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D'Souza GA, Rinaldi JE, Meki M, Crusan A, Richardson E, Shinnar M, Herbertson LH. Using a Mock Circulatory Loop as a Regulatory Science Tool to Simulate Different Heart Failure Conditions. J Biomech Eng 2024; 146:011004. [PMID: 37831143 DOI: 10.1115/1.4063746] [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: 05/09/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Mechanical circulatory support (MCS) device therapy is one of the primary treatment options for end-stage heart failure (HF), whereby a mechanical pump is integrated with the failing heart to maintain adequate tissue perfusion. The ISO 14708-5:2020 standard prescribes generic guidelines for nonclinical device evaluation and system performance testing of MCS devices using a mock circulatory loop (MCL). However, the utility of MCLs in premarket regulatory submissions of MCS devices is ambiguous, and the specific disease states that the device is intended to treat are not usually simulated. Hence, we aim to outline the potential of MCLs as a valuable regulatory science tool for characterizing MCS device systems by adequately representing target clinical-use HF conditions on the bench. Target pathophysiologic hemodynamics of HF conditions (i.e., cardiogenic shock (CS), left ventricular (LV) hypertrophy secondary to hypertension, and coronary artery disease), along with a healthy adult at rest and a healthy adult during exercise are provided as recommended test conditions. The conditions are characterized based on LV, aorta, and left atrium pressures using recommended cardiac hemodynamic indices such as systolic, diastolic, and mean arterial pressure, mean cardiac output (CO), cardiac cycle time, and systemic vascular resistance. This study is a first step toward standardizing MCLs to generate well-defined target HF conditions used to evaluate MCS devices.
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Affiliation(s)
- Gavin A D'Souza
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Jean E Rinaldi
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Moustafa Meki
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Annabelle Crusan
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Eric Richardson
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Meir Shinnar
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Luke H Herbertson
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
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Xu KW, Gao Q, Wan M, Zhang K. Mock circulatory loop applications for testing cardiovascular assist devices and in vitro studies. Front Physiol 2023; 14:1175919. [PMID: 37123281 PMCID: PMC10133581 DOI: 10.3389/fphys.2023.1175919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
The mock circulatory loop (MCL) is an in vitro experimental system that can provide continuous pulsatile flows and simulate different physiological or pathological parameters of the human circulation system. It is of great significance for testing cardiovascular assist device (CAD), which is a type of clinical instrument used to treat cardiovascular disease and alleviate the dilemma of insufficient donor hearts. The MCL installed with different types of CADs can simulate specific conditions of clinical surgery for evaluating the effectiveness and reliability of those CADs under the repeated performance tests and reliability tests. Also, patient-specific cardiovascular models can be employed in the circulation of MCL for targeted pathological study associated with hemodynamics. Therefore, The MCL system has various combinations of different functional units according to its richful applications, which are comprehensively reviewed in the current work. Four types of CADs including prosthetic heart valve (PHV), ventricular assist device (VAD), total artificial heart (TAH) and intra-aortic balloon pump (IABP) applied in MCL experiments are documented and compared in detail. Moreover, MCLs with more complicated structures for achieving advanced functions are further introduced, such as MCL for the pediatric application, MCL with anatomical phantoms and MCL synchronizing multiple circulation systems. By reviewing the constructions and functions of available MCLs, the features of MCLs for different applications are summarized, and directions of developing the MCLs are suggested.
