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Lee JD, Richter J, Pfaller MR, Szafron JM, Menon K, Zanoni A, Ma MR, Feinstein JA, Kreutzer J, Marsden AL, Schiavazzi DE. A probabilistic neural twin for treatment planning in peripheral pulmonary artery stenosis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3820. [PMID: 38544354 PMCID: PMC11131421 DOI: 10.1002/cnm.3820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 05/15/2024]
Abstract
The substantial computational cost of high-fidelity models in numerical hemodynamics has, so far, relegated their use mainly to offline treatment planning. New breakthroughs in data-driven architectures and optimization techniques for fast surrogate modeling provide an exciting opportunity to overcome these limitations, enabling the use of such technology for time-critical decisions. We discuss an application to the repair of multiple stenosis in peripheral pulmonary artery disease through either transcatheter pulmonary artery rehabilitation or surgery, where it is of interest to achieve desired pressures and flows at specific locations in the pulmonary artery tree, while minimizing the risk for the patient. Since different degrees of success can be achieved in practice during treatment, we formulate the problem in probability, and solve it through a sample-based approach. We propose a new offline-online pipeline for probabilistic real-time treatment planning which combines offline assimilation of boundary conditions, model reduction, and training dataset generation with online estimation of marginal probabilities, possibly conditioned on the degree of augmentation observed in already repaired lesions. Moreover, we propose a new approach for the parametrization of arbitrarily shaped vascular repairs through iterative corrections of a zero-dimensional approximant. We demonstrate this pipeline for a diseased model of the pulmonary artery tree available through the Vascular Model Repository.
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Affiliation(s)
- John D. Lee
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, Indiana, USA
| | - Jakob Richter
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - Martin R. Pfaller
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - Jason M. Szafron
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - Karthik Menon
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - Andrea Zanoni
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - Michael R. Ma
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
| | - Jeffrey A. Feinstein
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Jacqueline Kreutzer
- Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison L. Marsden
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California, USA
| | - Daniele E. Schiavazzi
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, Indiana, USA
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Menon K, Khan MO, Sexton ZA, Richter J, Nguyen PK, Malik SB, Boyd J, Nieman K, Marsden AL. Personalized coronary and myocardial blood flow models incorporating CT perfusion imaging and synthetic vascular trees. NPJ IMAGING 2024; 2:9. [PMID: 38706558 PMCID: PMC11062925 DOI: 10.1038/s44303-024-00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/25/2024] [Indexed: 05/07/2024]
Abstract
Computational simulations of coronary artery blood flow, using anatomical models based on clinical imaging, are an emerging non-invasive tool for personalized treatment planning. However, current simulations contend with two related challenges - incomplete anatomies in image-based models due to the exclusion of arteries smaller than the imaging resolution, and the lack of personalized flow distributions informed by patient-specific imaging. We introduce a data-enabled, personalized and multi-scale flow simulation framework spanning large coronary arteries to myocardial microvasculature. It includes image-based coronary anatomies combined with synthetic vasculature for arteries below the imaging resolution, myocardial blood flow simulated using Darcy models, and systemic circulation represented as lumped-parameter networks. We propose an optimization-based method to personalize multiscale coronary flow simulations by assimilating clinical CT myocardial perfusion imaging and cardiac function measurements to yield patient-specific flow distributions and model parameters. Using this proof-of-concept study on a cohort of six patients, we reveal substantial differences in flow distributions and clinical diagnosis metrics between the proposed personalized framework and empirical methods based purely on anatomy; these errors cannot be predicted a priori. This suggests virtual treatment planning tools would benefit from increased personalization informed by emerging imaging methods.
