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Deus J, Martin E. Efficient Cardiovascular Parameters Estimation for Fluid-Structure Simulations Using Gappy Proper Orthogonal Decomposition. Ann Biomed Eng 2024:10.1007/s10439-024-03568-z. [PMID: 38969956 DOI: 10.1007/s10439-024-03568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024]
Abstract
As full-scale detailed hemodynamic simulations of the entire vasculature are not feasible, numerical analysis should be focused on specific regions of the cardiovascular system, which requires the identification of lumped parameters to represent the patient behavior outside the simulated computational domain. We present a novel technique for estimating cardiovascular model parameters using gappy Proper Orthogonal Decomposition (g-POD). A POD basis is constructed with FSI simulations for different values of the lumped model parameters, and a linear operator is applied to retain information that can be compared to the available patient measurements. Then, the POD coefficients of the reconstructed solution are computed either by projecting patient measurements or by solving a minimization problem with constraints. The POD reconstruction is then used to estimate the model parameters. In the first test case, the parameter values of a 3-element Windkessel model are approximated using artificial patient measurements, obtaining a relative error of less than 4.2%. In the second case, 4 sets of 3-element Windkessel are approximated in a patient's aorta geometry, resulting in an error of less than 8% for the flow and less than 5% for the pressure. The method shows accurate results even with noisy patient data. It automatically calculates the delay between measurements and simulations and has flexibility in the types of patient measurements that can handle (at specific points, spatial or time averaged). The method is easy to implement and can be used in simulations performed in general-purpose FSI software.
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Affiliation(s)
- J Deus
- Departamento de Ingeniería Mecánica, Máquinas y Motores Térmicos y Fluidos, Universidade de Vigo, Campus Marcosende, 36310, Vigo, Spain
| | - E Martin
- Departamento de Ingeniería Mecánica, Máquinas y Motores Térmicos y Fluidos, Universidade de Vigo, Campus Marcosende, 36310, Vigo, Spain.
- Instituto de Física y Ciencias Aeroespaciales (IFCAE), Universidade de Vigo, Campus de As Lagoas, 32004, Ourense, Spain.
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2
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Lan IS, Yang W, Feinstein JA, Kreutzer J, Collins RT, Ma M, Adamson GT, Marsden AL. Virtual Transcatheter Interventions for Peripheral Pulmonary Artery Stenosis in Williams and Alagille Syndromes. J Am Heart Assoc 2022; 11:e023532. [PMID: 35253446 PMCID: PMC9075299 DOI: 10.1161/jaha.121.023532] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Despite favorable outcomes of surgical pulmonary artery (PA) reconstruction, isolated proximal stenting of the central PAs is common clinical practice for patients with peripheral PA stenosis in association with Williams and Alagille syndromes. Given the technical challenges of PA reconstruction and the morbidities associated with transcatheter interventions, the hemodynamic consequences of all treatment strategies must be rigorously assessed. Our study aims to model, assess, and predict hemodynamic outcomes of transcatheter interventions in these patients.
Methods and Results
Isolated proximal and “extensive” interventions (stenting and/or balloon angioplasty of proximal and lobar vessels) were performed in silico on 6 patient‐specific PA models. Autoregulatory adaptation of the cardiac output and downstream arterial resistance was modeled in response to intervention‐induced hemodynamic perturbations. Postintervention computational fluid dynamics predictions were validated in 2 stented patients and quantitatively assessed in 4 surgical patients. Our computational methods accurately predicted postinterventional PA pressures, the primary indicators of success for treatment of peripheral PA stenosis. Proximal and extensive treatment achieved median reductions of 14% and 40% in main PA systolic pressure, 27% and 56% in pulmonary vascular resistance, and 10% and 45% in right ventricular stroke work, respectively.
Conclusions
In patients with Williams and Alagille syndromes, extensive transcatheter intervention is required to sufficiently reduce PA pressures and right ventricular stroke work. Transcatheter therapy was shown to be ineffective for long‐segment stenosis and pales hemodynamically in comparison with published outcomes of surgical reconstruction. Regardless of the chosen strategy, a virtual treatment planning platform could identify lesions most critical for optimizing right ventricular afterload.