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Affiliation(s)
- Ke-Wei Xu
- Department of Engineering Mechanics, School of Aeronautics and Astronautics, Zhejiang University, Hangzhou, China
| | - Qi Gao
- Department of Engineering Mechanics, School of Aeronautics and Astronautics, Zhejiang University, Hangzhou, China
- *Correspondence: Qi Gao,
| | - Min Wan
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, China
| | - Ke Zhang
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, China
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Fresiello L, Muthiah K, Goetschalckx K, Hayward C, Rocchi M, Bezy M, Pauls JP, Meyns B, Donker DW, Zieliński K. Initial clinical validation of a hybrid in silico—in vitro cardiorespiratory simulator for comprehensive testing of mechanical circulatory support systems. Front Physiol 2022; 13:967449. [PMID: 36311247 PMCID: PMC9606213 DOI: 10.3389/fphys.2022.967449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Simulators are expected to assume a prominent role in the process of design—development and testing of cardiovascular medical devices. For this purpose, simulators should capture the complexity of human cardiorespiratory physiology in a realistic way. High fidelity simulations of pathophysiology do not only allow to test the medical device itself, but also to advance practically relevant monitoring and control features while the device acts under realistic conditions. We propose a physiologically controlled cardiorespiratory simulator developed in a mixed in silico-in vitro simulation environment. As inherent to this approach, most of the physiological model complexity is implemented in silico while the in vitro system acts as an interface to connect a medical device. As case scenarios, severe heart failure was modeled, at rest and at exercise and as medical device a left ventricular assist device (LVAD) was connected to the simulator. As initial validation, the simulator output was compared against clinical data from chronic heart failure patients supported by an LVAD, that underwent different levels of exercise tests with concomitant increase in LVAD speed. Simulations were conducted reproducing the same protocol as applied in patients, in terms of exercise intensity and related LVAD speed titration. Results show that the simulator allows to capture the principal parameters of the main adaptative cardiovascular and respiratory processes within the human body occurring from rest to exercise. The simulated functional interaction with the LVAD is comparable to the one clinically observed concerning ventricular unloading, cardiac output, and pump flow. Overall, the proposed simulation system offers a high fidelity in silico-in vitro representation of the human cardiorespiratory pathophysiology. It can be used as a test bench to comprehensively analyze the performance of physically connected medical devices simulating clinically realistic, critical scenarios, thus aiding in the future the development of physiologically responding, patient-adjustable medical devices. Further validation studies will be conducted to assess the performance of the simulator in other pathophysiological conditions.
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Affiliation(s)
- Libera Fresiello
- Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- *Correspondence: Libera Fresiello,
| | - Kavitha Muthiah
- Department of Cardiology, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Christopher Hayward
- Department of Cardiology, St Vincent’s Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Maria Rocchi
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maxime Bezy
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jo P. Pauls
- School of Engineering, Griffith University, Southport, QLD, Australia
| | - Bart Meyns
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk W. Donker
- Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Krzysztof Zieliński
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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Delaney M, Cleveland V, Mass P, Capuano F, Mandell JG, Loke YH, Olivieri L. Right ventricular afterload in repaired D-TGA is associated with inefficient flow patterns, rather than stenosis alone. Int J Cardiovasc Imaging 2021; 38:653-662. [PMID: 34727253 DOI: 10.1007/s10554-021-02436-4] [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: 07/03/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Treatment of D- transposition of great arteries (DTGA) involves the Arterial Switch Operation (ASO), which can create PA branch stenosis (PABS) and alter PA blood flow energetics. This altered PA flow may contribute to elevated right ventricular (RV) afterload more significantly than stenosis alone. Our aim was to correlate RV afterload and PA flow characteristics using 4D flow cardiac magnetic resonance (CMR) imaging of a mock circulatory system (MCS) incorporating 3D printed replicas. CMR imaging and clinical characteristics were analyzed from 22 ASO patients (age 11.9 ± 8.7 years, 68% male). Segmentation was performed to create 3D printed PA replicas that were mounted in an MRI-compatible MCS. Pressure drop across the PA replica was recorded and 4D flow CMR acquisitions were analyzed for blood flow inefficiency (energy loss, vorticity). In post-ASO patients, there is no difference in RV mass (p = 0.07), nor RV systolic pressure (p = 0.26) in the presence or absence of PABS. 4D flow analysis of MCS shows energy loss is correlated to RV mass (p = 0.01, r = 0.67) and MCS pressure differential (p = 0.02, r = 0.57). Receiver operating characteristic curve shows energy loss detects elevated RV mass above 30 g/m2 (p = 0.02, AUC 0.88) while index of PA dimensions (Nakata) does not (p = 0.09, AUC 0.79). PABS alone does not account for differences in RV mass or afterload in post-ASO patients. In MCS simulations, energy loss is correlated with both RV mass and PA pressure, and can moderately detect elevated RV mass. Inefficient PA flow may be an important predictor of RV afterload in this population.