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Affiliation(s)
- Karthik Menon
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA USA
| | - Muhammed Owais Khan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON Canada
| | | | - Jakob Richter
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA USA
| | - Patricia K. Nguyen
- VA Palo Alto Healthcare System, Palo Alto, CA USA
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA USA
| | | | - Jack Boyd
- Department of Cardiothoracic Surgery, Stanford School of Medicine, Stanford, CA USA
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA USA
- Department of Radiology, Stanford School of Medicine, Stanford, CA USA
| | - Alison L. Marsden
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA USA
- Department of Bioengineering, Stanford University, Stanford, CA USA
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Yu P, Xiong J, Tong Z, Chen L, Hu L, Liu J, Liu J. Hemodynamic-based virtual surgery design of double-patch repair for pulmonary arterioplasty in tetralogy of Fallot. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108012. [PMID: 38246096 DOI: 10.1016/j.cmpb.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Surgical correction of pulmonary artery stenosis (PAS) is essential to the prognosis of patients with tetralogy of Fallot (TOF). The double-patch method of pulmonary arterioplasty is usually applied in case of multiple stenosis in TOF patients' pulmonary artery (PA) and when PAS cannot be relieved by the single-patch method. The surgical planning for the double-patch design remains challenging. The purpose of this study is to investigate the double-patch design with different angulations between the left pulmonary artery (LPA) and the right pulmonary artery (RPA), and to understand postoperative hemodynamic alterations by the application of computer-aided design (CAD) and computational fluid dynamics (CFD) techniques. METHODS The three-dimensional model of the PA was reconstructed based on preoperative computed tomography imaging data obtained from the patient with TOF. Three postoperative models with different designs of double-patch were created by "virtual surgery" using the CAD technique. Double-Patch 120 Model was created with double patches implanted in the main pulmonary artery (MPA) and the PA bifurcation and without changing the spatial position of PA. The angulation between the LPA and the RPA was defined as θ, which equaled to 120° in Pre-Operative Model and Double-Patch 120 Model. Based on Double-Patch 120 Model, Double-Patch 110 Model and Double-Patch 130 Model were generated with θ equaled to 110° and 130°, respectively. Combined with CFD, the differences of velocity streamlines, wall shear stress (WSS), flow distribution ratio (FDR), and energy loss (EL) were compared to analyze postoperative pulmonary flow characteristics. RESULTS The values of velocity and WSS decreased significantly after virtual surgery. Obvious vortices and swirling flows were observed downstream of the stenosis of RPA and LPA in Pre-Operative Model, while fewer vortices developed along the anterior wall of the expanded lumens of RPA, especially in Double-Patch 110 Model. With the relief of PAS, two relatively higher WSS regions were observed at the posterior walls of RPA and LPA. The maximum WSS values in these regions of Double-Patch 110 Model were lower than those in Double-Patch 120 Model and Double-Patch 130 Model. Furthermore, the FDRs were elevated and the ELs were greatly reduced. It was found that Double-Patch 110 Model with the angulation between the LPA and the RPA equaled to 110° showed relatively better properties of hemodynamics than other models. CONCLUSIONS The angulation between the LPA and the RPA is an important factor that should be integrated in the double-patch design for TOF repair. Virtual surgery based on patient-specific vascular model and computational hemodynamics can be used to provide assistance for individualized surgical planning of double-patch arterioplasty.
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Affiliation(s)
- Pingping Yu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jiwen Xiong
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Zhirong Tong
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Lijun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jinfen Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jinlong Liu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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Brown AL, Sexton ZA, Hu Z, Yang W, Marsden AL. Computational approaches for mechanobiology in cardiovascular development and diseases. Curr Top Dev Biol 2024; 156:19-50. [PMID: 38556423 DOI: 10.1016/bs.ctdb.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The cardiovascular development in vertebrates evolves in response to genetic and mechanical cues. The dynamic interplay among mechanics, cell biology, and anatomy continually shapes the hydraulic networks, characterized by complex, non-linear changes in anatomical structure and blood flow dynamics. To better understand this interplay, a diverse set of molecular and computational tools has been used to comprehensively study cardiovascular mechanobiology. With the continual advancement of computational capacity and numerical techniques, cardiovascular simulation is increasingly vital in both basic science research for understanding developmental mechanisms and disease etiologies, as well as in clinical studies aimed at enhancing treatment outcomes. This review provides an overview of computational cardiovascular modeling. Beginning with the fundamental concepts of computational cardiovascular modeling, it navigates through the applications of computational modeling in investigating mechanobiology during cardiac development. Second, the article illustrates the utility of computational hemodynamic modeling in the context of treatment planning for congenital heart diseases. It then delves into the predictive potential of computational models for elucidating tissue growth and remodeling processes. In closing, we outline prevailing challenges and future prospects, underscoring the transformative impact of computational cardiovascular modeling in reshaping cardiovascular science and clinical practice.
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Affiliation(s)
- Aaron L Brown
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Zachary A Sexton
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Zinan Hu
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Weiguang Yang
- Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, United States; Department of Pediatrics, Stanford University, Stanford, CA, United States.
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Szafron JM, Yang W, Feinstein JA, Rabinovitch M, Marsden AL. A computational growth and remodeling framework for adaptive and maladaptive pulmonary arterial hemodynamics. Biomech Model Mechanobiol 2023; 22:1935-1951. [PMID: 37658985 PMCID: PMC10929588 DOI: 10.1007/s10237-023-01744-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 09/05/2023]
Abstract
Hemodynamic loading is known to contribute to the development and progression of pulmonary arterial hypertension (PAH). This loading drives changes in mechanobiological stimuli that affect cellular phenotypes and lead to pulmonary vascular remodeling. Computational models have been used to simulate mechanobiological metrics of interest, such as wall shear stress, at single time points for PAH patients. However, there is a need for new approaches that simulate disease evolution to allow for prediction of long-term outcomes. In this work, we develop a framework that models the pulmonary arterial tree through adaptive and maladaptive responses to mechanical and biological perturbations. We coupled a constrained mixture theory-based growth and remodeling framework for the vessel wall with a morphometric tree representation of the pulmonary arterial vasculature. We show that non-uniform mechanical behavior is important to establish the homeostatic state of the pulmonary arterial tree, and that hemodynamic feedback is essential for simulating disease time courses. We also employed a series of maladaptive constitutive models, such as smooth muscle hyperproliferation and stiffening, to identify critical contributors to development of PAH phenotypes. Together, these simulations demonstrate an important step toward predicting changes in metrics of clinical interest for PAH patients and simulating potential treatment approaches.
