Risk factors for acute aortic dissection.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"6974",leadTitle:null,fullTitle:"Integrated View of Population Genetics",title:"Integrated View of Population Genetics",subtitle:null,reviewType:"peer-reviewed",abstract:"Population genetics is the basis of evolutionary studies, and has been widely used in several researches. This recent field of science has important applications for the management of populations (natural and domesticated), as well as for evolutionary studies of the various factors that affect gene frequencies over time and spatial distribution.In this work, presented in three sections (Population and Quantitative Genetics, Genetic Diversity in Crop Management, Population Genetics for Conservation Studies), the reader will find cutting-edge information in carefully selected and revised works.This book is intended for all researchers, academics, and students who are interested in the intriguing area of population genetics.",isbn:"978-1-78985-778-8",printIsbn:"978-1-78985-777-1",pdfIsbn:"978-1-83962-089-8",doi:"10.5772/intechopen.73721",price:100,priceEur:109,priceUsd:129,slug:"integrated-view-of-population-genetics",numberOfPages:70,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"d0fce1c94e04593f309f807a4620cb39",bookSignature:"Rafael Trindade Maia and Magnólia de Araújo Campos",publishedDate:"March 20th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/6974.jpg",numberOfDownloads:5385,numberOfWosCitations:3,numberOfCrossrefCitations:2,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:4,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:9,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"July 2nd 2018",dateEndSecondStepPublish:"August 28th 2018",dateEndThirdStepPublish:"October 27th 2018",dateEndFourthStepPublish:"January 15th 2019",dateEndFifthStepPublish:"March 16th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"212393",title:"Prof.",name:"Rafael",middleName:"Trindade",surname:"Trindade Maia",slug:"rafael-trindade-maia",fullName:"Rafael Trindade Maia",profilePictureURL:"https://mts.intechopen.com/storage/users/212393/images/system/212393.jpg",biography:"Dr. Rafael Trindade Maia studied biological sciences at the Federal Rural University of Pernambuco, Brazil (2005). He received a master´s degree in Genetics, Conservation, and Evolutionary Biology from the National Institute of Amazonian Research, Brazil, in 2008, and a Ph.D. in Animal Biology from the Federal University of Pernambuco, Brazil, in 2013. He is currently an adjunct professor at the Center for the Sustainable Development for Semiarid (CDSA) at Federal University of Campina Grande (UFCG), Brazil. He has experience with population genetics, bioinformatics, molecular docking, and modeling and molecular dynamics of proteins. He works in science and biology education. Dr. Maia also leads the research groups Computational and Theoretical Biology (CTB) and Education in Sciences and Biology (ESB).",institutionString:"Federal University of Campina Grande",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Federal University of Campina Grande",institutionURL:null,country:{name:"Brazil"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"265397",title:"Dr.",name:"Magnólia De Araújo",middleName:null,surname:"Campos",slug:"magnolia-de-araujo-campos",fullName:"Magnólia De Araújo Campos",profilePictureURL:"https://mts.intechopen.com/storage/users/265397/images/system/265397.png",biography:"Magnólia A. Campos is a biologist, has a Masters in Agronomy / Plant Breeding from the Federal University of Pelotas and a PhD in Biological Sciences / Molecular Biology from the University of Brasília (2002). She had a total five years of experience in genomic sciences as a postdoctoral researcher at the Federal University of Lavras / Agronomic Institute (IAC). Since 2008, she has been a Professor at the Federal University of Campina Grande (UFCG). She has experience in the area of plant biotechnology, working mainly on the following topics: genomics, bioinformatics, tissue culture and plant cells, genetic transformation of plants, study of gene expression during plant-microbe interactions and expression of heterologous proteins in bacteria.",institutionString:"Federal University of Campina Grande",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Federal University of Campina Grande",institutionURL:null,country:{name:"Brazil"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"429",title:"Genetic Diversity",slug:"biochemistry-genetics-and-molecular-biology-population-genetics-genetic-diversity"}],chapters:[{id:"65713",title:"Introductory Chapter: Population Genetics - The Evolution Process as a Genetic Function",doi:"10.5772/intechopen.84418",slug:"introductory-chapter-population-genetics-the-evolution-process-as-a-genetic-function",totalDownloads:2370,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Rafael Trindade Maia and Magnólia de Araújo Campos",downloadPdfUrl:"/chapter/pdf-download/65713",previewPdfUrl:"/chapter/pdf-preview/65713",authors:[{id:"212393",title:"Prof.",name:"Rafael",surname:"Trindade Maia",slug:"rafael-trindade-maia",fullName:"Rafael Trindade Maia"}],corrections:null},{id:"64779",title:"Studying Growth and Vigor as Quantitative Traits in Grapevine Populations",doi:"10.5772/intechopen.82537",slug:"studying-growth-and-vigor-as-quantitative-traits-in-grapevine-populations",totalDownloads:896,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Vigor is considered as a propensity to assimilate, store, and/or use nonstructural carbohydrates for producing large canopies, and it is associated with high metabolism and fast growth. Growth involves cell expansion and cell division. Cell division depends on hormonal and metabolic processes. Cell expansion occurs because cell walls are extensible, meaning they deform under the action of tensile forces, generally caused by turgor. There is increasing interest in understanding the genetic basis of vigor and biomass production. It is well established that growth and vigor are quantitative traits and their genetic architecture consists of a big number of genes with small individual effects. The search for groups of genes with small individual effects, which control a specific quantitative trait, is performed by QTL analysis and genetic mapping. Today, several linkage maps are available, like “Syrah” × “grenache,” “Riesling” × “Cabernet Sauvignon,” and “Ramsey” × Vitis riparia. This last progeny segregates for vigor and constituted an interesting tool for our genetic studies on growth.",signatures:"Inés Pilar Hugalde, Summaira Riaz, Cecilia B. Agüero, Hernán Vila,\nSebastián Gomez Talquenca and M. Andrew Walker",downloadPdfUrl:"/chapter/pdf-download/64779",previewPdfUrl:"/chapter/pdf-preview/64779",authors:[{id:"265804",title:"M.Sc.",name:"Inés",surname:"Hugalde",slug:"ines-hugalde",fullName:"Inés Hugalde"},{id:"266196",title:"Dr.",name:"Cecilia",surname:"Aguero",slug:"cecilia-aguero",fullName:"Cecilia Aguero"},{id:"266197",title:"Dr.",name:"Sebastián",surname:"Gomez Talquenca",slug:"sebastian-gomez-talquenca",fullName:"Sebastián Gomez Talquenca"},{id:"266198",title:"Dr.",name:"Hernán",surname:"Vila",slug:"hernan-vila",fullName:"Hernán Vila"},{id:"266201",title:"Dr.",name:"Summaira",surname:"Riaz",slug:"summaira-riaz",fullName:"Summaira Riaz"},{id:"266451",title:"Dr.",name:"Andrew",surname:"Walker",slug:"andrew-walker",fullName:"Andrew Walker"}],corrections:null},{id:"64587",title:"Weedy Rice: Competitive Ability, Evolution, and Diversity",doi:"10.5772/intechopen.81838",slug:"weedy-rice-competitive-ability-evolution-and-diversity",totalDownloads:1204,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Weedy rice is conspecific, the most troublesome weed of cultivated rice identified as a threat to global rice production. The weed has inherited high reproductive ability and high dormancy by outcrossing with modern rice cultivars and wild cultivars, respectively. Traits such as rapid growth, high tillering, enhanced ability to uptake fertilizers, asynchronous maturation, seed shattering, and long dormancy periods make weedy rice more competitive than cultivated rice. Weedy rice infesting rice fields are morphologically diverse with different hull color, awn length, plant