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Affiliation(s)
- Marc Delaney
- Division of Pediatrics, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
| | - Vincent Cleveland
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Francesco Capuano
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, Bari, Italy
| | - Jason G Mandell
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Laura Olivieri
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
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Mirzaei E, Farahmand M, Kung E. An algorithm for coupling multibranch in vitro experiment to numerical physiology simulation for a hybrid cardiovascular model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3289. [PMID: 31816194 DOI: 10.1002/cnm.3289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
The hybrid cardiovascular modeling approach integrates an in vitro experiment with a computational lumped-parameter simulation, enabling direct physical testing of medical devices in the context of closed-loop physiology. The interface between the in vitro and computational domains is essential for properly capturing the dynamic interactions of the two. To this end, we developed an iterative algorithm capable of coupling an in vitro experiment containing multiple branches to a lumped-parameter physiology simulation. This algorithm identifies the unique flow waveform solution for each branch of the experiment using an iterative Broyden's approach. For the purpose of algorithm testing, we first used mathematical surrogates to represent the in vitro experiments and demonstrated five scenarios where the in vitro surrogates are coupled to the computational physiology of a Fontan patient. This testing approach allows validation of the coupling result accuracy as the mathematical surrogates can be directly integrated into the computational simulation to obtain the "true solution" of the coupled system. Our algorithm successfully identified the solution flow waveforms in all test scenarios with results matching the true solutions with high accuracy. In all test cases, the number of iterations to achieve the desired convergence criteria was less than 130. To emulate realistic in vitro experiments in which noise contaminates the measurements, we perturbed the surrogate models by adding random noise. The convergence tolerance achievable with the coupling algorithm remained below the magnitudes of the added noise in all cases. Finally, we used this algorithm to couple a physical experiment to the computational physiology model to demonstrate its real-world applicability.
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Affiliation(s)
- Ehsan Mirzaei
- Department of Mechanical Engineering, Clemson University, Clemson, South Carolina, USA
| | - Masoud Farahmand
- Department of Mechanical Engineering, Clemson University, Clemson, South Carolina, USA
| | - Ethan Kung
- Department of Mechanical Engineering, Clemson University, Clemson, South Carolina, USA
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
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Commentary: Mechanical support for the subpulmonary circulation of Fontan physiology-A step in the right direction. J Thorac Cardiovasc Surg 2019; 158:1436-1437. [PMID: 31255340 DOI: 10.1016/j.jtcvs.2019.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 11/22/2022]
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Tree M, Wei ZA, Trusty PM, Raghav V, Fogel M, Maher K, Yoganathan A. Using a Novel In Vitro Fontan Model and Condition-Specific Real-Time MRI Data to Examine Hemodynamic Effects of Respiration and Exercise. Ann Biomed Eng 2018; 46:135-147. [PMID: 29067563 PMCID: PMC5756106 DOI: 10.1007/s10439-017-1943-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/09/2017] [Indexed: 12/20/2022]
Abstract
Several studies exist modeling the Fontan connection to understand its hemodynamic ties to patient outcomes (Chopski in: Experimental and Computational Assessment of Mechanical Circulatory Assistance of a Patient-Specific Fontan Vessel Configuration. Dissertation, 2013; Khiabani et al. in J Biomech 45:2376-2381, 2012; Taylor and Figueroa in Annu Rev Biomed 11:109-134, 2009; Vukicevic et al. in ASAIO J 59:253-260, 2013). The most patient-accurate of these studies include flexible, patient-specific total cavopulmonary connections. This study improves Fontan hemodynamic modeling by validating Fontan model flexibility against a patient-specific bulk compliance value, and employing real-time phase contrast magnetic resonance flow data. The improved model was employed to acquire velocity field information under breath-held, free-breathing, and exercise conditions to investigate the effect of these conditions on clinically important Fontan hemodynamic metrics including power loss and viscous dissipation rate. The velocity data, obtained by stereoscopic particle image velocimetry, was visualized for qualitative three-dimensional flow field comparisons between the conditions. Key hemodynamic metrics were calculated from the velocity data and used to quantitatively compare the flow conditions. The data shows a multi-factorial and extremely patient-specific nature to Fontan hemodynamics.