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Affiliation(s)
- Jason M Szafron
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
- Cardiovascular Institute, Stanford University, Palo Alto, CA, 94305, USA
| | - Weiguang Yang
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Jeffrey A Feinstein
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
- Cardiovascular Institute, Stanford University, Palo Alto, CA, 94305, USA
| | - Marlene Rabinovitch
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
- Cardiovascular Institute, Stanford University, Palo Alto, CA, 94305, USA
| | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA.
- Cardiovascular Institute, Stanford University, Palo Alto, CA, 94305, USA.
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Marcinno’ F, Zingaro A, Fumagalli I, Dede’ L, Vergara C. A Computational Study of Blood Flow Dynamics in the Pulmonary Arteries. VIETNAM JOURNAL OF MATHEMATICS 2022; 51:127-149. [PMID: 36536831 PMCID: PMC9750052 DOI: 10.1007/s10013-022-00595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
In this work we study the blood dynamics in the pulmonary arteries by means of a 3D-0D geometric multiscale approach, where a detailed 3D model for the pulmonary arteries is coupled with a lumped parameters (0D) model of the cardiovascular system. We propose to investigate three strategies for the numerical solution of the 3D-0D coupled problem: the Splitting-Explicit and Implicit algorithms, where information are exchanged between 3D and 0D models at each time step at the interfaces, and the One-Way algorithm, where the 0D is solved first off-line. In our numerical experiments performed in a realistic patient-specific 3D domain with a physiologically calibrated 0D model, we discuss first the issue on instabilities that may arise when not suitable connections are considered between 3D and 0D models; second we compare the performance and accuracy of the three proposed numerical strategies. Finally, we report a comparison between a healthy and a hypertensive case, providing a preliminary result highlighting how our method could be used in future for clinical purposes.
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Affiliation(s)
- Fabio Marcinno’
- Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133 Italy
| | - Alberto Zingaro
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133 Italy
| | - Ivan Fumagalli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133 Italy
| | - Luca Dede’
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133 Italy
| | - Christian Vergara
- Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133 Italy
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Lan IS, Yang W, Feinstein JA, Kreutzer J, Collins RT, Ma M, Adamson GT, Marsden AL. Virtual Transcatheter Interventions for Peripheral Pulmonary Artery Stenosis in Williams and Alagille Syndromes. J Am Heart Assoc 2022; 11:e023532. [PMID: 35253446 PMCID: PMC9075299 DOI: 10.1161/jaha.121.023532] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Despite favorable outcomes of surgical pulmonary artery (PA) reconstruction, isolated proximal stenting of the central PAs is common clinical practice for patients with peripheral PA stenosis in association with Williams and Alagille syndromes. Given the technical challenges of PA reconstruction and the morbidities associated with transcatheter interventions, the hemodynamic consequences of all treatment strategies must be rigorously assessed. Our study aims to model, assess, and predict hemodynamic outcomes of transcatheter interventions in these patients.
Methods and Results
Isolated proximal and “extensive” interventions (stenting and/or balloon angioplasty of proximal and lobar vessels) were performed in silico on 6 patient‐specific PA models. Autoregulatory adaptation of the cardiac output and downstream arterial resistance was modeled in response to intervention‐induced hemodynamic perturbations. Postintervention computational fluid dynamics predictions were validated in 2 stented patients and quantitatively assessed in 4 surgical patients. Our computational methods accurately predicted postinterventional PA pressures, the primary indicators of success for treatment of peripheral PA stenosis. Proximal and extensive treatment achieved median reductions of 14% and 40% in main PA systolic pressure, 27% and 56% in pulmonary vascular resistance, and 10% and 45% in right ventricular stroke work, respectively.
Conclusions
In patients with Williams and Alagille syndromes, extensive transcatheter intervention is required to sufficiently reduce PA pressures and right ventricular stroke work. Transcatheter therapy was shown to be ineffective for long‐segment stenosis and pales hemodynamically in comparison with published outcomes of surgical reconstruction. Regardless of the chosen strategy, a virtual treatment planning platform could identify lesions most critical for optimizing right ventricular afterload.
