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Garber L, Khodaei S, Maftoon N, Keshavarz-Motamed Z. Impact of TAVR on coronary artery hemodynamics using clinical measurements and image-based patient-specific in silico modeling. Sci Rep 2023; 13:8948. [PMID: 37268642 PMCID: PMC10238523 DOI: 10.1038/s41598-023-31987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/21/2023] [Indexed: 06/04/2023] Open
Abstract
In recent years, transcatheter aortic valve replacement (TAVR) has become the leading method for treating aortic stenosis. While the procedure has improved dramatically in the past decade, there are still uncertainties about the impact of TAVR on coronary blood flow. Recent research has indicated that negative coronary events after TAVR may be partially driven by impaired coronary blood flow dynamics. Furthermore, the current technologies to rapidly obtain non-invasive coronary blood flow data are relatively limited. Herein, we present a lumped parameter computational model to simulate coronary blood flow in the main arteries as well as a series of cardiovascular hemodynamic metrics. The model was designed to only use a few inputs parameters from echocardiography, computed tomography and a sphygmomanometer. The novel computational model was then validated and applied to 19 patients undergoing TAVR to examine the impact of the procedure on coronary blood flow in the left anterior descending (LAD) artery, left circumflex (LCX) artery and right coronary artery (RCA) and various global hemodynamics metrics. Based on our findings, the changes in coronary blood flow after TAVR varied and were subject specific (37% had increased flow in all three coronary arteries, 32% had decreased flow in all coronary arteries, and 31% had both increased and decreased flow in different coronary arteries). Additionally, valvular pressure gradient, left ventricle (LV) workload and maximum LV pressure decreased by 61.5%, 4.5% and 13.0% respectively, while mean arterial pressure and cardiac output increased by 6.9% and 9.9% after TAVR. By applying this proof-of-concept computational model, a series of hemodynamic metrics were generated non-invasively which can help to better understand the individual relationships between TAVR and mean and peak coronary flow rates. In the future, tools such as these may play a vital role by providing clinicians with rapid insight into various cardiac and coronary metrics, rendering the planning for TAVR and other cardiovascular procedures more personalized.
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Affiliation(s)
- Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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2
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Ban E, Humphrey JD. New Computational Approach to Shunt Design in Congenital Heart Palliation. J Biomech 2023; 152:111568. [PMID: 37099931 DOI: 10.1016/j.jbiomech.2023.111568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
Shunts are commonly used to redirect blood to pulmonary arteries in procedures that palliate congenital cardiovascular defects. Previous clinical studies and hemodynamic simulations reveal a critical role of shunt diameter in balancing flow to pulmonary versus systemic vessels, but the biomechanical process of creating the requisite anastomosis between the shunt and host vessel has received little attention. Here, we report a new Lagrange multiplier-based finite element approach that represents the shunt and host vessels as individual structures and predicts the anastomosis geometry and attachment force that result when the shunt is sutured at an incision in the host, followed by pressurization. Simulations suggest that anastomosis orifice opening increases markedly with increasing length of the host incision and moderately with increasing blood pressure. The host artery is further predicted to conform to common stiff synthetic shunts, whereas more compliant umbilical vessel shunts should conform to the host, with orifice area transitioning between these two extremes via a Hill-type function of shunt stiffness. Moreover, a direct relationship is expected between attachment forces and shunt stiffness. This new computational approach promises to aid in surgical planning for diverse vascular shunts by predicting in vivo pressurized geometries.
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Affiliation(s)
- E Ban
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA.
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3
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Das A, Hameed M, Prather R, Farias M, Divo E, Kassab A, Nykanen D, DeCampli W. In-Silico and In-Vitro Analysis of the Novel Hybrid Comprehensive Stage II Operation for Single Ventricle Circulation. Bioengineering (Basel) 2023; 10:bioengineering10020135. [PMID: 36829630 PMCID: PMC9952694 DOI: 10.3390/bioengineering10020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
Single ventricle (SV) anomalies account for one-fourth of all congenital heart disease cases. The existing palliative treatment for this anomaly achieves a survival rate of only 50%. To reduce the trauma associated with surgical management, the hybrid comprehensive stage II (HCSII) operation was designed as an alternative for a select subset of SV patients with the adequate antegrade aortic flow. This study aims to provide better insight into the hemodynamics of HCSII patients utilizing a multiscale Computational Fluid Dynamics (CFD) model and a mock flow loop (MFL). Both 3D-0D loosely coupled CFD and MFL models have been tuned to match baseline hemodynamic parameters obtained from patient-specific catheterization data. The hemodynamic findings from clinical data closely match the in-vitro and in-silico measurements and show a strong correlation (r = 0.9). The geometrical modification applied to the models had little effect on the oxygen delivery. Similarly, the particle residence time study reveals that particles injected in the main pulmonary artery (MPA) have successfully ejected within one cardiac cycle, and no pathological flows were observed.
