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| Coronary
bridgings |
| Velocity
fields and parietal friction |
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The analysis
of the velocities fields puts several major phenomena into light.
The phase-shift between the two intake flows (1st case) can
change the flow configurations. The recirculation zone nearby
the higher lining is amplified by a backward flow from the graft
in the receiving artery. This provokes the jet deflection towards
the lower lining, while for two flows with a diastolic component
(case 2), the jet is deviated towards the higher lining.
Secondary flows are perturbed by the post-stenotic jet. The
star shaped flow usually observed downstream from constriction,
is sooner asymmetric during the cardiac cycle for case 1 compared
to case 2. Furthermore, downstream from anastomosis, the secondary
motions initiated by the opposition between the pressure transverse
gradient and the centrifugal forces are also influence by the
post-stenotic jet. The contrarotating structures which occupy
the entire transverse section in the obstruct case (3), remained
confined nearby the upper lining as soon as a remaining flow
occurs in the sick artery. |
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| Emitting
lines and secondary flows in transverse plans for three bridging
models at various instants of the cardiac cycle |
Taking the stenosis into account generates downstream from it
values of parietal shearing which are, considering their average,
, are lower than those admitted in an artery (between 10 and
15 dyn/cm2, according to some authors), at the heel and suture
line level. The friction values fluctuate in time and in the
space limiting the high-risk areas, which are different from
the occlusive case which is described in the literature. In
addition to the negative effect of the suture and the non-concordance
of the mechanical properties of the graft and the receiving
artery, the site of junction seems to be one of the most favorable
site for neointimous proliferation. Fluctuations at the resticking
point can be also added as other damaging event. Moreover, these
results are confirmed by the point of view of Reininger et al.
(1994) : if it is considered that the thrombus growth due to
the deposit of fibrine is correlated to the increased time of
resting in the recirculation zone rather than to a strong or
reduced parietal friction. An "intermediate" distance of bridging
equivalent to three diameters could thus constitute a good compromise,
as on the one hand, the recirculation zone does not expands
as far as the heel during most of the cycle. On the other hand,
the jets manage to preserve a non neglectable influence downstream
from the junction, which minimizes the stasis zone at the point. |
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