Computed tomography-derived biomechanical simulations as a proof-of-concept tool for evaluating coronary dynamics in anomalous aortic origin of coronary arteries.

Aims: We aim to explore whether biomechanical simulations can identify coronary compression sites and support pre-operative assessment as a proof-of-concept approach in subjects with anomalous aortic origin of a coronary artery. Methods and results: Patient-specific computer-aided engineering models of the aortic root and coronary arteries were developed from computed tomography scans of subjects with anomalous aortic origin of coronary arteries, retrospectively evaluated to include variants with and without an intramural segment. The fixed and dynamic components of stenosis were assessed by simulating blood pressure from rest to extreme effort and by retrieving the percentage of narrowing of the proximal anomalous lumen with reference to the distal segment. Patients were classified as potential candidates for surgery if the degree of stenosis was >50% in any of the simulated pressure scenarios. A total of 31 patients (19 with interarterial course and intramural segment, 12 with non-intramural course) were simulated. Simulations showed promising trends of agreement with retrospective clinical treatment decisions (13 aligned with surgery, 11 aligned with non-surgical management). This concordance with surgical decisions should not be interpreted as validation for predicting myocardial ischaemia. Conclusion: Computational models of the anomalous aortic origin of a coronary artery have not yet been routinely introduced into the clinical setting. Our method demonstrates potential as a proof-of-concept tool for identifying coronary compression-prone regions and estimating stenosis severity, but further studies are needed to validate its diagnostic and clinical utility.