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Affiliation(s)
- Arka Das
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA
- Correspondence: ; Tel.: +1-386-241-1457
| | - Marwan Hameed
- Department of Mechanical Engineering, American University of Bahrain, Riffa 942, Bahrain
| | - Ray Prather
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
- The Heart Center at Orlando Health Arnold Palmer Hospital for Children, Orlando, FL 32806, USA
| | - Michael Farias
- The Heart Center at Orlando Health Arnold Palmer Hospital for Children, Orlando, FL 32806, USA
- Department of Clinical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Eduardo Divo
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA
| | - Alain Kassab
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - David Nykanen
- The Heart Center at Orlando Health Arnold Palmer Hospital for Children, Orlando, FL 32806, USA
- Department of Clinical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - William DeCampli
- The Heart Center at Orlando Health Arnold Palmer Hospital for Children, Orlando, FL 32806, USA
- Department of Clinical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
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4
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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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Chi Z, Beile L, Deyu L, Yubo F. Application of multiscale coupling models in the numerical study of circulation system. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Xiong J, Sun Q, Qian Y, Hu L, Tong Z, Liu J, Liu J. Effects of Patent Ductus Arteriosus on the Hemodynamics of Modified Blalock-Taussig Shunt Based on Patient-Specific Simulation. Front Physiol 2021; 12:707128. [PMID: 34531758 PMCID: PMC8438520 DOI: 10.3389/fphys.2021.707128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
The question of preserving the patent ductus arteriosus (PDA) during the modified Blalock–Taussig shunt (MBTS) procedure remains controversial. The goal of this study was to investigate the effects of the PDA on the flow features of the MBTS to help with preoperative surgery design and postoperative prediction. In this study, a patient with pulmonary atresia and PDA was included. A patient-specific three-dimensional model was reconstructed, and virtual surgeries of shunt insertion and ductus ligation were performed using computer-aided design. Computational fluid dynamics was utilized to analyze the hemodynamic parameters of varied models based on the patient-specific anatomy and physiological data. The preservation of the PDA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided, causing significant and complicated turbulence in the pulmonary artery where low wall shear stress, high oscillatory shear index, and high relative residence time were distributed. The highest energy loss was found when the PDA was preserved. The preservation of PDA is not recommended during MBTS procedures because it negatively influences hemodynamics. This may lead to pulmonary overperfusion, inadequate systemic perfusion, and a heavier cardiac burden, thus increasing the risk of heart failure. Also, it seems to bring no benefit in terms of reducing the risk for thrombosis.
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Affiliation(s)
- Jiwen Xiong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Sun
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Qian
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Liwei Hu
- Diagnostic Imaging Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 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, China
| | - Zhirong Tong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 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, China.,Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfen Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 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, China
| | - Jinlong Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 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, China.,Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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7
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Hameed M, Prather R, Divo E, Kassab A, Nykanen D, Farias M, DeCampli WM. Computational fluid dynamics investigation of the novel hybrid comprehensive stage II operation. JTCVS OPEN 2021; 7:308-323. [PMID: 36003745 PMCID: PMC9390546 DOI: 10.1016/j.xjon.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 05/31/2023]
Abstract
Background The hybrid comprehensive stage 2 (HCS2) procedure is a novel palliative operation applicable to a select subset of single ventricle patients with adequate native antegrade aortic flow to the upper body. Flow to the descending aorta, through the pulmonary outlet and ductal arch, is influenced by a stented intrapulmonary baffle connecting the branch pulmonary arteries. We used computational fluid dynamics (CFD) to elucidate the hemodynamic characteristics of this reconstruction. Methods We used multiscale CFD analysis of a synthetic, patient-derived HCS2 anatomic configuration with unsteady laminar flow conditions and a non-Newtonian blood model to quantify the resultant hemodynamics. The 3-dimensional CFD model was coupled to a 0-dimensional lumped parameter model of the peripheral circulation to determine the required boundary conditions. Results For the specific anatomy studied, the intrapulmonary baffle did not obstruct flow from the pulmonary trunk to ductal arch as long as the distance between the anterior pulmonary artery wall and baffle wall exceeded ∼7 mm. Vortex shedding off of the baffle wall did not develop, because of the short distance to the ductal arch. The stented baffle experienced significantly uneven "inward" loading from the systemic side. Pulmonary outlet flow separation distal to the baffle produced a low-speed recirculation region. Conclusions Hemodynamic patterns in this complex anatomy are generally favorable. Low flow recirculation could be mitigated by preoperative shape optimization. Calculated inward stresses on the pulmonary baffle can be used in the future to study baffle stent deformation, which is expected to be small.
