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Chidyagwai SG, Kaplan MS, Jensen CW, Chen JS, Chamberlain RC, Hill KD, Barker PCA, Slesnick TC, Randles A. Surgical Modulation of Pulmonary Artery Shear Stress: A Patient-Specific CFD Analysis of the Norwood Procedure. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00724-3. [PMID: 38459240 DOI: 10.1007/s13239-024-00724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
PURPOSR This study created 3D CFD models of the Norwood procedure for hypoplastic left heart syndrome (HLHS) using standard angiography and echocardiogram data to investigate the impact of shunt characteristics on pulmonary artery (PA) hemodynamics. Leveraging routine clinical data offers advantages such as availability and cost-effectiveness without subjecting patients to additional invasive procedures. METHODS Patient-specific geometries of the intrathoracic arteries of two Norwood patients were generated from biplane cineangiograms. "Virtual surgery" was then performed to simulate the hemodynamics of alternative PA shunt configurations, including shunt type (modified Blalock-Thomas-Taussig shunt (mBTTS) vs. right ventricle-to-pulmonary artery shunt (RVPAS)), shunt diameter, and pulmonary artery anastomosis angle. Left-right pulmonary flow differential, Qp/Qs, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) were evaluated. RESULTS There was strong agreement between clinically measured data and CFD model output throughout the patient-specific models. Geometries with a RVPAS tended toward more balanced left-right pulmonary flow, lower Qp/Qs, and greater TAWSS and OSI than models with a mBTTS. For both shunt types, larger shunts resulted in a higher Qp/Qs and higher TAWSS, with minimal effect on OSI. Low TAWSS areas correlated with regions of low flow and changing the PA-shunt anastomosis angle to face toward low TAWSS regions increased TAWSS. CONCLUSION Excellent correlation between clinically measured and CFD model data shows that 3D CFD models of HLHS Norwood can be developed using standard angiography and echocardiographic data. The CFD analysis also revealed consistent changes in PA TAWSS, flow differential, and OSI as a function of shunt characteristics.
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Affiliation(s)
- Simbarashe G Chidyagwai
- Department of Biomedical Engineering, Duke University, 534 Research Drive, 27708, Durham, NC, USA
| | - Michael S Kaplan
- Department of Biomedical Engineering, Duke University, 534 Research Drive, 27708, Durham, NC, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Christopher W Jensen
- Department of Biomedical Engineering, Duke University, 534 Research Drive, 27708, Durham, NC, USA
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - James S Chen
- Department of Biomedical Engineering, Duke University, 534 Research Drive, 27708, Durham, NC, USA
| | - Reid C Chamberlain
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Kevin D Hill
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Piers C A Barker
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Timothy C Slesnick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda Randles
- Department of Biomedical Engineering, Duke University, 534 Research Drive, 27708, Durham, NC, USA.
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Birla AK, Brimmer S, Short WD, Olutoye OO, Shar JA, Lalwani S, Sucosky P, Parthiban A, Keswani SG, Caldarone CA, Birla RK. Current state of the art in hypoplastic left heart syndrome. Front Cardiovasc Med 2022; 9:878266. [PMID: 36386362 PMCID: PMC9651920 DOI: 10.3389/fcvm.2022.878266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition in which a neonate is born with an underdeveloped left ventricle and associated structures. Without palliative interventions, HLHS is fatal. Treatment typically includes medical management at the time of birth to maintain patency of the ductus arteriosus, followed by three palliative procedures: most commonly the Norwood procedure, bidirectional cavopulmonary shunt, and Fontan procedures. With recent advances in surgical management of HLHS patients, high survival rates are now obtained at tertiary treatment centers, though adverse neurodevelopmental outcomes remain a clinical challenge. While surgical management remains the standard of care for HLHS patients, innovative treatment strategies continue to be developing. Important for the development of new strategies for HLHS patients is an understanding of the genetic basis of this condition. Another investigational strategy being developed for HLHS patients is the injection of stem cells within the myocardium of the right ventricle. Recent innovations in tissue engineering and regenerative medicine promise to provide important tools to both understand the underlying basis of HLHS as well as provide new therapeutic strategies. In this review article, we provide an overview of HLHS, starting with a historical description and progressing through a discussion of the genetics, surgical management, post-surgical outcomes, stem cell therapy, hemodynamics and tissue engineering approaches.