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Affiliation(s)
- Ingrid S. Lan
- Department of Bioengineering Stanford University Stanford CA
| | - Weiguang Yang
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
| | - Jeffrey A. Feinstein
- Department of Bioengineering Stanford University Stanford CA
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
| | - Jacqueline Kreutzer
- Department of Pediatrics (Cardiology) University of Pittsburgh Pittsburgh PA
| | - R. Thomas Collins
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
- Department of Medicine (Cardiovascular Medicine) Stanford University Stanford CA
| | - Michael Ma
- Department of Cardiothoracic Surgery Stanford University Stanford CA
| | | | - Alison L. Marsden
- Department of Bioengineering Stanford University Stanford CA
- Department of Pediatrics (Cardiology) Stanford University Stanford CA
- Institute for Computational and Mathematical Engineering Stanford University Stanford CA
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3
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Non-Newtonian Effects on Patient-Specific Modeling of Fontan Hemodynamics. Ann Biomed Eng 2020; 48:2204-2217. [PMID: 32372365 DOI: 10.1007/s10439-020-02527-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
The Fontan procedure is a common palliative surgery for congenital single ventricle patients. In silico and in vitro patient-specific modeling approaches are widely utilized to investigate potential improvements of Fontan hemodynamics that are related to long-term complications. However, there is a lack of consensus regarding the use of non-Newtonian rheology, warranting a systematic investigation. This study conducted in silico patient-specific modeling for twelve Fontan patients, using a Newtonian and a non-Newtonian model for each patient. Differences were quantified by examining clinically relevant metrics: indexed power loss (iPL), indexed viscous dissipation rate (iVDR), hepatic flow distribution (HFD), and regions of low wall shear stress (AWSS). Four sets of "non-Newtonian importance factors" were calculated to explore their effectiveness in identifying the non-Newtonian effect. No statistical differences were observed in iPL, iVDR, and HFD between the two models at the population-level, but large inter-patient variations exist. Significant differences were detected regarding AWSS, and its correlations with non-Newtonian importance factors were discussed. Additionally, simulations using the non-Newtonian model were computationally faster than those using the Newtonian model. These findings distinguish good importance factors for identifying non-Newtonian rheology and encourage the use of a non-Newtonian model to assess Fontan hemodynamics.
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4
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Bianchi D, Monaldo E, Gizzi A, Marino M, Filippi S, Vairo G. A FSI computational framework for vascular physiopathology: A novel flow-tissue multiscale strategy. Med Eng Phys 2017; 47:25-37. [PMID: 28690045 DOI: 10.1016/j.medengphy.2017.06.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/05/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
Abstract
A novel fluid-structure computational framework for vascular applications is herein presented. It is developed by combining the double multi-scale nature of vascular physiopathology in terms of both tissue properties and blood flow. Addressing arterial tissues, they are modelled via a nonlinear multiscale constitutive rationale, based only on parameters having a clear histological and biochemical meaning. Moreover, blood flow is described by coupling a three-dimensional fluid domain (undergoing physiological inflow conditions) with a zero-dimensional model, which allows to reproduce the influence of the downstream vasculature, furnishing a realistic description of the outflow proximal pressure. The fluid-structure interaction is managed through an explicit time-marching approach, able to accurately describe tissue nonlinearities within each computational step for the fluid problem. A case study associated to a patient-specific aortic abdominal aneurysmatic geometry is numerically investigated, highlighting advantages gained from the proposed multiscale strategy, as well as showing soundness and effectiveness of the established framework for assessing useful clinical quantities and risk indexes.
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Affiliation(s)
- Daniele Bianchi
- Department of Civil Engineering and Computer Science (DICII), Universitá degli Studi di Roma "Tor Vergata", Via del Politecnico 1, Rome 00133, Italy.