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Affiliation(s)
- Ingrid S. Lan
- Department of Bioengineering Stanford University Stanford CA
| | - Weiguang Yang
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
| | - Jeffrey A. Feinstein
- Department of Bioengineering Stanford University Stanford CA
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
| | - Jacqueline Kreutzer
- Department of Pediatrics (Cardiology) University of Pittsburgh Pittsburgh PA
| | - R. Thomas Collins
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
- Department of Medicine (Cardiovascular Medicine) Stanford University Stanford CA
| | - Michael Ma
- Department of Cardiothoracic Surgery Stanford University Stanford CA
| | | | - Alison L. Marsden
- Department of Bioengineering Stanford University Stanford CA
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
- Institute for Computational and Mathematical Engineering Stanford University Stanford CA
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Pant S, Sizarov A, Knepper A, Gossard G, Noferi A, Boudjemline Y, Vignon-Clementel I. Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study. Biomech Model Mechanobiol 2022; 21:471-511. [PMID: 35000016 PMCID: PMC8940869 DOI: 10.1007/s10237-021-01545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/04/2021] [Indexed: 11/02/2022]
Abstract
Potts shunt (PS) was suggested as palliation for patients with suprasystemic pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. PS, however, can result in poorly understood mortality. Here, a patient-specific geometrical multiscale model of PAH physiology and PS is developed for a paediatric PAH patient with stent-based PS. In the model, 7.6mm-diameter PS produces near-equalisation of the aortic and PA pressures and [Formula: see text] (oxygenated vs deoxygenated blood flow) ratio of 0.72 associated with a 16% decrease of left ventricular (LV) output and 18% increase of RV output. The flow from LV to aortic arch branches increases by 16%, while LV contribution to the lower body flow decreases by 29%. Total flow in the descending aorta (DAo) increases by 18% due to RV contribution through the PS with flow into the distal PA branches decreasing. PS induces 18% increase of RV work due to its larger stroke volume pumped against lower afterload. Nonetheless, larger RV work does not lead to increased RV end-diastolic volume. Three-dimensional flow assessment demonstrates the PS jet impinging with a high velocity and wall shear stress on the opposite DAo wall with the most of the shunt flow being diverted to the DAo. Increasing the PS diameter from 5mm up to 10mm results in a nearly linear increase in post-operative shunt flow and a nearly linear decrease in shunt pressure-drop. In conclusion, this model reasonably represents patient-specific haemodynamics pre- and post-creation of the PS, providing insights into physiology of this complex condition, and presents a predictive tool that could be useful for clinical decision-making regarding suitability for PS in PAH patients with drug-resistant suprasystemic PAH.
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Affiliation(s)
- Sanjay Pant
- Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom.
| | - Aleksander Sizarov
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Pediatric Cardiology, Necker University Hospital for Sick Children, Paris, France
| | - Angela Knepper
- Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
| | | | | | - Younes Boudjemline
- Cardiac Catheterization Laboratories, Sidra Heart Center, Sidra Medicine, Doha, Qatar
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Chen Z, Zhou YP, Liu X, Jiang X, Wu T, Ghista D, Xu XQ, Zhang H, Jing ZC. A Personalized Pulmonary Circulation Model to Non-Invasively Calculate Fractional Flow Reserve for Artery Stenosis Detection. IEEE Trans Biomed Eng 2021; 69:1435-1448. [PMID: 34633925 DOI: 10.1109/tbme.2021.3119188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Fractional Flow Reserve (FFR) is regarded as a fundamental index to assess pulmonary artery stenosis. The application of FFR can increase the accuracy of detection of pulmonary artery stenosis. However, the invasive examination may carry a number of physiological risks for patients. Therefore, we propose a personalized pulmonary circulation model to non- invasively calculate FFR of pulmonary artery stenosis. Method- ology: We employed a personalized pulmonary circulation model to non-invasively calculate FFR using only computed tomography angiogram (CTA) data. This model combined boundary conditions estimation and 3D pulmonary artery morphology reconstruction for CFD simulation. First, we obtained patient-specific boundary conditions by adapting the right ventricle stroke volume and main pulmonary artery pressure feature points (systolic, diastolic, and mean pressure). Secondly, the 3D pulmonary artery morphology was reconstructed by threshold segmentation. The CFD simulation was then performed to obtain pressure distribution in the entire pulmonary artery. Finally, the FFR in pulmonary artery stenoses was calculated as the ratio of distal pressure and proximal pres- sure. RESULTS To validate our model, we compared the calculated FFR with measured FFR by pressure guide wires examination of 8 patients. The FFR calculated by our model showed a good agreement with measured FFR by pressure guide wires exami- nation. The average accuracy rate was 91.41%. CONCLUSION The proposed personalized pulmonary model is capable of reasonably non-invasively calculating FFR with sufficient accuracy. SIGNIFICANCE FFR calculated in our model may contribute to non-invasive detection of pulmonary artery stenosis and to the assessment of invasive interventions.