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Affiliation(s)
- Aditya K. Birla
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
| | - Sunita Brimmer
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Walker D. Short
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Oluyinka O. Olutoye
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Jason A. Shar
- Department of Mechanical Engineering, Kennesaw State University, Marietta, GA, United States
| | - Suriya Lalwani
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
| | - Philippe Sucosky
- Department of Mechanical Engineering, Kennesaw State University, Marietta, GA, United States
| | - Anitha Parthiban
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, United States
| | - Sundeep G. Keswani
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Christopher A. Caldarone
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Ravi K. Birla
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
- *Correspondence: Ravi K. Birla
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3
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Hoffman GM, Scott JP, Stuth EA. Effects of Arterial Carbon Dioxide Tension on Cerebral and Somatic Regional Tissue Oxygenation and Blood Flow in Neonates After the Norwood Procedure With Deep Hypothermic Cardiopulmonary Bypass. Front Pediatr 2022; 10:762739. [PMID: 35223690 PMCID: PMC8873518 DOI: 10.3389/fped.2022.762739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Neonates undergoing the Norwood procedure for hypoplastic left heart syndrome are at higher risk of impaired systemic oxygen delivery with resultant brain, kidney, and intestinal ischemic injury, shock, and death. Complex developmental, anatomic, and treatment-related influences on cerebral and renal-somatic circulations make individualized treatment strategies physiologically attractive. Monitoring cerebral and renal circulations with near infrared spectroscopy can help drive rational therapeutic interventions. The primary aim of this study was to describe the differential effects of carbon dioxide tension on cerebral and renal circulations in neonates after the Norwood procedure. Using a prospectively-maintained database of postoperative physiologic and hemodynamic parameters, we analyzed the relationship between postoperative arterial carbon dioxide tension and tissue oxygen saturation and arteriovenous saturation difference in cerebral and renal regions, applying univariate and multivariate multilevel mixed regression techniques. Results were available from 7,644 h of data in 178 patients. Increases in arterial carbon dioxide tension were associated with increased cerebral and decreased renal oxygen saturation. Differential changes in arteriovenous saturation difference explained these effects. The cerebral circulation showed more carbon dioxide sensitivity in the early postoperative period, while sensitivity in the renal circulation increased over time. Multivariate models supported the univariate findings and defined complex time-dependent interactions presented graphically. The cerebral and renal circulations may compete for blood flow with critical limitations of cardiac output. The cerebral and renal-somatic beds have different circulatory control mechanisms that can be manipulated to change the distribution of cardiac output by altering the arterial carbon dioxide tension. Monitoring cerebral and renal circulations with near infrared spectroscopy can provide rational physiologic targets for individualized treatment.
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Affiliation(s)
- George M Hoffman
- Division of Pediatric Cardiac Anesthesia, Children's Hospital of Wisconsin Herma Heart Institute, Milwaukee, WI, United States.,Division of Pediatric Cardiac Critical Care, Children's Hospital of Wisconsin Herma Heart Institute, Milwaukee, WI, United States.,Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - John P Scott
- Division of Pediatric Cardiac Anesthesia, Children's Hospital of Wisconsin Herma Heart Institute, Milwaukee, WI, United States.,Division of Pediatric Cardiac Critical Care, Children's Hospital of Wisconsin Herma Heart Institute, Milwaukee, WI, United States.,Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Eckehard A Stuth
- Division of Pediatric Cardiac Anesthesia, Children's Hospital of Wisconsin Herma Heart Institute, Milwaukee, WI, United States.,Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States
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Shimizu S, Une D, Kawada T, Hayama Y, Kamiya A, Shishido T, Sugimachi M. Lumped parameter model for hemodynamic simulation of congenital heart diseases. J Physiol Sci 2018; 68:103-111. [PMID: 29270856 PMCID: PMC10717555 DOI: 10.1007/s12576-017-0585-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
The recent development of computer technology has made it possible to simulate the hemodynamics of congenital heart diseases on a desktop computer. However, multi-scale modeling of the cardiovascular system based on computed tomographic and magnetic resonance images still requires long simulation times. The lumped parameter model is potentially beneficial for real-time bedside simulation of congenital heart diseases. In this review, we introduce the basics of the lumped parameter model (time-varying elastance chamber model combined with modified Windkessel vasculature model) and illustrate its usage in hemodynamic simulation of congenital heart diseases using examples such as hypoplastic left heart syndrome and Fontan circulation. We also discuss the advantages of the lumped parameter model and the problems for clinical use.