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Affiliation(s)
- Michael Tree
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Zhenglun Alan Wei
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Institute of Computational Science and Cardiovascular Disease, Nanjing Medical University, Nanjing, China
| | - Phillip M Trusty
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Vrishank Raghav
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Mark Fogel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin Maher
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ajit Yoganathan
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
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Windsor J, Townsley MM, Briston D, Villablanca PA, Alegria JR, Ramakrishna H. Fontan Palliation for Single-Ventricle Physiology: Perioperative Management for Noncardiac Surgery and Analysis of Outcomes. J Cardiothorac Vasc Anesth 2017; 31:2296-2303. [DOI: 10.1053/j.jvca.2017.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/14/2022]
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Tree M, Wei ZA, Munz B, Maher K, Deshpande S, Slesnick T, Yoganathan A. A Method for In Vitro TCPC Compliance Verification. J Biomech Eng 2017; 139:2621590. [DOI: 10.1115/1.4036474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 01/29/2023]
Abstract
The Fontan procedure is a common palliative intervention for sufferers of single ventricle congenital heart defects that results in an anastomosis of the venous return to the pulmonary arteries called the total cavopulmonary connection (TCPC). Local TCPC and global Fontan circulation hemodynamics are studied with in vitro circulatory models because of hemodynamic ties to Fontan patient long-term complications. The majority of in vitro studies, to date, employ a rigid TCPC model. Recently, a few studies have incorporated flexible TCPC models, but provide no justification for the model material properties. The method set forth in this study successfully utilizes patient-specific flow and pressure data from phase contrast magnetic resonance images (PCMRI) (n = 1) and retrospective pulse-pressure data from an age-matched patient cohort (n = 10) to verify the compliance of an in vitro TCPC model. These data were analyzed, and the target compliance was determined as 1.36 ± 0.78 mL/mm Hg. A method of in vitro compliance testing and computational simulations was employed to determine the in vitro flexible TCPC model material properties and then use those material properties to estimate the wall thickness necessary to match the patient-specific target compliance. The resulting in vitro TCPC model compliance was 1.37 ± 0.1 mL/mm Hg—a value within 1% of the patient-specific compliance. The presented method is useful to verify in vitro model accuracy of patient-specific TCPC compliance and thus improve patient-specific hemodynamic modeling.
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Affiliation(s)
- Mike Tree
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
| | - Brady Munz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Kevin Maher
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30332
| | - Shriprasad Deshpande
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30332
| | - Timothy Slesnick
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30332
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
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Respiratory Effects on Fontan Circulation During Rest and Exercise Using Real-Time Cardiac Magnetic Resonance Imaging. Ann Thorac Surg 2016; 101:1818-25. [PMID: 26872728 DOI: 10.1016/j.athoracsur.2015.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/25/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND It is known that respiration modulates cavopulmonary flows, but little data compare mean flows under breath-holding and free-breathing conditions to isolate the respiratory effects and effects of exercise on the respiratory modulation. METHODS Real-time phase-contrast magnetic resonance combined with a novel method to track respiration on the same image acquisition was used to investigate respiratory effects on Fontan caval and aortic flows under breath-holding, free-breathing, and exercise conditions. Respiratory phasicity indices that were based on beat-averaged flow were used to quantify the respiratory effect. RESULTS Flow during inspiration was substantially higher than expiration under the free-breathing and exercise conditions for both inferior vena cava (inspiration/expiration: 1.6 ± 0.5 and 1.8 ± 0.5, respectively) and superior vena cava (inspiration/expiration: 1.9 ± 0.6 and 2.6 ± 2.0, respectively). Changes from rest to exercise in the respiratory phasicity index for these vessels further showed the impact of respiration. Total systemic venous flow showed no significant statistical difference between the breath-holding and free-breathing conditions. In addition, no substantial difference was found between the descending aorta and inferior vena cava mean flows under either resting or exercise conditions. CONCLUSIONS This study demonstrated that inferior vena cava and superior vena cava flow time variance is dominated by respiratory effects, which can be detected by the respiratory phasicity index. However, the minimal respiration influence on net flow validates the routine use of breath-holding techniques to measure mean flows in Fontan patients. Moreover, the mean flows in the inferior vena cava and descending aorta are interchangeable.