height, and variable tiller number. Morphological diversity in weedy rice can be attributed to its high genetic diversity. Introgression of alleles from cultivated rice into weedy has resulted in high genetic and morphological diversity in weedy rice. Although variations among weedy rice populations make them difficult to control, on the brighter side, competitive nature of weedy rice could be considered as raw genetic materials for rice breeding program to develop vigorous rice plants able to tolerate high biotic and abiotic stresses.",signatures:"Swati Shrestha, Shandrea Stallworth and Te-Ming Tseng",downloadPdfUrl:"/chapter/pdf-download/64587",previewPdfUrl:"/chapter/pdf-preview/64587",authors:[{id:"268014",title:"Dr.",name:"Te-Ming",surname:"Tseng",slug:"te-ming-tseng",fullName:"Te-Ming Tseng"},{id:"268015",title:"MSc.",name:"Swati",surname:"Shrestha",slug:"swati-shrestha",fullName:"Swati Shrestha"},{id:"273965",title:"MSc.",name:"Shandrea",surname:"Stallworth",slug:"shandrea-stallworth",fullName:"Shandrea Stallworth"}],corrections:null},{id:"64268",title:"The Research of Population Genetic Differentiation for Marine Fishes (Hyporthodus septemfasciatus) Based on Fluorescent AFLP Markers",doi:"10.5772/intechopen.81796",slug:"the-research-of-population-genetic-differentiation-for-marine-fishes-hyporthodus-septemfasciatus-bas",totalDownloads:915,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Hyporthodus septemfasciatus is a commercially important proliferation fish which is distributed in the coastal waters of Japan, Korea, and China. We used the fluorescent AFLP technique to check the genetic differentiations between broodstock and offspring populations. A total of 422 polymorphic bands (70.10%) were detected from the 602 amplified bands. A total of 308 polymorphic loci were checked for broodstock I (Pbroodstock I = 55.50%) coupled with 356 and 294 for broodstock II (Pbroodstock II = 63.12%) and offspring (Poffspring = 52.88%), respectively. The levels of population genetic diversities for broodstock were higher than those for offspring. Both AMOVA and Fst analyses showed that significant genetic differentiation existed among populations, and limited fishery recruitment to the offspring was detected. STRUCTURE and PCoA analyses indicated that two management units existed and most offspring individuals (95.0%) only originated from 44.0% of the individuals of broodstock I, which may have negative effects on sustainable fry production.",signatures:"Yongshuang Xiao, Zhizhong Xiao, Jing Liu, Daoyuan Ma, Qinghua Liu\nand Jun Li",downloadPdfUrl:"/chapter/pdf-download/64268",previewPdfUrl:"/chapter/pdf-preview/64268",authors:[{id:"99828",title:"Prof.",name:"Zhizhong",surname:"Xiao",slug:"zhizhong-xiao",fullName:"Zhizhong Xiao"},{id:"267948",title:"Associate Prof.",name:"Yongshuang",surname:"Xiao",slug:"yongshuang-xiao",fullName:"Yongshuang Xiao"},{id:"275347",title:"Prof.",name:"Jing",surname:"Liu",slug:"jing-liu",fullName:"Jing Liu"},{id:"275348",title:"Prof.",name:"Daoyuan",surname:"Ma",slug:"daoyuan-ma",fullName:"Daoyuan Ma"},{id:"281056",title:"Dr.",name:"Qinghua",surname:"Liu",slug:"qinghua-liu",fullName:"Qinghua 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Type A aortic dissection is a life threatening condition requiring emergency surgical intervention. Statistics show an incidence of approximately three cases per 100,000 per year [1, 2]. Data analysis from the International Registry of Acute Aortic Dissections (IRAD) reported a predominant male patient population and a mean age of 63 years at presentation [3]. Surgical repair for Type A Aortic dissection is challenging, the complexity proportionate to the location and extent of aortic tissue dissected, cardiac complications and end organ ischemia. The current standard surgical approach includes replacement of the aortic root (Bentall technique) or valve sparing root replacement, isolated ascending aorta replacement, and hemi or full arch replacement. Recent advances include frozen elephant trunk (FET) technique, total aortic repair, endovascular and hybrid approaches and stenting. All of these surgical approaches, including classification, clinical presentation, risk factors, diagnosis, pre-operative preparation, cannulation strategies, and cerebral protection will be discussed in this review.
The Stanford classification (1970) is the most commonly used system (Figure 1) [4]. It does not classify the site of tear. It is more of a clinically useful classification to guide acute management. Stanford type A involves ascending aorta proximal to innominate artery, irrespective of involvement of aortic arch or descending aorta. Stanford type B dissection involves only the thoracic aorta distal to the left subclavian artery [5]. Intimal tears originating distal to left subclavian artery but dissecting retrogradely into ascending aorta will be type A. Intimal tears starting in the aortic arch and extending into ascending aorta are type A and extending into descending aorta are type B. If the intimal tear is restricted to aortic arch, then it is type non-A non-B.
Stanford and DeBakey classification.
The DeBakey type I involves ascending aorta and extends beyond the innominate artery. Type II involves only the ascending aorta. Type III involves thoracic aorta distal to left subclavian artery. It is more useful for long-term follow-up as it differentiates between proximal and distal aortic dissection extent (Figure 1) [4].
The Penn classification is a recently introduced method of classifying based on clinical presentation [6]. Class Aa—absence of branch vessel malperfusion or circulatory collapse; Class Ab—symptoms or signs of localised organ ischemia; Class Ac—circulatory collapse with or without cardiac involvement; Class Abc—combined localised and generalised ischemia.
Men form approximately 62–68% of all patients undergoing surgery [7]. The triad of hypertension (67–86% patients), smoking and atherosclerosis is an independent predictor of type A aortic dissection [8]. Data correlating the risk of aortic dissection in bicuspid aortic valve is limited and controversial. However, some centres advocate early prophylactic ascending aortic replacement in patients with aortas larger than approximately 5.0 cm in diameter or with a cross-sectional area to height ratio greater than approximately 10 cm2/m [9]. In the NORCAAD registry, 6% patients were reported to have bicuspid aortic valve [7]. The Marfan syndrome is present in around 4% of ATAAD patients in NORCAAD registry [10]. The patients typically have pear- shaped aneurysm of aortic root. Due to mutation in FBN1 gene, there is decreased strength and elasticity of elastin—rich tissue of aortic wall. Predominantly, medium and large sized arteries are involved in dissection (Table 1).
(1) Cardiovascular and life style factors |
Uncontrolled hypertension |
Age |
Smoking |
Dyslipidemia |
Cocaine |
Pregnancy |
(2) Congenital and connective tissue |
Bicuspid aortic valve |
Marfan syndrome |
(3) Iatrogenic |
Coronary catheterisation |
Arterial cannulation |
Aortic cross clamping |
IABP |
(4) Vascular inflammation |
Takayasu arteritis |
(5) Trauma |
Deceleration injury |
Risk factors for acute aortic dissection.
TAAD patients (85%) typically present with sudden intense central chest pain (ripping or tearing) radiating to the neck, back or abdomen. [11]. ECG abnormalities (50% patients) include ST/T wave changes, conduction defects, and arrhythmias. This sometimes leads to the misdiagnosis of myocardial infarction leading to fatal mistake of giving antiplatelet therapy or thrombolysis. This delays the diagnosis and increases peri-operative bleeding complications. Aortic regurgitation (70% patients) can occur through prolapse of right or non- coronary valve cusps and detachment of commissures. Pulmonary oedema may occur through acute dilation of the left ventricle. Haemorrhagic pericardial tamponade is a very strong predictor of aortic dissection. Reduced or absent femoral pulses are seen. Neurological sequlae include syncope, stroke. Mal-perfusion of spinal cord leads to paraplegia. Acute renal failure and mesenteric ischemia are seen if the dissection involves descending thoracic and abdominal aorta [12]. Rupture of the aneurysm is immediately fatal.