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Pewowaruk R, Ralphe J, Lamers L, Roldán-Alzate A. Non-invasive MRI Derived Hemodynamic Simulation to Predict Successful vs. Unsuccessful Catheter Interventions for Branch Pulmonary Artery Stenosis: Proof-of-Concept and Experimental Validation in Swine. Cardiovasc Eng Technol 2021; 12:494-504. [PMID: 34008077 DOI: 10.1007/s13239-021-00543-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study assessed the ability of hemodynamic simulations to predict the success of catheter interventions in a swine model of branch pulmonary artery stenosis (bPAS). BACKGROUND bPAS commonly occurs in congenital heart disease and is often managed with catheter based interventions. However, despite technical success, bPAS interventions do not lead to improved distal pulmonary blood flow (PBF) distribution in approximately 1/3rd of patients. New tools are needed to better identify which patients with bPAS would most benefit from catheter interventions. METHODS For 13 catheter intervention cases in swine with surgically created left PAS (LPAS), PA pressures from right heart catheterization (RHC) and PBF distributions from MRI were measured before and after catheter interventions. Hemodynamic simulations with a reduced order computational fluid dynamics (CFD) model were performed using non-invasive PBF measurements derived from MRI, and then correlated with changes in invasive measures of hemodynamics and PBF distributions before and after catheter intervention to relieve bPAS. RESULTS Compared to experimentally measured changes in left PBF distribution, simulations had a small bias (3.4 ± 11.1%), moderate agreement (ICC = 0.69 [0.24-0.90], 0.71 [0.23-0.91]), and good diagnostic capability to predict successful interventions (> 20% PBF increase) (AUC 0.83 [0.59-1.0]). Simulations had poorer prediction of changes in stenotic pressure gradient (ICC = 0.28 [- 0.33 to 0.73], r = 0.57 [- 0.04 to 0.87]) and MPA systolic pressure (ICC = 0.00 [- 0.52 to 0.53], r = 0.29 [- 0.32 to 0.72]). CONCLUSION While there was only weak to moderate agreement between predicted and measured changes in PA pressures and pulmonary blood flow distributions, hemodynamic simulations did show good diagnostic value for predicting successful versus unsuccessful catheter based interventions to relieve bPAS. The results of this proof of concept study are promising and should encourage future development for using hemodynamic models in planning interventions for patients with bPAS.
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Affiliation(s)
- Ryan Pewowaruk
- Cardiovascular Research Center, University of Wisconsin - Madison, Madison, USA. .,Division of Cardiology, Department of Medicine, William S. Middleton Memorial Veteran's Hospital, Office: D222, 2500 Overlook Terrace, Madison, WI, 53705-4108, USA.
| | - John Ralphe
- Division of Cardiology, Department of Pediatrics, University of Wisconsin - Madison, Madison, USA
| | - Luke Lamers
- Division of Cardiology, Department of Pediatrics, University of Wisconsin - Madison, Madison, USA
| | - Alejandro Roldán-Alzate
- Mechanical Engineering, University of Wisconsin - Madison, Madison, USA.,Department of Radiology, University of Wisconsin - Madison, Madison, USA
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11
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Computational Analysis of the Pulmonary Arteries in Congenital Heart Disease: A Review of the Methods and Results. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2618625. [PMID: 33868449 PMCID: PMC8035004 DOI: 10.1155/2021/2618625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/25/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022]
Abstract
With the help of computational fluid dynamics (CFD), hemodynamics of the pulmonary arteries (PA's) can be studied in detail and varying physiological circumstances and treatment options can be simulated. This offers the opportunity to improve the diagnostics and treatment of PA stenosis in biventricular congenital heart disease (CHD). The aim of this review was to evaluate the methods of computational studies for PA's in biventricular CHD and the level of validation of the numerical outcomes. A total of 34 original research papers were selected. The literature showed a great variety in the used methods for (re) construction of the geometry as well as definition of the boundary conditions and numerical setup. There were 10 different methods identified to define inlet boundary conditions and 17 for outlet boundary conditions. A total of nine papers verified their CFD outcomes by comparing results to clinical data or by an experimental mock loop. The diversity in used methods and the low level of validation of the outcomes result in uncertainties regarding the reliability of numerical studies. This limits the current clinical utility of CFD for the study of PA flow in CHD. Standardization and validation of the methods are therefore recommended.
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Ristori T, Sjöqvist M, Sahlgren CM. Ex Vivo Models to Decipher the Molecular Mechanisms of Genetic Notch Cardiovascular Disorders. Tissue Eng Part C Methods 2021; 27:167-176. [PMID: 33403934 PMCID: PMC7984653 DOI: 10.1089/ten.tec.2020.0327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/04/2020] [Indexed: 12/13/2022] Open
Abstract
Notch is an evolutionary, conserved, cell-cell signaling pathway that is central to several biological processes, from tissue morphogenesis to homeostasis. It is therefore not surprising that several genetic mutations of Notch components cause inherited human diseases, especially cardiovascular disorders. Despite numerous efforts, current in vivo models are still insufficient to unravel the underlying mechanisms of these pathologies, hindering the development of utmost needed medical therapies. In this perspective review, we discuss the limitations of current murine models and outline how the combination of microphysiological systems (MPSs) and targeted computational models can lead to breakthroughs in this field. In particular, while MPSs enable the experimentation on human cells in controlled and physiological environments, in silico models can provide a versatile tool to translate the in vitro findings to the more complex in vivo setting. As a showcase example, we focus on Notch-related cardiovascular diseases, such as Alagille syndrome, Adams-Oliver syndrome, and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Impact statement In this review, a comprehensive overview of the limitations of current in vivo models of genetic Notch cardiovascular diseases is provided, followed by a discussion over the potential of microphysiological systems and computational models in overcoming these limitations and in potentiating drug testing and modeling of these pathologies.