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Key Words
- AA, ascending aorta
- BC, boundary condition
- CFD, computational fluid dynamics
- CHD, congenital heart disease
- DA, descending aorta
- HCS2, hybrid comprehensive stage 2
- HLHS, hypoplastic left heart syndrome
- LCA, left coronary artery
- LCCA, left common carotid artery
- LPA, left pulmonary artery
- LPM, lumped parameter model
- LSCA, left subclavian artery
- MPA, main pulmonary artery
- ODE, ordinary differential equation
- PA, pulmonary artery/trunk
- RCA, right coronary artery
- RCCA, right common carotid artery
- RPA, right pulmonary artery
- RSCA, right subclavian artery
- SV, single ventricle
- SVC, superior vena cava
- VSD, ventricular septal defect
- WSS, wall shear stress
- computational fluid dynamics
- congenital heart disease
- hypoplastic left heart syndrome
- lumped parameter model
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Affiliation(s)
- Marwan Hameed
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Fla
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Fla
| | - Ray Prather
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Fla
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Fla
- Pediatric Cardiology, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Eduardo Divo
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Fla
| | - Alain Kassab
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Fla
| | - David Nykanen
- Pediatric Cardiology, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Michael Farias
- Pediatric Cardiology, Arnold Palmer Hospital for Children, Orlando, Fla
| | - William M. DeCampli
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Fla
- Pediatric Cardiology, Arnold Palmer Hospital for Children, Orlando, Fla
- Department of Clinical Sciences, College of Medicine, University of Central Florida, Orlando, Fla
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8
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Ling Y, Tang J, Liu H. Numerical investigation of two-phase non-Newtonian blood flow in bifurcate pulmonary arteries with a flow resistant using Eulerian multiphase model. Chem Eng Sci 2021. [DOI: 10.1016/j.ces.2020.116426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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9
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Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
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Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
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Yang XY, Jing XY, Chen Z, Li L, Fan XM, Su JW. A summary of second systemic pulmonary shunt for congenital heart disease with pulmonary hypoxemia. J Cardiothorac Surg 2020; 15:97. [PMID: 32410655 PMCID: PMC7224346 DOI: 10.1186/s13019-020-01132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been an increasing number of children with congenital heart disease that undergo primary or second systemic-pulmonary shunt, while there are few reports on the second systemic-pulmonary shunt. Therefore, this study summarizes the experience of second systemic-pulmonary shunt for congenital heart disease in our hospital. METHODS AND RESULTS Sixty-five children with congenital heart disease who underwent systemic-pulmonary shunt for the second time in our hospital were analyzed. At the early stage after the operation, cyanosis improved and SpO2 significantly increased. One patient died in hospital (1.54%) and the causes of death were aggravated atrioventricular regurgitation, low cardiac output syndrome, and liver failure. Early complications occurred in 18 patients (27.7%). All the children were rechecked in our hospital every 3-6 months and the McGoon index significantly increased. CONCLUSION Systemic-pulmonary artery shunt can promote pulmonary vascular development, improve cyanosis symptoms, and increase the chance of radical treatment in children with pulmonary vascular dysplasia.
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Affiliation(s)
- Xue-Yong Yang
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, No.2 An zhen road, Chaoyang District, Beijing, 100029, China
| | - Xiao-Yong Jing
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, No.2 An zhen road, Chaoyang District, Beijing, 100029, China
| | - Zhe Chen
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, No.2 An zhen road, Chaoyang District, Beijing, 100029, China
| | - Lun Li
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, No.2 An zhen road, Chaoyang District, Beijing, 100029, China
| | - Xiang-Ming Fan
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, No.2 An zhen road, Chaoyang District, Beijing, 100029, China
| | - Jun-Wu Su
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, No.2 An zhen road, Chaoyang District, Beijing, 100029, China.
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3D Simulation Analysis of Central Shunt in Patient-Specific Hemodynamics: Effects of Varying Degree of Pulmonary Artery Stenosis and Shunt Diameters. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:4720908. [PMID: 32148557 PMCID: PMC7042498 DOI: 10.1155/2020/4720908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 12/27/2022]
Abstract
The objective of this study was to compare the effects of different shunt diameters and pulmonary artery (PA) stenosis grades on the hemodynamics of central shunts to determine an optimal surgical plan and improve the long-term outcomes of the operation. A 3D anatomical model was reconstructed based on the patient's clinical CT data. 3D computational fluid dynamics models were built with varying degrees of stenosis (the stenosis ratio α was represented by the ratio of blood flow through the main pulmonary artery to cardiac output, ranging from 0 to 30%; the smaller the value of α, the more severe the pulmonary artery stenosis) and varying shunt diameters (3, 3.5, 4, 4.5, and 5 mm). Our results show that the asymmetry of pulmonary artery flow increased with increasing shunt diameter and α, which will be more conducive to the development of the left pulmonary artery. Additionally, the pulmonary-to-systemic flow ratio (QP/QS) increases with the shunt diameter and α, and all the values exceed 1. When the shunt diameter is 3 mm and α = 0%, QP/QS reaches the minimum value of 1.01, and the oxygen delivery reaches the maximum value of 205.19 ml/min. However, increasing shunt diameter and α is beneficial to reduced power loss and smoother PA flow. In short, for patients with severe PA stenosis (α is small), a larger-diameter shunt may be preferred. Conversely, when the degree of PA stenosis is moderate, a smaller shunt diameter can be considered.
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