Chest X-ray of a patient with ATAD showing a widened mediastinum.
CT-scan of a patient with TAAD.
The following information may be provided from a CT-scan:
Detection of the true and false lumen in the dissected aorta
Identification of the site of the intimal tear The extent of the dissection
Arch vessel and thoracic and abdominal branch vessel involvement
Planning the site of cannulation
Limitations of CT-scanning include not providing information about dissection entry site and functional status of the heart.
5. Trans-oesophageal echocardiography (TEE; Figure 4)
TEE of a patient with ATAD.
TEE is portable, less invasive and has sensitivity and specificity approximately 100% [16]. It provides information about:
The dissection flap and false lumen in ascending aorta
The entry site of tear using colour Doppler
Coronary ostial obstruction due to the dissection
Dilation of aorta and left ventricle function
Pericardial effusion and tamponade
Aortic regurgitation and anatomy of aortic root
Has a better window than TTE to visualise aortic arch and descending aorta
Pleural effusion
Limitations include difficulty in visualisation of the proximal arch due to the interposition of bronchial air [17].
6.
MRI is an accurate investigative modality for acute aortic dissection (sensitivity and specificity, 98%) [18]. It is rarely used in the setting of TAAD where most of the patients are wheeled into operating room as soon as the diagnosis is made. It may have a small role in those patients allergic to iodinated contrast agents or in patients with acute renal failure who are stable enough to undergo MRI.
Blood pressure (BP) control: One of the most important pre-requisites of successful outcome is very strict control of BP. Systolic BP should be less than 110 mmHg. It can be lowered using intravenous beta blocker (esmolol) or combined alpha & beta receptor antagonists (labetalol) or glyceryl trinitrate. Intravenous adrenaline should be used in patients presenting with cardiogenic shock and cardiac tamponade. Anaesthetic induction is also another step where BP should be tightly controlled. Commonly used medications include Fentanyl, isoflurane and glyceryl trinitrate. Peri-operatively, a target systolic blood pressure of 90–110 mmHg, mean arterial pressure of 60 mmHg, and central venous pressure of 8–12 mmHg are recommended [21].
Coagulation status: Aortic dissection activates inflammatory, coagulation and fibrinolytic pathways leading to disseminated intravascular coagulation. Consumption coagulopathy is worsened in some patients by inadvertently prescribing aspirin, clopidogrel by misdiagnosing these patients as having acute coronary syndromes. Hence, adequate amounts of packed red blood cells, platelets, fresh frozen plasma and cryoprecipiate should be kept ready for use.
2 arterial lines (both arms) should be placed to monitor differential blood pressures.
Also include a femoral arterial line to monitor distal perfusion pressures
Cerebral oxygenation monitoring by near—infrared spectroscopy
Invasive monitoring of intracranial pressure by lumbar catheter (occasionally)
Femoral artery cannulation (Figure 5)
For many years, it has been the cannulation site of choice [22]. Allowing rapid access, it is usually used in hemodynamically unstable patients, especially with impending cardiac tamponade and aortic rupture. It is important to mark the femoral artery before skin preparation as it may be difficult to localise it during hypotension. Common femoral artery is situated medial and inferior to the midpoint of the inguinal ligament. An oblique or vertical incision may be used for exposure [23]. An open Seldinger technique is quick and can be performed with minimal dissection. Advantages of this approach include (i) cardiopulmonary bypass is established quickly, (ii) easy to access with a closed chest, (iii) less likely to be dissected, (iv) prevents aortic rupture in patients with cardiac tamponade. Disadvantages include (i) stroke and malperfusion due to dynamic obstruction and (ii) retrograde perfusion leading to embolic complications due to atherosclerotic emboli. The femoral artery with a dissection flap is not used for cannulation.
Axillary artery cannulation (Figure 6)
Introduced in 1990s [24], axillary artery cannulation is gaining greater acceptance among surgeons as they switch to an antegrade perfusion strategy. It is more commonly used in hemodynamically stable patients. Infraclavicular dissection exposes the first part of axillary artery [25]. The pectoralis major muscle is split. The neurovascular bundle is situated deep in the clavipectoral fascia. The deltopectoral approach exposes the second and third parts for cannulation [26]. The axillary artery can be directly cannulated or anastomosed with end to side 8 mm vascular graft. Advantages include (i) antegrade perfusion flow and (ii) can be used for antegrade cerebral perfusion by occluding innominate artery. Disadvantages of this approach include (i) takes more time than femoral cannulation especially in obese patients and (ii) technically more difficult and risk of injury to brachial plexus nerves.
Central aortic cannulation:
Locating a site where the chances of not entering into the false lumen is the most critical part. It can be done with TEE, CT or epiaortic scanning. Cannulation can be performed with Seldinger technique or directly. Advantages include (i) CPB established quickly in unstable patients and (ii) antegrade flow. Disadvantages include (i) rupture of cannulation site and (ii) false lumen perfusion [27].
Femoral artery cannulation.
Axillary artery cannulation.
An expeditious midline sternotomy should be done with SBP maintained around 100–110 mmHg. The dissected aorta is usually dilated, thinned out and blood seeping through adventitial layers (Figure 7).
Upon opening the pericardium, be prepared for free aortic rupture (Figure 8). To minimise the risk either (i) femoral arterial and venous cannula should be in place or (ii) if axillary artery cannulation is done, then the surgeon should be prepared to quickly place the two-stage cannula into right atrium.
Patient is cooled to a core temperature of 26–28°C. For hemi-arch replacement and short duration of total hypothermic circulatory arrest, 27°C temperature is optimum. If total arch replacement is planned, then the patient can be further cooled to 22–24°C.
After going on CPB, a left ventricular vent is placed to prevent left ventricular distension due to associated acute aortic regurgitation. Retrogarde cardioplegia catheter is placed to arrest the heart, as antegrade cardioplegic arrest may not be possible due to aortic regurgitation. After the cardiac arrest and upon opening the aorta, antegrade ostial cardioplegia can be administered.
If the patient is stable, innominate artery is carefully dissected and looped with a vascular loop before going on CPB. This can be occluded or clamped later to provide antegrade cerebral perfusion through the previously cannulated axillary artery.
After going on CPB, the aorta is dissected free from surrounding adhesions. When creating the plane between ascending aorta and main pulmonary artery, it is important to retain as much adventitial tissue on the aortic side.
It is important to identify right pulmonary artery and avoid injuring it, while dissecting ascending aorta.
Clamp the aorta somewhere in the mid-ascending aorta, which will be eventually resected while doing open distal anastomoses. This allows assessment of the site of the tear and of the aortic root and also minimises the total circulatory arrest time.
While excising the dissected ascending aorta, it is important to avoid injury to the main and right pulmonary artery.
While dissecting towards aortic root, left and right coronary ostia are identified and coronary buttons prepared (if aortic root replacement is planned).
The dissected ascending aorta.
Aortic rupture prior to establishing CPB.
Because of the low threshold tolerance to ischemia, brain protection is of paramount importance during aortic arch procedures. Hypothermia is an option to increase the ischemic time. However, there are limitations of hypothermia and hypothermic circulatory arrest. Protective effects of hypothermia last no more than 9 minutes at 30°, 14 minutes at 25°, 21 minutes at 2°, 31 minutes at 15° and 45 minutes at 10° [28]. Neurological deficits are seen in elderly patients subjected to hypothermic circulatory arrest exceeding 25 minutes.
