computational fluid dynamics simulated pressure and wall shear stress comparing pre- and post-total arch replacement. After total arch replacement, false lumen pressure in the distal aortic arch increased (pre, 138.5 mmHg; post, 148.2 mmHg). Wall shear stress also increased in the distal aortic arch (pre, 10.5 Pa; post, 16.9 Pa). Computational fluid dynamics could retrospectively predict a significant postoperative increase in false lumen pressure and wall shear stress of chronic dissections after total arch replacement, potentially leading to aneurysm rupture.