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Affiliation(s)
- Tommaso Ristori
- Department of Biomedical Engineering, Technical University of Eindhoven, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Marika Sjöqvist
- Faculty of Science and Engineering, Biosciences, Åbo Akademi University, Turku, Finland
- Turku Bioscience Centre, Åbo Akademi University and University of Turku, Turku, Finland
| | - Cecilia M. Sahlgren
- Department of Biomedical Engineering, Technical University of Eindhoven, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Faculty of Science and Engineering, Biosciences, Åbo Akademi University, Turku, Finland
- Turku Bioscience Centre, Åbo Akademi University and University of Turku, Turku, Finland
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13
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Pewowaruk R, Lamers L, Roldán-Alzate A. Longitudinal Evolution of Pulmonary Artery Wall Shear Stress in a Swine Model of Pulmonary Artery Stenosis and Stent Interventions. Ann Biomed Eng 2021; 49:1477-1492. [PMID: 33398618 DOI: 10.1007/s10439-020-02696-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
Branch pulmonary artery stenosis (PAS) commonly occurs in congenital heart disease and it has previously been hypothesized that in branch PAS the pulmonary arteries (PAs) remodel their lumen diameter to maintain constant wall shear stress (WSS). We quantified the longitudinal progression of PA WSS in a swine model of unilateral PAS and two different intervention time courses to test this hypothesis. To quantify WSS in the entire pulmonary tree we used 4D Flow MRI for the large-proximal PAs and a structured tree model for the small-distal PAs. Our results only partially supported the hypothesis that in branch PAS the PAs remodel their lumen diameter to maintain WSS homeostasis. Proximal PA WSS was similar between groups at the final study time-point but WSS of mid-sized (5 mm to 500 μm) PA segments was found to be different between the sham and LPAS groups. This suggests that WSS homeostasis may only be achieved for the large-proximal PAs. Additionally, our results do not show WSS homeostasis being achieved over shorter periods of time suggesting that any potential WSS dependent changes in PA lumen diameter were a long-term remodeling response rather than a short-term vasodilation response. Future studies should confirm if these findings hold true in humans and investigate the impacts of WSS at different levels of the pulmonary tree on growth.
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Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, USA
| | - Luke Lamers
- Pediatrics, Division of Cardiology, University of Wisconsin - Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, USA. .,Mechanical Engineering, University of Wisconsin - Madison, Madison, WI, USA. .,Radiology, University of Wisconsin - Madison, Madison, WI, USA. .,Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53792-4108, USA.
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14
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Dong M, Yang W, Tamaresis JS, Chan FP, Zucker EJ, Kumar S, Rabinovitch M, Marsden AL, Feinstein JA. Image-based scaling laws for somatic growth and pulmonary artery morphometry from infancy to adulthood. Am J Physiol Heart Circ Physiol 2020; 319:H432-H442. [PMID: 32618514 DOI: 10.1152/ajpheart.00123.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary artery (PA) morphometry has been extensively explored in adults, with particular focus on intra-acinar arteries. However, scaling law relationships for length and diameter of extensive preacinar PAs by age have not been previously reported for in vivo human data. To understand preacinar PA growth spanning children to adults, we performed morphometric analyses of all PAs visible in the computed tomography (CT) and magnetic resonance (MR) images from a healthy subject cohort [n = 16; age: 1-51 yr; body surface area (BSA): 0.49-2.01 m2]. Subject-specific anatomic PA models were constructed from CT and MR images, and morphometric information-diameter, length, tortuosity, bifurcation angle, and connectivity-was extracted and sorted into diameter-defined Strahler orders. Validation of Murray's law, describing optimal scaling exponents of radii for branching vessels, was performed to determine how closely PAs conform to this classical relationship. Using regression analyses of vessel diameters and lengths against orders and patient metrics (BSA, age, height), we found that diameters increased exponentially with order and allometrically with patient metrics. Length increased allometrically with patient metrics, albeit weakly. The average tortuosity index of all vessels was 0.026 ± 0.024, average bifurcation angle was 28.2 ± 15.1°, and average Murray's law exponent was 2.92 ± 1.07. We report a set of scaling laws for vessel diameter and length, along with other morphometric information. These provide an initial understanding of healthy structural preacinar PA development with age, which can be used for computational modeling studies and comparison with diseased PA anatomy.NEW & NOTEWORTHY Pulmonary artery (PA) morphometry studies to date have focused primarily on large arteries and intra-acinar arteries in either adults or children, neglecting preacinar arteries in both populations. Our study is the first to quantify in vivo preacinar PA morphometry changes spanning infants to adults. For preacinar arteries > 1 mm in diameter, we identify scaling laws for vessel diameters and lengths with patient metrics of growth and establish a healthy PA morphometry baseline for most preacinar PAs.