Several cerebral perfusion techniques have been introduced to extend the safe period of arch repair without residual neurological deficits. Retrograde cerebral perfusion (RCP) in tandem with hypothermic circulatory arrest was introduced in 1990 by Ueda et al. [29] Because the cerebral venous sinuses have no valves, RCP was proposed to provide retrograde perfusion and cooling of central nervous system (CNS). It offered to back-flush air emboli and debris from the cerebral circulation. Neuroprotective effects were most likely related to cooling rather than true nutritive flow [30]. It was also found to provide limited benefit in patients with significant carotid stenosis and vascular anomalies (e.g. an incomplete Circle of Willis) [31].
Antegrade selective cerebral perfusion (SCP) was introduced by Jean Bachet and Daniel Guilmet in Europe [32] and by Teruhisa Kazui in Japan in 1986 [33]. This new perfusion method of “cold cerebroplegia” in combination with hypothermia significantly reduced neurologic complications. Antegrade selective perfusion can be established either by direct cannulation or by anastomosing a prosthetic graft. The options for locating such are (i) right subclavian artery, (ii) innominate artery, (iii) right common carotid artery. These may be combined with left common carotid artery cannulation to provide bilateral antegrade cerebral perfusion. Direct cannulation is limited by high risk of embolism due to plaque mobilisation from manipulation or by jet flow [34].
Axillary artery cannulation can be used to provide unilateral antegrade SCP during hypothermic arrest without manipulation of the arch vessels. This can be combined with balloon occludable perfusion catheter to left carotid artery to provide bilateral antegrade SCP. To avoid steal, an occlusive balloon catheter is inserted in left subclavian artery.
Unilateral antegrade SCP is sufficient for majority of patients with no pathology of the arch vessels and cerebral vessels. Adequate backflow from the contralateral carotid artery suggests good collateralisation. Near-infrared spectroscopy (NIRS) monitoring can also help to exclude contralateral malperfusion. Bilateral cerebral perfusion may be useful in patients with carotid artery stenosis, previous stroke or cerebrovascular anomalies (incomplete Circle of Willis). Malvindi concluded in his review that “While both unilateral and bilateral ASCP are acceptable, bilateral antegrade cerebral perfusion is safer, when the antegrade SCP time is more than 40-50 minute” [35].
Cerebral perfusion is performed at a rate of 8–12 cc/min/kg body weight, perfusion pressure of 40–60 mmHg at 23–28°C. Alpha stat pH management compared to pH stat management prevents “luxury perfusion” by marinating cerebral autoregulation decreasing the risk of embolization [35].
The aortic root is frequently involved with aortic valve rendered incompetent due to commissural dehiscence or annular dilation. Grade II and grade III aortic regurgitation was found in 40 and 23% patients, respectively, in German Registry for Acute Aortic Dissection type A (GERAADA) [36]. There are different surgical approaches for management of aortic root replacement—an aggressive or a more conservative approach.
According to the International Registry of Acute Dissection (IRAD), aortic root replacement compared with conservative root management is not associated with increased in-hospital mortality. In 1995 patients, 18 and 21.3% hospital mortality was found in root replacement and conservative root group respectively (OR 0.989; CI 0.710–1.379; p = 0.949). Mid-term results at 3 years showed a survival of 91.6+/1.3% and 92.5+/1.7% for conservative root management and root replacement group, respectively [37].
Indications to perform root replacement in a patient with ATAD include:
younger age
Marfan syndrome
bicuspid aortic valve
known aortic valve disease
moderate or severe aortic valve insufficiency
previous aortic valve replacement
large diameter aortic annulus, sinuses of Valsalva and ascending aorta
coronary artery involvement
aortic root as the most proximal site of dissection
Proximal reconstruction technical (Figures 9 and 10) details: After the excision of the dissected aortic root, aortic root reconstruction is done.
Aortic root replacement (right coronary ostial anastomosis).
Proximal anastomoses of aortic root.
Technical principles include:
Obliteration of false lumen.
To take the maximum possible adventitia in the anastomoses.
Needle should enter the tissue at right angle to avoid tearing of needle holes.
Sutures should be spaced uniformly and pulled just enough tight to prevent cutting through the fragile tissue.
To avoid distortion of the aortic valve, the planar relationship between the graft and sinotubular junction should be maintained.
The Bentall procedure [38] is a fairly standard procedure. It includes anastomosing the composite graft to the aortic annulus and reimplantation of coronary arteries. Patients with type A aortic dissection usually have normal aortic valve cusps, as the pathology is usually limited to the aortic wall.
Valve sparing root replacement is a viable option in hemodynamically stable young patients. But it is technically more complex than straight aortic root replacement. It involves replacing the aortic root by composite graft without replacing the aortic valve. The native aortic root must be dissected from surrounding structures to 2 mm below the nadir of the aortic annulus. Coronary ostia are reimplanted into the graft. It is used to treat aortic regurgitation due to annular enlargement. Contraindications include significant cardiomyopathy, malperfusion, coronary artery disease, >65 years age.
Results from Emory in a 43 patients showed operative mortality of 4.7%. Freedom from aortic valve replacement was 100% and freedom from more than mild aortic regurgitation was 94% at 9 years follow-up. No aortic root reinterventions were required in this series [39].
Conservative approaches to the aortic root (CRR)—In most of the patients presenting with TAAD, the most common pathology seen is a primary intimal tear in the ascending aorta with dissection flap extending to non-coronary cusp. Left and right coronary sinuses are relatively preserved. Any aortic regurgitation is due to unhinging of one of the aortic valve commissural posts. The dissected sinus segments are preserved and supported with resuspension of the native valve commissural posts or prosthetic ascending aorta replacement. The advantages are that it preserves the native sinus tissue, coronary ostia are not reimplanted, shorter ischemic time, avoiding life-long anticoagulation [40]. The most commonly used methods to fortify the aortic wall include Teflon felt and biologic glue. University of Pennsylvania in their series of 489 patients showed freedom from reoperation with this technique of 96, 92 and 89% at 1, 10 and 15 years respectively. The operative mortality was 11% [41].
The entry site of the dissection tear is usually found the ascending aorta, which is at very high risk of rupture. After excising the dissected portion of ascending aorta, supracommissural ascending aorta replacement can be performed. Open distal anastomoses can be done under hypothermic circulatory arrest after releasing the cross clamp. This facilitates inspection of the aortic arch and if required, arch repair can be undertaken. Also, it is technically much easier to construct a very distal ascending aortic anastomoses. Around 5.6% patients underwent ascending aorta replacement in GERAADA survey [42]. But this procedure also allows for subsequent aneurysmal dilation of the remaining portion of the aorta [43].
When the aortic arch is examined during hypothermic circulatory arrest to look for intimal or re-entry tears, a decision is made whether an aortic arch replacement has to be done. The pre-operative CT aortogram helps in localising the dissection and also on deciding the placement of the aortic cross clamp. If the tear is in the ascending aorta or start of the aortic curvature, then hemi-arch replacement is required. If the dissection is extends more distally, a total aortic arch repair should be performed (Figure 11a, b).
Total arch replacement. (a, b) Debranching of aortic arch vessels – innominate , carotid artery and left subclavian artery.