| | - Elisabetta Monaldo
- Department of Engineering, Universitá degli Studi "Niccoló Cusano" - Telematica, Roma, Via Don C. Gnocchi 3, Rome 00166, Italy
| | - Alessio Gizzi
- Department of Engineering, Unit of Nonlinear Physics and Mathematical Modeling, University Campus Bio-Medico of Rome, Via A. del Portillo 21, Rome 00128, Italy
| | - Michele Marino
- Institute of Continuum Mechanics, Leibniz Universität Hannover, Appelstr. 11, Hannover 30167, Germany
| | - Simonetta Filippi
- Department of Engineering, Unit of Nonlinear Physics and Mathematical Modeling, University Campus Bio-Medico of Rome, Via A. del Portillo 21, Rome 00128, Italy
| | - Giuseppe Vairo
- Department of Civil Engineering and Computer Science (DICII), Universitá degli Studi di Roma "Tor Vergata", Via del Politecnico 1, Rome 00133, Italy
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5
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Blanco PJ, Müller LO, Watanabe SM, Feijóo RA. Computational modeling of blood flow steal phenomena caused by subclavian stenoses. J Biomech 2016; 49:1593-1600. [PMID: 27062592 DOI: 10.1016/j.jbiomech.2016.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
The study of steal mechanisms caused by vessel obstructions is of the utmost importance to gain understanding about their pathophysiology, as well as to improve diagnosis and management procedures. The goal of this work is to perform a computational study to gain insight into the hemodynamic forces that drive blood flow steal mechanisms caused by subclavian artery stenosis. Such condition triggers a flow disorder known as subclavian steal. When this occurs in patients with internal thoracic artery anastomosed to the coronary vessels, the phenomenon includes a coronary-subclavian steal. True steal can exist in cases of increased arm blood flow, potentially resulting in neurological complications and, in the case of coronary-subclavian steal, graft function failure. In this context, the anatomically detailed arterial network (ADAN) model is employed to simulate subclavian steal and coronary-subclavian steal phenomena. Model results are verified by comparison with published data. It is concluded that this kind of model allows us to effectively address complex hemomdynamic phenomena occurring in clinical practice. More specifically, in the studied conditions it is observed that a regional brain steal occurs, primarily affecting the posterior circulation, not fully compensated by the anterior circulation. In the case of patients with coronary revascularization, it is concluded that there is a large variability in graft hemodynamic environments, which physically explain both the success of the procedure in cases of severe occlusive disease, and the reason for graft dysfunction in mildly stenosed left anterior descending coronary artery, due to alternating graft flow waveform signatures.
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Affiliation(s)
- P J Blanco
- National Laboratory for Scientific Computing, LNCC/MCTI, Av. Getúlio Vargas, 333, Petrópolis-RJ, 25651-075, Brazil; INCT-MACC Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Brazil.
| | - L O Müller
- National Laboratory for Scientific Computing, LNCC/MCTI, Av. Getúlio Vargas, 333, Petrópolis-RJ, 25651-075, Brazil; INCT-MACC Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Brazil.
| | - S M Watanabe
- Federal Rural University of Pernambuco, UFRPE, Av. Bom Pastor, s/n, Boa Vista, Garanhuns-PE 55292-270, Brazil; INCT-MACC Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Brazil.
| | - R A Feijóo
- National Laboratory for Scientific Computing, LNCC/MCTI, Av. Getúlio Vargas, 333, Petrópolis-RJ, 25651-075, Brazil; INCT-MACC Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Brazil.
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6
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Haemodynamic impact of stent implantation for lateral tunnel Fontan stenosis: a patient-specific computational assessment. Cardiol Young 2016; 26:116-26. [PMID: 25712430 DOI: 10.1017/s1047951114002765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The physiological importance of the lateral tunnel stenosis in the Fontan pathway for children with single ventricle physiology can be difficult to determine. The impact of the stenosis and stent implantation on total cavopulmonary connection resistance has not been characterized, and there are no clear guidelines for intervention. Methods and results A computational framework for haemodynamic assessment of stent implantation in patients with lateral tunnel stenosis was developed. Cardiac magnetic resonances images were reconstructed to obtain total cavopulmonary connection anatomies before stent implantation. Stents with 2-mm diameter increments were virtually implanted in each patient to understand the impact of stent diameter. Numerical simulations were performed in all geometries with patient-specific flow rates. Exercise conditions were simulated by doubling and tripling the lateral tunnel flow rate. The resulting total cavopulmonary connection vascular resistances were computed. A total of six patients (age: 14.4 ± 3.1 years) with lateral tunnel stenosis were included for preliminary analysis. The mean baseline resistance was 1.54 ± 1.08 WU · m(2) and dependent on the stenosis diameter. It was further exacerbated during exercise. It was observed that utilising a stent with a larger diameter lowered the resistance, but the resistance reduction diminished at larger diameters. CONCLUSIONS Using a computational framework to assess the severity of lateral tunnel stenosis and the haemodynamic impact of stent implantation, it was observed that stenosis in the lateral tunnel pathway was associated with higher total cavopulmonary connection resistance than unobstructed pathways, which was exacerbated during exercise. Stent implantation could reduce the resistance, but the improvement was specific to the minimum diameter.