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Affiliation(s)
- Melody Dong
- Department of Bioengineering, Stanford University, Stanford, California
| | - Weiguang Yang
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - John S Tamaresis
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Frandics P Chan
- Department of Radiology, Stanford University, Stanford, California
| | - Evan J Zucker
- Department of Radiology, Stanford University, Stanford, California
| | - Sahana Kumar
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Marlene Rabinovitch
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Jeffrey A Feinstein
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Pediatrics-Cardiology, Stanford University, Stanford, California
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15
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Goo HW. Computed Tomography Pulmonary Vascular Volume Ratio Can Be Used to Evaluate the Effectiveness of Pulmonary Angioplasty in Peripheral Pulmonary Artery Stenosis. Korean J Radiol 2020; 20:1422-1430. [PMID: 31544367 PMCID: PMC6757002 DOI: 10.3348/kjr.2019.0286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/12/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore whether computed tomography (CT) pulmonary vascular volume ratio can be used to evaluate the effectiveness of pulmonary artery angioplasty in patients with peripheral pulmonary artery stenosis. MATERIALS AND METHODS Changes in CT pulmonary vascular volume ratio between serial cardiothoracic CT examinations were calculated in 38 patients. Fifteen patients underwent interim pulmonary artery angioplasty (group 1), while 23 did not (group 2). According to the effectiveness of pulmonary artery angioplasty, patients in group 1 were further divided into group 1A (improved or aggravated) and group 1B (ineffective). Changes in the pulmonary vascular volume percentages among the three groups (group 1A, group 1B, and group 2) on serial CT examinations were compared. RESULTS Pulmonary artery angioplasty on serial CT examinations was successful in seven patients, ineffective in seven patients, and aggravated in one patient. As a result, eight patients were included in group 1A and seven were included in group 1B. Changes in the CT pulmonary vascular volume percentages in group 1A were statistically significantly greater than those in group 1B (11.6 ± 5.6% vs. 2.7 ± 1.6%, p < 0.003) and group 2 (11.6 ± 5.6% vs. 1.9 ± 1.4%, p < 0.002), while no statistically significant difference was found between group 1B and group 2 (2.7 ± 1.6% vs. 1.9 ± 1.4%, p > 0.1). CONCLUSION CT pulmonary vascular volume ratio can be used to evaluate the effectiveness of pulmonary artery angioplasty in patients with peripheral pulmonary artery stenosis.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Pewowaruk R, Roldán-Alzate A. 4D Flow MRI Estimation of Boundary Conditions for Patient Specific Cardiovascular Simulation. Ann Biomed Eng 2019; 47:1786-1798. [PMID: 31069584 DOI: 10.1007/s10439-019-02285-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
Accurate image based cardiovascular simulations require patient specific boundary conditions (BCs) for inlets, outlets and vessel wall mechanical properties. While inlet BCs are typically determined non-invasively, invasive pressure catheterization is often used to determine patient specific outlet BCs and vessel wall mechanical properties. A method using 4D Flow MRI to non-invasively determine both patient specific outlet BCs and vessel wall mechanical properties is presented and results for both in vitro validation with a latex tube and an in vivo pulmonary artery stenosis (PAS) stent intervention are presented. For in vitro validation, acceptable agreement is found between simulation using BCs from 4D Flow MRI and benchtop measurements. For the PAS virtual intervention, simulation correctly predicts flow distribution with 9% error compared to MRI. Using 4D Flow MRI to noninvasively determine patient specific BCs increases the ability to use image based simulations as pressure catheterization is not always performed.
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Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA. .,Mechanical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA. .,Department of Radiology, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA.
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Vignon-Clementel IE, Pant S. Patient-specific hemodynamics simulations: model parameterization from clinical data to enable interventional planning. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1713501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Sanjay Pant
- Zienkiewicz Centre for Computational Engineering, Swansea University, Swansea, UK
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18
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Capuano F, Loke YH, Cronin I, Olivieri LJ, Balaras E. Computational Study of Pulmonary Flow Patterns After Repair of Transposition of Great Arteries. J Biomech Eng 2019; 141:2727821. [DOI: 10.1115/1.4043034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 11/08/2022]
Abstract
Patients that undergo the arterial switch operation (ASO) to repair transposition of great arteries (TGA) can develop abnormal pulmonary trunk morphology with significant long-term complications. In this study, cardiovascular magnetic resonance was combined with computational fluid dynamics to investigate the impact of the postoperative layout on the pulmonary flow patterns. Three ASO patients were analyzed and compared to a volunteer control. Results showed the presence of anomalous shear layer instabilities, vortical and helical structures, and turbulent-like states in all patients, particularly as a consequence of the unnatural curvature of the pulmonary bifurcation. Streamlined, mostly laminar flow was instead found in the healthy subject. These findings shed light on the correlation between the post-ASO anatomy and the presence of altered flow features, and may be useful to improve surgical planning as well as the long-term care of TGA patients.