Indications for arch replacement include:
Pre-existing aneurysm of the arch
Primary intimal tear in distal arch or descending thoracic aorta
Secondary intimal tear in arch >10 mm
False lumen more than 22 mm
Descending thoracic aorta diameter more than 35 mm
A study of 188 patients by Kim et al. [44] showed that 5 year survival was lower in patients with total arch replacement compared to patients who had hemi-arch repair (65.8% vs. 83.2%, p = 0.013). Neurological complications were higher in total arch repair group compared to hemi-arch (56.9% vs. 24.8%, p < 0.001).There was a direct correlation between patent false lumen in aortic arch or descending aorta and re-intervention. The German registry for TAAD showed no significant difference in peri-operative outcomes between both groups [45]. This group suggested a more aggressive approach to reduce the rate of interventions.
The immediate post-operative results have improved post type A Aortic dissection repair. However, long-term results are guarded by the need for aortic re-interventions due to residual dissection and patent false lumen extending into descending thoracic aorta [46]. The frozen elephant trunk technique involves total arch replacement and per-procedural deployment of stent through the true aortic lumen. It is more complex and takes more time. However, there is 90% chance of false lumen obliteration and reduced rates of re-intervention and improved long-term survival [47]. Uchida et al. [47] showed improved survival in the FET group at 5 years (95.3% vs. 69%, p = 0.03) and 100% thrombosis of false lumen in FET group compared to 29% patent false lumen in the non-FET group. However, both groups had similar operative mortality. Caution should be exercised that it should be done in high volume centres and by experienced suregons.as the total duration of hypothermic circulatory arrest can be dramatically increased.
Deployment of stent in the descending thoracic aorta has its drawbacks. Stent induced false lumen thrombosis activated inflammatory markers like metalloproteinases and proinflammatory cytokines [48], which contribute in the progression of aneurysm by destruction of the extracellular matrix in the aortic wall and neo-angiogenesis. Risk factors for the late development of aneurysm include (i) patent false lumen, (ii) helicoidal flow distal to the endoprosthesis, (iii) aortic wall shear stress gets modified.
Matalanis [49] has introduced the concept of total aortic repair to prevent the above mentioned complication. Patients presenting with TAAD and a descending thoracic aorta diameter of more than 40 mm can benefited from this approach. The repair involves a “Branch first “total aortic arch repair and surgical ascending aorta repair. Second part included endovascular treatment of descending aorta. It includes covered stent graft deployment in the proximal part of descending aorta and rupture of the intimal flap for the last part of aorta. The rupture is managed with the deployment and dilation under balloon of uncovered stent graft. With this approach, aneurysmal dilatation of the false channel is avoided by the creation of this new aortic channel. But, currently there is no long-term follow-up of this approach.
Based on the NORCAAD registry [50].
Bleeding
Major bleeding −39 %
Reoperation for bleeding 22%.
Cardiac tamponade −15%
Neurological
Stroke 20%.
Coma 11%.
Transient ischemic attack 5%.
Infections:
Sepsis 10%.
Deep sternal wound infections 2%.
Pneumonia 19%
Renal
Acute kidney injury 39%.
Renal replacement therapy 12%
Malperfusion
Mesenteric ischemia 6%.
Myocardial infarction 6%.
Limb ischemia requiring surgery 4%
Reoperations of the aorta
Proximal reoperation.
1 year 0.8%.
5 years 2.1%
Distal reoperations.
year 0.8%
5 years 4.3%
Bleeding is one of the most feared complication from a surgeon’s point of view. When blood comes in contact with subendothelial tissue of false lumen, it leads to a coagulopathy. Consumption of coagulation factors and fibrinolysis leads to disseminated intravascular coagulation. Activation and consumption of platelets also contributes to mortality [51]. Patients with pre-operative cardiac mal-perfusion was found to be associated with 30-day mortality of 33% (47). Pre-operative cerebral malperfusion is associated with three-fold increase in risk of stroke. Post-operative stroke and coma occurred in 10–15% and 3–9% patients respectively in one series [46]. Acute kidney injury may occur in 40–55% [50].
Long-term post-operative survival in recent years at 5, 10 and 30 years is 84–85, 64–68, and 38%, respectively [52]. Health-related quality of life is lower compared to the general population. There is 32% incidence of depression and post-traumatic stress disorder [53]. Over 50% patients have resistant hypertension on follow-up.
As per the EACTS/ESC 2014 guidelines, a follow-up CT-scan of the aorta is recommended at 1, 6 and 12 months and annually thereafter [54]. There are no recommendations specific to the aortic valve or aortic regurgitation for follow-up. To follow general guidelines, one can perform follow-up echocardiography every 1–2 years for mild regurgitation and annually for moderate and asymptomatic severe regurgitation [55].
Type A Aortic dissection is an emergency requiring timely surgical intervention. With improved imaging techniques, an accurate diagnosis can now be made. Open surgical repair techniques have given good long-term results. Endovascular intervention is an emerging less invasive option which can be combined with a surgical approach to give excellent long-term results.
TAAD | type A aortic dissection |
aSCP | antegrade selective cerebral perfusion |
RCP | retrograde cerebral perfusion |
Shale gas refers to a kind of self-generating and self-preserving natural gas, which gathers mainly in a free or adsorbed state in the organic-rich dark shale or high-carbon mud shale [1]. With vast reserves and the potential to offset the gradually depleted conventional resources worldwide and cut down carbon emissions at the same time, shale gas is playing an increasingly important role in ensuring global energy safety. Because shale matrix is characterized by various nanopores, where the gas flow is of high nonlinearity and complexity, an in-depth study of the mathematical model for the gas flow capacity in shale matrix is in urgent demand.
\nThe mechanisms considered in different literature are listed in Table 1. It is obvious that opinions vary greatly on the flow mechanism scheme applied. The noteworthy aspects include the following: what the relationship among the various flow mechanisms of shale gas, e.g., slippage, Fick diffusion, Knudsen diffusion, etc., is; whether there is a repeated superposition of these mechanisms for specific flow calculation; and how to deal with the relationship among the various flow mechanisms, etc. There is no clear answer to these problems in current literature.
\nLiterature | \nMechanisms considered | \n
---|---|
Klinkenberg [2] | \nSlip flow | \n
Javadpour [3], Haghshenas et al. [4], Wu et al. [5], Sun et al. [6] | \nKnudsen diffusion and slippage | \n
Veltzke and Thöming [7] | \nViscous flow and Knudsen diffusion | \n
Li et al. [8] | \nContinuum flow, slip flow, transition flow, and free molecular flow | \n
Mi et al. [9] | \nDiffusion and slippage, where the form of diffusion varies according to the Knudsen number range, including Fick diffusion, transitional diffusion, and Knudsen diffusion | \n
Song et al. [10] | \nViscous flow, Knudsen diffusion, and surface diffusion, with surface diffusion not considered for inorganic pores | \n
Different flow mechanism schemes in literature.
\nFigure 1 shows the common research methodology of the flow models used in different literature. It indicates that because the method of the continuum model with a boundary condition based on the molecular one is considered inconsistent and the limitations and drawbacks of first-order, second-order, and 1.5-order slip models are described, some studies, which are listed in Figure 1, are inclined to add related flow mechanisms linearly. Furthermore, the mathematical models of viscous flow and various types of diffusion do not fully agree with common flow cognition as these theories and models were experimentally verified or developed for a limited range of conditions [27]. For this reason, coupling coefficients are introduced to rectify this kind of limitation, so as to enhance the correspondence between the flow model and Knudsen number (Kn). Finally, because the secondhand average method, e.g., assuming the pore space of shale to be composed of a certain number of isodiametric pores regardless of the pore size distribution, is widely used in the research of shale gas flow, more explicit means, like taking the existence of various pore sizes in shale into account, should be adopted for transforming the flow model in nanopores to that in macroscopic-scale shale matrix.