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Feng L, Axel L, Chandarana H, Block KT, Sodickson DK, Otazo R. XD-GRASP: Golden-angle radial MRI with reconstruction of extra motion-state dimensions using compressed sensing. Magn Reson Med 2016; 75:775-88. [PMID: 25809847 PMCID: PMC4583338 DOI: 10.1002/mrm.25665] [Citation(s) in RCA: 395] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/15/2015] [Accepted: 02/01/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a novel framework for free-breathing MRI called XD-GRASP, which sorts dynamic data into extra motion-state dimensions using the self-navigation properties of radial imaging and reconstructs the multidimensional dataset using compressed sensing. METHODS Radial k-space data are continuously acquired using the golden-angle sampling scheme and sorted into multiple motion-states based on respiratory and/or cardiac motion signals derived directly from the data. The resulting undersampled multidimensional dataset is reconstructed using a compressed sensing approach that exploits sparsity along the new dynamic dimensions. The performance of XD-GRASP is demonstrated for free-breathing three-dimensional (3D) abdominal imaging, two-dimensional (2D) cardiac cine imaging and 3D dynamic contrast-enhanced (DCE) MRI of the liver, comparing against reconstructions without motion sorting in both healthy volunteers and patients. RESULTS XD-GRASP separates respiratory motion from cardiac motion in cardiac imaging, and respiratory motion from contrast enhancement in liver DCE-MRI, which improves image quality and reduces motion-blurring artifacts. CONCLUSION XD-GRASP represents a new use of sparsity for motion compensation and a novel way to handle motions in the context of a continuous acquisition paradigm. Instead of removing or correcting motion, extra motion-state dimensions are reconstructed, which improves image quality and also offers new physiological information of potential clinical value.
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Affiliation(s)
- Li Feng
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, New York, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, New York, USA
| | - Leon Axel
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, New York, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, New York, USA
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, New York, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Kai Tobias Block
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, New York, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Daniel K. Sodickson
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, New York, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, New York, USA
| | - Ricardo Otazo
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, New York, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, New York, USA
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Control of respiration-driven retrograde flow in the subdiaphragmatic venous return of the Fontan circulation. ASAIO J 2015; 60:391-9. [PMID: 24814833 DOI: 10.1097/mat.0000000000000093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Respiration influences the subdiaphragmatic venous return in the total cavopulmonary connection (TCPC) of the Fontan circulation whereby both the inferior vena cava (IVC) and hepatic vein flows can experience retrograde motion. Controlling retrograde flows could improve patient outcomes. Using a patient-specific model within a Fontan mock circulatory system with respiration, we inserted a valve into the IVC to examine its effects on local hemodynamics while varying retrograde volumes by changing vascular impedances. A bovine valved conduit reduced IVC retrograde flow to within 3% of antegrade flow in all cases. The valve closed only under conditions supporting retrograde flow and its effects on local hemodynamics increased with larger retrograde volume. Liver and TCPC pressures improved only when the valve leaflets were closed whereas cycle-averaged pressures improved only slightly (<1 mm Hg). Increased pulmonary vascular resistance raised mean circulation pressures, but the valve functioned and cardiac output improved and stabilized. Power loss across the TCPC improved by 12%-15% (p < 0.05) with a valve. The effectiveness of valve therapy is dependent on patient vascular impedance.
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Zhou J, Esmaily-Moghadam M, Conover TA, Hsia TY, Marsden AL, Figliola RS. In Vitro Assessment of the Assisted Bidirectional Glenn Procedure for Stage One Single Ventricle Repair. Cardiovasc Eng Technol 2015; 6:256-67. [PMID: 26577359 DOI: 10.1007/s13239-015-0232-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/25/2015] [Indexed: 11/28/2022]
Abstract
This in vitro study compares the hemodynamic performance of the Norwood and the Glenn circulations to assess the performance of a novel assisted bidirectional Glenn (ABG) procedure for stage one single ventricle surgery. In the ABG, the flow in a bidirectional Glenn procedure is assisted by injection of a high-energy flow stream from the systemic circulation using an aorta-caval shunt with nozzle. The aim is to explore experimentally the potential of the ABG as a surgical alternative to current surgical practice. The experiments are directly compared against previously published numerical simulations. A multiscale mock circulatory system was used to measure the hemodynamic performance of the three circulations. For each circulation, the system was tested using both low and high values of pulmonary vascular resistance. Resulting parameters measured were: pressure and flow rate at left/right pulmonary artery and superior vena cava (SVC). Systemic oxygen delivery (OD) was calculated. A parametric study of the ratio of ABG nozzle to shunt diameter was done. We report time-based comparisons with numerical simulations for the three surgical variants tested. The ABG circulation demonstrated an increase of 30-38% in pulmonary flow with a 2-3.7 mmHg increase in SVC pressure compared to the Glenn and a 4-14% higher systemic OD than either the Norwood or the Glenn. The nozzle/shunt diameter ratio affected the local hemodynamics. These experimental results agreed with those of the numerical model: mean flow values were not significantly different (p > 0.05) while mean pressures were comparable within 1.2 mmHg. The results verify the approaches providing two tools to study this complicated circulation. Using a realistic experimental model we demonstrate the performance of a novel surgical procedure with potential to improve patient hemodynamics in early palliation of the univentricular circulation.