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Affiliation(s)
- Francesco Capuano
- Department of Industrial Engineering, Università di Napoli Federico II, Napoli 80125, Italy e-mail:
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Health System, Washington, DC 20010 e-mail:
| | - Ileen Cronin
- Division of Cardiology, Children's National Health System, Washington, DC 20010 e-mail:
| | - Laura J. Olivieri
- Division of Cardiology, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC 20010 e-mail:
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC 20052 e-mail:
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Evolution of hemodynamic forces in the pulmonary tree with progressively worsening pulmonary arterial hypertension in pediatric patients. Biomech Model Mechanobiol 2019; 18:779-796. [DOI: 10.1007/s10237-018-01114-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/24/2018] [Indexed: 01/26/2023]
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20
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Qureshi MU, Colebank MJ, Paun LM, Ellwein Fix L, Chesler N, Haider MA, Hill NA, Husmeier D, Olufsen MS. Hemodynamic assessment of pulmonary hypertension in mice: a model-based analysis of the disease mechanism. Biomech Model Mechanobiol 2018; 18:219-243. [DOI: 10.1007/s10237-018-1078-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022]
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21
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Yang W, Hanley FL, Chan FP, Marsden AL, Vignon-Clementel IE, Feinstein JA. Computational simulation of postoperative pulmonary flow distribution in Alagille patients with peripheral pulmonary artery stenosis. CONGENIT HEART DIS 2017; 13:241-250. [PMID: 29194961 DOI: 10.1111/chd.12556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Up to 90% of individuals with Alagille syndrome have congenital heart diseases. Peripheral pulmonary artery stenosis (PPS), resulting in right ventricular hypertension and pulmonary flow disparity, is one of the most common abnormalities, yet the hemodynamic effects are ill-defined, and optimal patient management and treatment strategies are not well established. The purpose of this pilot study is to use recently refined computational simulation in the setting of multiple surgical strategies, to examine the influence of pulmonary artery reconstruction on hemodynamics in this population. MATERIALS AND METHODS Based on computed tomography angiography and cardiac catheterization data, preoperative pulmonary artery models were constructed for 4 patients with Alagille syndrome with PPS (all male, age range: 0.6-2.9 years), and flow simulations with deformable walls were performed. Surgeon directed virtual surgery, mimicking the surgical procedure, was then performed to derive postoperative models. Postoperative simulation-derived hemodynamics and blood flow distribution were then compared with the clinical results. RESULTS Simulations confirmed substantial resistance, resulting from preoperative severe ostial stenoses, and the use of newly developed adaptive outflow boundary conditions led to excellent agreement with in vivo measurements. Relief of PPS decreased pulmonary artery pressures and improved pulmonary flow distribution both in vivo and in silico with good correlation. CONCLUSIONS Using adaptive outflow boundary conditions, computational simulations can estimate postoperative overall pulmonary flow distribution in patients with Alagille syndrome after pulmonary artery reconstruction. Obstruction relief along with pulmonary artery vasodilation determines postoperative pulmonary flow distribution and newer methods can incorporate these physiologic changes. Evolving blood flow simulations may be useful in surgical or transcatheter planning and in understanding the complex interplay among various obstructions in patients with peripheral pulmonary stenosis.
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Affiliation(s)
- Weiguang Yang
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, USA
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Frandics P Chan
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, USA.,Department of BioEngineering, Stanford University School of Medicine, Stanford, California, USA
| | - Irene E Vignon-Clementel
- INRIA and Sorbonne Universités UPMC, Univ. Paris 6, Laboratoire Jacques-Louis Lions, Paris, France
| | - Jeffrey A Feinstein
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, USA.,Department of BioEngineering, Stanford University School of Medicine, Stanford, California, USA
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Acosta S, Puelz C, Rivière B, Penny DJ, Brady KM, Rusin CG. Cardiovascular mechanics in the early stages of pulmonary hypertension: a computational study. Biomech Model Mechanobiol 2017; 16:2093-2112. [PMID: 28733923 DOI: 10.1007/s10237-017-0940-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/12/2017] [Indexed: 01/12/2023]
Abstract
We formulate and study a new mathematical model of pulmonary hypertension. Based on principles of fluid and elastic dynamics, we introduce a model that quantifies the stiffening of pulmonary vasculature (arteries and arterioles) to reproduce the hemodynamics of the pulmonary system, including physiologically consistent dependence between compliance and resistance. This pulmonary model is embedded in a closed-loop network of the major vessels in the body, approximated as one-dimensional elastic tubes, and zero-dimensional models for the heart and other organs. Increasingly severe pulmonary hypertension is modeled in the context of two extreme scenarios: (1) no cardiac compensation and (2) compensation to achieve constant cardiac output. Simulations from the computational model are used to estimate cardiac workload, as well as pressure and flow traces at several locations. We also quantify the sensitivity of several diagnostic indicators to the progression of pulmonary arterial stiffening. Simulation results indicate that pulmonary pulse pressure, pulmonary vascular compliance, pulmonary RC time, luminal distensibility of the pulmonary artery, and pulmonary vascular impedance are much better suited to detect the early stages of pulmonary hypertension than mean pulmonary arterial pressure and pulmonary vascular resistance, which are conventionally employed as diagnostic indicators for this disease.
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Affiliation(s)
- Sebastián Acosta
- Department of Pediatrics-Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
| | - Charles Puelz
- Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA
| | - Béatrice Rivière
- Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA
| | - Daniel J Penny
- Department of Pediatrics-Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Ken M Brady
- Department of Anesthesiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Craig G Rusin
- Department of Pediatrics-Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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