\nA brief summary of the common methodology used in different research [
Based on the literature survey for shale gas flow in shale matrix, we know that the flow mechanism scheme with its corresponding coupling method is very crucial and has not yet been solved. In addition, although the integration method using specific functions has been proposed to facilitate the consideration of various pore sizes in shale matrix, real shale experiments are rarely involved to realize this point with definitely determined parameters.
\nFirstly, in this chapter, the concept of wall-associated diffusion is presented to clarify the relationship between slippage effect and several types of diffusion. Secondly, a physically sound flow mechanism scheme, which considers both division of mechanical mechanisms in nanopores and partition of flow space, has been proposed by virtue of the proposition of wall-associated diffusion. Thirdly, the coupling coefficients corresponding to the flow mechanisms considered are deduced to comply with the basic flow regime cognition, so as to establish a new coupled flow model in nanopores. Fourthly, the pore size distribution experiments for real shale samples from a gas field are utilized to realize the upscaling transformation of the flow model in nanopores into that in the macroscopic-scale shale matrix, with definitely determined fitting parameters for the establishment of a unified model for the gas flow prediction in shale matrix. Finally, a case study is presented to show how the lab-scale results are translated into field-scale ones.
\nThere are many types of flow mechanisms in shale matrix, including slippage effect, Fick diffusion, transition diffusion, Knudsen diffusion, surface diffusion, etc. It can be seen from the literature survey in Section 1 that different flow mechanism schemes have formed aiming at establishing a calculation model to properly characterize the nanoscale shale gas flow. There may be views that the more flow mechanisms are taken into account, the more precise the established models are. However, this is not the opinion in this chapter.
\nAs is known, Klinkenberg [33] first discovered in 1941 the phenomenon that, when measuring the gas permeability of rock, not only the measurement result is higher than the liquid measurement value but also it has strong pressure dependence and attributed it to the slippage behavior of gas in the rock pores. Specifically, gas slippage refers to the phenomenon that the near-wall gas molecules move relative to the wall surface when flowing through the medium channels [34]. In essence, the gas slip flow results from the interaction of gas molecules and pore walls, so the gas molecules in the vicinity of walls are in motion and contribute an additional flux, which is macroscopically characterized by the non-zero gas velocities on channel walls, thus resulting in slip flow [35, 36]. The jump model assumes that the adsorbed gas molecules jump from one adsorption site to the adjacent adsorption site on the pore surface, which is considered to be suitable for the research on the surface diffusion of the adsorbed gas in shale nanopores [37]. Meanwhile, when the molecular mean free path is obviously larger than the pore diameter, the gas-wall collision dominates, and the collision between gas molecules is secondary, which is characterized by Knudsen diffusion [9, 38, 39].
\nIn brief, both Knudsen diffusion and surface diffusion lead to non-zero moving speeds of the gas molecules around walls. Furthermore, from the viewpoint of microscopic motion mechanisms, they are both related to gas–solid interactions, which is consistent with slippage phenomenon in essence. Therefore, a new concept named “wall-associated diffusion” [40] is proposed, which characterizes the overall role of surface diffusion and Knudsen diffusion, as shown in Figure 2.
\nRelationship between wall-associated diffusion and slippage effect [
The proposition of wall-associated diffusion has practical significance and multiple research significance as follows [40].
\nTo begin with, in terms of mechanical mechanisms, since wall-associated diffusion describes the diffusion mechanisms of shale gas related to gas-wall interactions, it bridges the relationship between slippage effect and several types of diffusion, which prevents reduplicated superposition of shale gas flow mechanisms in nanoscale pores. This is where the practical significance lies. Besides, wall-associated diffusion can be regarded as a detailed form of slippage effect, dividing slippage effect into two distinct parts, i.e., surface diffusion and Knudsen diffusion. The two parts differ obviously in their mechanical mechanisms and motion patterns. Accordingly, the research significance of wall-associated diffusion involves not only the function of morphological descriptions but also the possibility of slip phenomenon research by different mechanical mechanisms. Lastly, another research significance is that wall-associated diffusion breaks through the limitation that the concept of slippage does not apply for high Knudsen number, with, however, the fact that wall effects still contribute to gas flow for high Knudsen number. Therefore, in extremely small nanopores, for example, where slip flow regime is not applicable, the wall-associated diffusion derived from physical morphology can well be used to explore the so-called slip phenomenon in other flow regimes apart from slip flow regime.
\nBy virtue of the concept of wall-associated diffusion, the flow mechanism scheme used in this work is to be discussed next.
\nThere is no doubt that all the mechanisms, such as continuum flow, slip flow, Knudsen diffusion, bulk diffusion, etc., have been studied in previous literature for the exploration of shale gas flow. However, it is a determinative flow mechanism scheme that is vital. According to the literature survey, apart from combining the Navier-Stokes solution with slip boundary condition whose deficiency has been mentioned in Section 1, there is also a trend in literature to assume a combination of certain flow mechanisms and check the consistency of the model results with experimental data. This method is favorable from an engineering point of view but meanwhile leads to the status that coincidence often exists and no commonly accepted consensus has formed currently. In this work, we discuss the issue physically. Firstly, due to the multiple advantages of wall-associated diffusion over the concept of slippage effect, slippage effect is replaced with wall-associated diffusion in the following discussion. On the one hand, the flow space in nanopores can be divided into two parts: the bulk phase region and the Knudsen layer [41]. On the other hand, the microscopic mechanical mechanisms can be divided into the gas–gas and gas-wall interactions. If a new comprehensive flow scheme, including viscous flow and bulk diffusion which belong to bulk phase flow and surface diffusion and Knudsen diffusion which are associated with gas-wall interactions causing non-zero flow velocities near pore walls, is proposed, the considerations of the division of flow space and mechanical mechanisms can be both realized.
\nIt should be noted that with the help of the methodology applied here, some flow mechanisms that are easily omitted are now included, such as bulk diffusion, an important diffusion process which is controlled by a mechanical mechanism obviously different from Knudsen diffusion. Furthermore, because the individual flow expressions, e.g., those for viscous flow and diffusion, were experimentally verified or developed for a limited range of conditions [27], the proposed physical flow mechanism scheme avoids unnecessary attempts to fit the mathematical models to experimental data so as to determine which flow mechanisms should be considered, laying a solid foundation for the research on the coupled flow model in nanopores discussed below.
\nTo conclude, taking both division of mechanical mechanisms in nanopores and partition of flow space into account, viscous flow and bulk diffusion, which belong to bulk phase flow and result from gas–gas interactions, and surface diffusion and Knudsen diffusion, which are associated with gas-solid interactions and result in non-zero flow velocities near pore walls, are included in the proposed flow mechanism scheme.
\nBased on the flow scheme proposed in Section 2, the flow mechanisms considered include viscous flow, bulk diffusion, surface diffusion, and Knudsen diffusion. Considering the influence of adsorption layers, in which the system is assumed to reach dynamic adsorption equilibrium state instantaneously, the mass flow of the four mechanisms can be expressed, respectively, as:
\nwhere
\n
\n
\n
\n
\n
\n
\n
\n
\n
d
\n
\n
\n
\n
\n
\n
\n
\n
The expression of Fick diffusion (2) is referred to as bulk diffusion and represented by
The case study in literature [42] shows that although the equations of viscous flow and diffusion already contain variables varying with temperature, pressure, and other factors, they make sense within only a certain range of flow regimes and deviate from the actual situation within other range that is not taken into account. Introducing coupling coefficients to different flow mechanisms can help modify the correspondence between the mathematical models (i.e., those of viscous flow and diffusion) and Knudsen number and establish generalized models without segment processing as Kn varies.
