Computational fluid dynamics of the airways after left-upper pulmonary lobectomy: A case study,International Journal for Numerical Methods in Biomedical Engineering

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Computational fluid dynamics of the airways after left-upper pulmonary lobectomy: A case study
International Journal for Numerical Methods in Biomedical Engineering ( IF 2.2 ) Pub Date : 2021-04-07 , DOI: 10.1002/cnm.3462
Marta Tullio ₁ , Lorenzo Aliboni ₁ , Francesca Pennati ₁ , Rosaria Carrinola ₂ , Alessandro Palleschi _{2,

3} , Andrea Aliverti ₁

Affiliation

Pulmonary lobectomy is the gold standard intervention for lung cancer removal and consists of the complete resection of the affected lung lobe, which, coupled with the re-adaptation of the remaining thoracic structures, decreases the postoperative pulmonary function of the patient. Current clinical practice, based on spirometry and cardiopulmonary exercise tests, does not consider local changes, providing an average at-the-mouth estimation of residual functionality. Computational Fluid Dynamics (CFD) has proved a valuable solution to obtain quantitative and local information about airways airflow dynamics. A CFD investigation was performed on the airway tree of a left-upper pulmonary lobectomy patient, to quantify the effects of the postoperative alterations. The patient-specific bronchial models were reconstructed from pre- and postoperative CT scans. A parametric laryngeal model was merged to the geometries to account for physiological-like inlet conditions. Numerical simulations were performed in Fluent. The postoperative configuration revealed fluid dynamic variations in terms of global velocity (+23%), wall pressure (+48%), and wall shear stress (+39%). Local flow disturbances emerged at the resection site: a high-velocity peak of 4.92 m/s was found at the left-lower lobe entrance, with a local increase of pressure at the suture zone (18 Pa). The magnitude of pressure and secondary flows increased in the trachea and flow dynamics variations were observed also in the contralateral lung, causing altered lobar ventilation. The results confirmed that CFD is a patient-specific approach for a quantitative evaluation of fluid dynamics parameters and local ventilation providing additional information with respect to current clinical approaches.

中文翻译：

左上肺叶切除术后气道的计算流体动力学：案例研究

肺叶切除术是肺癌切除的金标准干预措施，包括完全切除受影响的肺叶，再加上剩余胸廓结构的重新适应，降低了患者术后肺功能。当前的临床实践基于肺活量测定法和心肺运动测试，不考虑局部变化，提供残余功能的平均口腔估计。计算流体动力学 (CFD) 已被证明是获取有关气道气流动力学的定量和局部信息的有价值的解决方案。对左上肺叶切除术患者的气道树进行了 CFD 调查，以量化术后改变的影响。从术前和术后 CT 扫描重建患者特异性支气管模型。参数喉模型被合并到几何形状以解释类似生理的入口条件。数值模拟在 Fluent 中进行。术后配置显示整体速度 (+23%)、壁压力 (+48%) 和壁剪切应力 (+39%) 方面的流体动力学变化。切除部位出现局部血流紊乱：左下叶入口处出现4.92 m/s的高速峰值，缝合区局部压力增加（18 Pa）。气管中压力和二次流动的幅度增加，并且在对侧肺中也观察到流动动力学变化，导致大叶通气改变。

更新日期：2021-04-07

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