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Affiliation(s)
- Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-5685, Japan.
| | - Dai Une
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-5685, Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-5685, Japan
| | - Yohsuke Hayama
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-5685, Japan
| | - Atsunori Kamiya
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-5685, Japan
| | - Toshiaki Shishido
- Department of Research Promotion, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-5685, Japan
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Burch PT, Gerstenberger E, Ravishankar C, Hehir DA, Davies RR, Colan SD, Sleeper LA, Newburger JW, Clabby ML, Williams IA, Li JS, Uzark K, Cooper DS, Lambert LM, Pemberton VL, Pike NA, Anderson JB, Dunbar‐Masterson C, Khaikin S, Zyblewski SC, Minich LL. Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial. J Am Heart Assoc 2014; 3:e000079. [PMID: 24958780 PMCID: PMC4309036 DOI: 10.1161/jaha.114.000079] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. METHODS AND RESULTS We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients <37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P<0.001, P=0.05, respectively) and age 3 years (P<0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were <-2 in 6% and 18%, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002). CONCLUSIONS WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (>2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets. CLINICAL TRIAL REGISTRATION URL http://clinicaltrials.gov/. Unique identifier: NCT00115934.
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Affiliation(s)
- Phillip T. Burch
- Department of Surgery, University of Utah, Salt Lake City, UT (P.T.B., L.M.L.)
| | | | | | - David A. Hehir
- The Children's Hospital of Wisconsin, Milwaukee, WI (D.A.H.)
| | - Ryan R. Davies
- Nemours/A.I. DuPont Hospital for Children, Wilmington, DE (R.R.D.)
| | - Steven D. Colan
- Children's Hospital Boston and Harvard Medical School, Boston, MA (S.D.C., J.W.N., C.D.M.)
| | - Lynn A. Sleeper
- New England Research Institutes, Watertown, MA (E.G., L.A.S.)
| | - Jane W. Newburger
- Children's Hospital Boston and Harvard Medical School, Boston, MA (S.D.C., J.W.N., C.D.M.)
| | - Martha L. Clabby
- The Hospital for Sick Children, Toronto, Ontario, Canada (M.L.C., S.K.)
| | | | | | - Karen Uzark
- University of Michigan Medical School, Ann Arbor, MI (K.U.)
| | | | - Linda M. Lambert
- Department of Surgery, University of Utah, Salt Lake City, UT (P.T.B., L.M.L.)
| | | | - Nancy A. Pike
- University of California Los Angeles, Los Angeles, CA (N.A.P.)
| | | | | | - Svetlana Khaikin
- The Hospital for Sick Children, Toronto, Ontario, Canada (M.L.C., S.K.)
| | | | - L. LuAnn Minich
- Department of Pediatrics, University of Utah, Salt Lake City, UT (L.A.M.)
| | - the Pediatric Heart Network Investigators
- Department of Surgery, University of Utah, Salt Lake City, UT (P.T.B., L.M.L.)
- Department of Pediatrics, University of Utah, Salt Lake City, UT (L.A.M.)
- New England Research Institutes, Watertown, MA (E.G., L.A.S.)
- The Children's Hospital of Philadelphia, Philadelphia, PA (C.R.)
- The Children's Hospital of Wisconsin, Milwaukee, WI (D.A.H.)
- Nemours/A.I. DuPont Hospital for Children, Wilmington, DE (R.R.D.)
- Children's Hospital Boston and Harvard Medical School, Boston, MA (S.D.C., J.W.N., C.D.M.)
- The Hospital for Sick Children, Toronto, Ontario, Canada (M.L.C., S.K.)
- Columbia University Medical Center, New York, NY (I.A.W.)
- Duke University Medical Center, Durham, NC (J.S.L.)
- University of Michigan Medical School, Ann Arbor, MI (K.U.)
- University of Cincinnati, Cincinnati, OH (D.S.C., J.B.A.)
- National Institutes of Health, Bethesda, MD (V.L.P.)
- University of California Los Angeles, Los Angeles, CA (N.A.P.)
- Medical University of South Carolina, Charleston, SC (S.C.Z.)
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Butts RJ, Hsia TY, Baker GH. Feasibility of conductance catheter-derived pressure-volume loops to investigate ventricular mechanics in shunted single ventricles. Cardiol Young 2013; 23:776-9. [PMID: 23347797 PMCID: PMC3997067 DOI: 10.1017/s1047951112002053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present pressure–volume loops obtained from two patients with single-ventricle physiology, one with a modified Blalock–Taussig shunt and one with a right ventricle-to-pulmonary artery shunt. The dissimilarities in pressure–volume loop contour and related indices highlight potentially important differences in ventricular mechanics between the shunt types.
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Affiliation(s)
- Ryan J. Butts
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Tain-Yen Hsia
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - G. Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
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