\nIn contrast to the coupling coefficients reported in published literatures [29, 31, 43, 44], the derivation of new coupling coefficients corresponding to the proposed flow mechanism scheme is performed, and the coupling coefficient of one certain flow mechanism will not be optionally set as 100%. The coupling coefficients of viscous flow, bulk diffusion, Knudsen diffusion, and surface diffusion are represented by
Let
When Kn equals to 0, only viscous flow is assumed to exist [45], i.e.,
It is transition flow when 10−1 < Kn < 10, and several diffusion processes play roles at the same time ([31, 46]; thus,
As Kn approaches to 0 or is sufficiently large,
\n
In the whole range of flow regimes,
Based on the above narrations, it physically defines that
Hence, the mass flow in nanopores can be expressed as:
\nwhere
The variation curves of the four coupling coefficients and
Variation curves of the coupling coefficients (dimensionless) of viscous flow, bulk diffusion, Knudsen diffusion, and surface diffusion with Kn (dimensionless) [
Variations of viscous flow and diffusion with Kn (dimensionless) after introducing coupling coefficients for the gas flow in pores of (a) 5 nm, (b) 10 nm, (c) 20 nm, and (d) 40 nm at 353 K. f1*ND, f2*Nb, f3*NK, and f4*Ns denote the results of viscous flow, bulk diffusion, Knudsen diffusion, and surface diffusion, respectively [
The benefits of introducing the above coupling coefficients to viscous flow and diffusion are significant:
It is clear that because
\nEq. (5) bridges the gaps between different flow regimes, i.e., the jumps of flow rates at the critical points between different regimes have vanished. Furthermore, the mathematical models are further constrained by virtue of the molecular collision theory to better reflect the basic flow regime knowledge.
Taking the viewpoints of Refs. [30, 32] as examples for comparison with this work, it should be noted that slip flow refers to the enhanced flow, including the part of original viscous flow and the other part called slippage effect which is represented by the non-zero velocities of the near-wall molecules due to gas-wall interactions. Therefore, it is more suitable to regard the ratio of gas–gas collision frequency to total collision frequency as the total coupling coefficient of viscous flow and bulk diffusion rather than that of the slip flow [30, 32].
The same examples [30, 32] are used for comparison. It is continuum flow when Kn approximates to 0. However, the coupling coefficient of slip flow is 1 when Kn = 0 in papers [30, 32], implying slip flow dominates in continuum flow regime, which contradicts the flow regime knowledge. This issue has been solved in this chapter.
In this section, the experimental results of full-scale pore size distributions of real shale samples from a gas field are combined with the coupled flow model in nanopores to realize the upscaling transformation of the flow model into that in macroscopic-scale shale matrix by integration.
\nIn the unitary model which is widely used for the flow estimation on a macroscopic scale [12, 18, 19, 20, 21, 22], indirect averaging methods are applied, e.g., the pore space of shale is assumed to be composed of a certain number of isodiametric pores, regardless of the pore size distributions. Some research [15, 47] used specific functions to characterize the probability density function of shale pore size distributions, with, however, assumed parameters for the purpose of conducting parameter sensitivity analysis. Here, the fitting parameters needed for the macroscopic form of the derived coupled flow model in nanopores are obtained by performing the experiments of pore size distributions of real shale samples from a gas field.
\nMichel et al. [15] and Xiong et al. [47] described the probability density function of shale pore size distributions as logarithmic normal distribution. Enlightened by their studies, the following expression is used to fit the experimental data of full-scale shale pore size distributions:
\nwhere
\n
Three kinds of experiments, i.e., the high-pressure mercury intrusion experiment, the liquid nitrogen adsorption experiment, and the low-temperature carbon dioxide adsorption experiment, were performed, and the full-scale pore size distribution data of the three shale samples from the Well “Ning 203”, Longmaxi formation of Changning-Weiyuan district, Sichuan Basin of China, were obtained by stitching the three results together according to the effective range of each experiment, where the total volume of pores greater than 100 nm is attributed to the pore whose radius is closest to 100 nm in the experiments allowing for the difficulty of curve fitting caused by the severe fluctuations of the pore size data [42]. The values of
Samples | \n\n | \n\n | \n
---|---|---|
Ning 203-219 | \n0.9428 | \n1.0890 | \n
Ning 203-240 | \n1.3530 | \n1.2100 | \n
Ning 203-250 | \n0.1207 | \n0.4189 | \n
Average | \n0.8055 | \n0.9060 | \n
Fitting results of η and σ.
The number of single pipes in shale with the radius range of
where
\n
\n
\n
The macroscopic-scale mathematical model of shale gas flow can be obtained by substituting Eqs. (5) and (6) into Eq. (8) as:
\nLiterature survey shows that there are several main upscaling methods of flow models from microscopic to macroscopic scale, i.e.:
\nMethod (1): the commonly used unitary model [12, 18, 19, 20, 21, 22] as already mentioned.
\nMethod (2): the sum method of calculating the permeability of every straight capillary tube [27].
\nMethod (3): the statistical sum method of the individual permeability from each shape type [49, 50].
\nMethod (4): the 3D fractal model with variable pore sizes [51].
\nMethod (5): the homogenization method to upscale gas flow through two distinct constituents, a mineral matrix and organic matter [52, 53].
\nMethod (6): the pore network model including pore size distribution, anisotropy, and low connectivity of the pore structure, etc. in shale [54, 55].
\nThe comparison among them is summarized in Table 3.
\nMethod | \nDescription/equation | \nAdvantages | \nShortcomings | \n
---|---|---|---|
Unitary pipe model [12] | \n\n\n | \nSimple in formula and easy for calculation | \nNegligence of pore structure, e.g., different pore shapes, pore connectivity, etc. | \n
Integral pipe model (this chapter) | \n\n\n | \nMake the consideration of various pore sizes happen; easy for calculation | \nNegligence of pore structure, e.g., different pore shapes, pore connectivity, etc. | \n
Total addition model [27] | \n\n\n ( | \nConsider the flow rate in every single pipe | \nImpractical to implement; negligence of pore structure, e.g., different pore shapes, pore connectivity, etc. | \n
Model of statistical sum of permeability from each shape type [49, 50] | \n\n\n ( | \nPore shapes, i.e., rectangular slits and cylindrical tubes, are taken into account | \nThe quantification of the percentages of different pore types using image analysis tools is hard to implement; negligence of various pore sizes | \n
3D fractal model [51] | \nPlease refer to Eqs. (24)–(27) in literature [51] for the specific expressions where the formulas are complex | \nMulti-scale pore size distribution and tortuous flow line in 3D space of shale matrix are characterized | \nMany parameters to be determined; negligence of different pore shapes | \n
Homogenization model [52, 53] | \nThe homogenization method is used to upscale gas flow through two distinct constituents, a mineral matrix and organic matter. A gas flow in a two-constituent composite porous medium is considered, in which a microscopic unit cell is periodically repeated | \nThe constituents, i.e., mineral matrix and organic matter, in shale are taken into account | \nMultiple assumptions; redundant processing for model establishment and solution | \n
Pore network model [54, 55] | \nGenerate pore network models by extracting pore structure information from real images or generate porous media by simulating the sedimentation and diagenesis processes and then incorporate relevant flow mechanisms into the gas flow models | \nPore size distribution, anisotropy and low connectivity of the pore structure, etc. can be taken into account | \nSubstantial work for model establishment; representativeness and verisimilitude of pore network models to the real pore structures remain a challenge | \n
Comparison of upscaling methods from microscopic to macroscopic scale.