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Affiliation(s)
- Jian Zhou
- Department of Mechanical Engineering, Clemson University, 247 Fluor Daniel Building, Clemson, SC, 29634, USA
| | | | - Timothy A Conover
- Department of Mechanical Engineering, Clemson University, 247 Fluor Daniel Building, Clemson, SC, 29634, USA
| | | | - Alison L Marsden
- Mechanical and Aerospace Engineering Department, University of California, San Diego, La Jolla, CA, USA
| | - Richard S Figliola
- Department of Mechanical Engineering, Clemson University, 247 Fluor Daniel Building, Clemson, SC, 29634, USA.
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15
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Comparison Between Bench-Top and Computational Modelling of Cerebral Thromboembolism in Ventricular Assist Device Circulation. Cardiovasc Eng Technol 2015; 6:242-55. [DOI: 10.1007/s13239-015-0230-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
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16
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Yamada A, Shiraishi Y, Miura H, Hashem HMO, Tsuboko Y, Yamagishi M, Yambe T. Development of a thermodynamic control system for the Fontan circulation pulsation device using shape memory alloy fibers. J Artif Organs 2015; 18:199-205. [DOI: 10.1007/s10047-015-0827-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 03/05/2015] [Indexed: 12/19/2022]
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17
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Malekzadeh-Milani S, Ladouceur M, Iserin L, Boudjemline Y. Percutaneous valvulation of failing Fontan: Rationale, acute effects and follow-up. Arch Cardiovasc Dis 2014; 107:599-606. [DOI: 10.1016/j.acvd.2014.07.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/06/2014] [Accepted: 07/22/2014] [Indexed: 01/08/2023]
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18
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Biglino G, Giardini A, Hsia TY, Figliola R, Taylor AM, Schievano S. Modeling single ventricle physiology: review of engineering tools to study first stage palliation of hypoplastic left heart syndrome. Front Pediatr 2013; 1:31. [PMID: 24400277 PMCID: PMC3864195 DOI: 10.3389/fped.2013.00031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/11/2013] [Indexed: 12/27/2022] Open
Abstract
First stage palliation of hypoplastic left heart syndrome, i.e., the Norwood operation, results in a complex physiological arrangement, involving different shunting options (modified Blalock-Taussig, RV-PA conduit, central shunt from the ascending aorta) and enlargement of the hypoplastic ascending aorta. Engineering techniques, both computational and experimental, can aid in the understanding of the Norwood physiology and their correct implementation can potentially lead to refinement of the decision-making process, by means of patient-specific simulations. This paper presents some of the available tools that can corroborate clinical evidence by providing detailed insight into the fluid dynamics of the Norwood circulation as well as alternative surgical scenarios (i.e., virtual surgery). Patient-specific anatomies can be manufactured by means of rapid prototyping and such models can be inserted in experimental set-ups (mock circulatory loops) that can provide a valuable source of validation data as well as hydrodynamic information. Such models can be tuned to respond to differing the patient physiologies. Experimental set-ups can also be compatible with visualization techniques, like particle image velocimetry and cardiovascular magnetic resonance, further adding to the knowledge of the local fluid dynamics. Multi-scale computational models include detailed three-dimensional (3D) anatomical information coupled to a lumped parameter network representing the remainder of the circulation. These models output both overall hemodynamic parameters while also enabling to investigate the local fluid dynamics of the aortic arch or the shunt. As an alternative, pure lumped parameter models can also be employed to model Stage 1 palliation, taking advantage of a much lower computational cost, albeit missing the 3D anatomical component. Finally, analytical techniques, such as wave intensity analysis, can be employed to study the Norwood physiology, providing a mechanistic perspective on the ventriculo-arterial coupling for this specific surgical scenario.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science , London , UK ; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Alessandro Giardini
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Tain-Yen Hsia
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Richard Figliola
- Departments of Bioengineering and Mechanical Engineering, Clemson University , Clemson, SC , USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science , London , UK ; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science , London , UK ; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
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Marsden AL. Simulation based planning of surgical interventions in pediatric cardiology. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2013; 25:101303. [PMID: 24255590 PMCID: PMC3820639 DOI: 10.1063/1.4825031] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/22/2013] [Indexed: 05/17/2023]
Abstract
Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.
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Affiliation(s)
- Alison L Marsden
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, California 92093, USA
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