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Understanding the complex interplay between morphologic and hemodynamicfeatures in aortic dissection is critical for risk stratification and for thedevelopment of individualized therapy. This work evaluates the effects of entryand exit tear size on the hemodynamics in type B aortic dissection by comparingfluid-structure interaction (FSI) simulations with in vitro 4D-flow magneticresonance imaging (MRI). A baseline patient-specific 3D-printed model and twovariants with modified tear size (smaller entry tear, smaller exit tear) wereembedded into a flow- and pressure-controlled setup to perform MRI as well as12-point catheter-based pressure measurements. The same models defined the walland fluid domains for FSI simulations, for which boundary conditions werematched with measured data. Results showed exceptionally well matched complexflow patterns between 4D-flow MRI and FSI simulations. Compared to the baselinemodel, false lumen flow volume decreased with either a smaller entry tear(-17.8 and -18.5 %, for FSI simulation and 4D-flow MRI, respectively) orsmaller exit tear (-16.0 and -17.3 %). True to false lumen pressure difference(initially 11.0 and 7.9 mmHg, for FSI simulation and catheter-based pressuremeasurements, respectively) increased with a smaller entry tear (28.9 and 14.6mmHg), and became negative with a smaller exit tear (-20.6 and -13.2 mmHg).This work establishes quantitative and qualitative effects of entry or exittear size on hemodynamics in aortic dissection, with particularly notableimpact observed on FL pressurization. FSI simulations demonstrate acceptablequalitative and quantitative agreement with flow imaging, supporting itsdeployment in clinical studies.

Hemodynamic Effects of Entry and Exit Tear Size in Aortic Dissection  Evaluated with In Vitro Magnetic Resonance Imaging and Fluid-Structure  Interaction Simulation