After reviewing the upscaling methods in Table 3, it is obvious that the method used in this work is not a bad compromise when compared to method (1) which is too simple and coarse, methods (2) and (3) where it is impractical and daunting to count the size/shape of every single pore with huge computational efforts, method (5) where complex processing for the model establishment and solution is needed, and methods (4) and (6) where redundant parameters/information about pore structure need to be assumed or obtained from multiple ways. Therefore, on the one hand, only the pore size distribution experiment is needed for the determination of the upscaling parameters in this chapter to make the consideration of various pore sizes happen. On the other hand, the derived model in this chapter is practical to operate, and the results can thus be readily obtained. However, it does not necessarily mean that there is no drawback for the upscaling method used. For example, although SEM images of the shale samples show that the pores in the organic matter are mostly circular [56], various types of pore shapes, e.g., cylindrical, triangular, rectangular shaped, etc., can be detected in shale samples [50, 57]. Singh et al. [50] concluded that the geometry of pores significantly influences apparent permeability of shale and diffusive flux. The study of effective liquid permeability in a shale system by Afsharpoor and Javadpour [58] confirmed that the assumption of simplified circular pore causes apparent permeability to be significantly overestimated and the discrepancy between the realistic multi-geometry pore model and the simplified circular pore model becomes more pronounced when pore sizes reduce and liquid slip on the inner pore wall is taken into account. Xu et al. [59] developed a model for gas transport in tapered noncircular nanopores of shale rocks and found the following: (1) pore proximity induces faster gas transport, and omitting pore proximity leads to the enlargement of the adsorbed gas-dominated region; (2) increasing taper ratio (ratio of inlet size to outlet size) and aspect ratio weakens real gas effect and lowers free gas transport; (3) moreover, it lowers the total transport capacity of the nanopore, and the tapered circular nanopore owns the greatest transport capacity, followed by tapered square, elliptical, and rectangular nanopores. To conclude, there is still much room for improvement of the upscaling method in this work in multiple aspects in future research.
\nWith the properties of multi-scale pore structures and various reservoir modes, the shale gas reservoir is complex in reservoir space and occurrence modes, which in turn leads to different flow mechanisms in multi-scale spaces. Therefore, adopting single-scale equations and flow simulation methods will not accurately reveal the flow mechanism in complex shale gas reservoirs [60]. Jiao et al. [61] established an effective conversion relation between physical simulation parameters and field parameters based on similarity criterion to better simulate gas reservoir development. The ideas in literature [61] are narrated as follows.
\nFirst, considering the flow mechanism of shale gas in the reservoir, the selected characteristic physical parameters are permeability
Number | \nSimilarity criterion | \nSimilar attributes | \nPhysical significance | \nValue of physical simulation | \nActual value of reservoir | \n
---|---|---|---|---|---|
1 | \nπ1 = | \nPorosity similarity | \nDetermine porosity | \n0.02–0.2 | \n0.02–0.2 | \n
2 | \nπ2 = | \nCompression similarity | \nDetermine model gas | \n0.9–1.2 | \n0.9–1.2 | \n
3 | \nπ3 = | \nTemperature similarity | \nDetermine model temperature | \n1–1.1 | \n1.1–1.3 | \n
4 | \nπ4 = | \nGeometric similarity | \nDetermine model size | \n0.3–1 | \n0.3–1 | \n
5 | \nπ5 = | \nDynamic similarity | \nDetermine original pressure of model | \n0.002–0.01 | \n0.002–0.005 | \n
6 | \nπ6 = | \nDynamic similarity | \nDetermine conversion relation for bottom hole pressure | \n0–1.0 | \n0.1–1.0 | \n
7 | \nπ7\n\n | \nMovement similarity | \nDetermine production rate | \n0–0.5 | \n0.1–0.3 | \n
Similarity criterion numerals of the gas reservoir physical simulation.
Second, based on the similarity criterion, the conversion relation between physical simulation parameters and field parameters can be established, which is expressed as:
\nwhere
Finally, choose the core sample “Ning 211-1” for an example to conduct dynamic physical experiment under different conditions, which is used to verify the rationality of the similarity criterion. The related parameters, values of physical simulation (
\n | \n293.15 | \n||||||
\n | \n5.6% | \n||||||
\n | \n0.0127 | \n||||||
\n | \n40 | \n||||||
\n | \n0.0557 | \n||||||
\n | \n20 | \n||||||
\n | \n298.15 | \n||||||
\n | \n353.15 | \n||||||
\n | \n3.0745 | \n4.0995 | \n5.0800 | \n6.5750 | \n7.6500 | \n10.2300 | \n12.5900 | \n
\n | \n1.1560 | \n1.1785 | \n1.2030 | \n1.2461 | \n1.2817 | \n1.3830 | \n1.4944 | \n
\n | \n0.9481 | \n0.9316 | \n0.9163 | \n0.8942 | \n0.8795 | \n0.8493 | \n0.8294 | \n
\n | \n0.9747 | \n0.9670 | \n0.9602 | \n0.9507 | \n0.9445 | \n0.9326 | \n0.9254 | \n
\n | \n0.0344 | \n0.0466 | \n0.0570 | \n0.0746 | \n0.0877 | \n0.1205 | \n0.1450 | \n
\n | \n785.5063 | \n1055.4281 | \n1278.7645 | \n1649.5661 | \n1919.8761 | \n2579.8383 | \n3055.2185 | \n
\n | \n748.2798 | \n1021.0548 | \n1255.2453 | \n1601.7201 | \n1902.6402 | \n2529.7590 | \n3038.9881 | \n
Parameters for application.
\nFigure 5 displays the curves of actual values of reservoir and predicted field results based on similarity conversion, the latter of which are calculated from the physical experiment. The results calculated by similarity criterion are basically consistent with the on-site tested data. It is expected that applying the similarity translation from physical simulation of gas reservoirs is capable of predicting the development performance effectively, showing the rationality of the translation method.
\nComparison of actual values of reservoir and predicted field results based on similarity conversion.
Based on our study in this chapter, the following conclusions have been reached:
A new concept “wall-associated diffusion” was introduced to the study of gas flow in shale nanopores, which has practical significance and multiple research significance. By virtue of this concept, viscous flow, bulk diffusion, surface diffusion, and Knudsen diffusion were considered in the proposed flow mechanism scheme for nanoscale shale gas flow, with both division of mechanical mechanisms in nanopores and partition of flow space taken into account. Viscous flow and bulk diffusion belong to the bulk phase flow, which result from gas-gas interactions. In addition, surface diffusion and Knudsen diffusion are of boundary layer flow, which are associated with gas-wall interactions.
An easy-to-operate coupling method of the flow mechanism scheme containing four coupling coefficients and thus a coupled shale gas flow model in nanopores, which applies within the scope of full flow regimes and avoids segment processing, was proposed.
Based on the experimental data of pore size distributions of real shale samples from a gas field, a new coupled upscaling flow model in macroscopic-scale shale matrix with the experimentally determined fitting parameters was established. The model uses smooth functions to fit the full-scale pore size distribution results to facilitate the upscaling transformation of the model in nanopores into that in the macroscopic matrix.
A case study was presented to show how the lab-scale results are translated into field-scale ones, revealing the rationality of the translation method used.
In summary, sounder in theoretical bases and better in application effects, the proposed model is expected to be of practical significance for evaluating the gas flow capacity in shale matrix and guiding gas reservoir development in gas fields.
\nThis work was supported by the National Science and Technology Major Project of the Ministry of Science and Technology of China (grant number 2017ZX05037 − 001); the Demonstration Project of the National Science and Technology Major Project of the Ministry of Science and Technology of China (grant number 2016ZX05062 − 002 − 001); and the Science and Technology Major Project of PetroChina (grant number 2016E−0611).
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She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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