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Arbia G, Corsini C, Baker C, Pennati G, Hsia TY, Vignon-Clementel IE. Pulmonary Hemodynamics Simulations Before Stage 2 Single Ventricle Surgery: Patient-Specific Parameter Identification and Clinical Data Assessment. Cardiovasc Eng Technol 2015; 6:268-80. [DOI: 10.1007/s13239-015-0212-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/10/2015] [Indexed: 10/24/2022]
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Biglino G, Cosentino D, Steeden JA, De Nova L, Castelli M, Ntsinjana H, Pennati G, Taylor AM, Schievano S. Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study. Front Pediatr 2015; 3:107. [PMID: 26697416 PMCID: PMC4677094 DOI: 10.3389/fped.2015.00107] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022] Open
Abstract
Computational fluid dynamics (CFD) can have a complementary predictive role alongside the exquisite visualization capabilities of 4D cardiovascular magnetic resonance (CMR) imaging. In order to exploit these capabilities (e.g., for decision-making), it is necessary to validate computational models against real world data. In this study, we sought to acquire 4D CMR flow data in a controllable, experimental setup and use these data to validate a corresponding computational model. We applied this paradigm to a case of congenital heart disease, namely, transposition of the great arteries (TGA) repaired with arterial switch operation. For this purpose, a mock circulatory loop compatible with the CMR environment was constructed and two detailed aortic 3D models (i.e., one TGA case and one normal aortic anatomy) were tested under realistic hemodynamic conditions, acquiring 4D CMR flow. The same 3D domains were used for multi-scale CFD simulations, whereby the remainder of the mock circulatory system was appropriately summarized with a lumped parameter network. Boundary conditions of the simulations mirrored those measured in vitro. Results showed a very good quantitative agreement between experimental and computational models in terms of pressure (overall maximum % error = 4.4% aortic pressure in the control anatomy) and flow distribution data (overall maximum % error = 3.6% at the subclavian artery outlet of the TGA model). Very good qualitative agreement could also be appreciated in terms of streamlines, throughout the cardiac cycle. Additionally, velocity vectors in the ascending aorta revealed less symmetrical flow in the TGA model, which also exhibited higher wall shear stress in the anterior ascending aorta.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Daria Cosentino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Lorenzo De Nova
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Matteo Castelli
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Hopewell Ntsinjana
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Giancarlo Pennati
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
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Pant S, Fabrèges B, Gerbeau JF, Vignon-Clementel IE. A methodological paradigm for patient-specific multi-scale CFD simulations: from clinical measurements to parameter estimates for individual analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1614-1648. [PMID: 25345820 DOI: 10.1002/cnm.2692] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/19/2014] [Accepted: 10/19/2014] [Indexed: 06/04/2023]
Abstract
A new framework for estimation of lumped (for instance, Windkessel) model parameters from uncertain clinical measurements is presented. The ultimate aim is to perform patient-specific haemodynamic analysis. This framework is based on sensitivity analysis tools and the sequential estimation approach of the unscented Kalman filter. Sensitivity analysis and parameter estimation are performed in lumped parameter models, which act as reduced order surrogates of the 3D domain for haemodynamic analysis. While the goal of sensitivity analysis is to assess potential identifiability problems, the unscented Kalman filter estimation leads to parameter estimates based on clinical measurements and modelling assumptions. An application of such analysis and parameter estimation methodology is demonstrated for synthetic and real data. Equality constraints on various physiological parameters are enforced. Since the accuracy of the Windkessel parameter estimates depends on the lumped parameter representativeness, the latter is iteratively improved by running few 3D simulations while simultaneously improving the former. Such a method is applied on a patient-specific aortic coarctation case. Less than 3% and 9% errors between the clinically measured quantities and 3D simulation results for rest and stress are obtained, respectively. Knowledge on how these Windkessel parameters change from rest to stress can thus be learned by such an approach. Lastly, it is demonstrated that the proposed approach is capable of dealing with a wide variety of measurements and cases where the pressure and flow clinical measurements are not taken simultaneously.
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Affiliation(s)
- S Pant
- INRIA Paris-Rocquencourt, 78153 Le Chesnay, France; UPMC Université Paris 6, Laboratoire Jacques-Louis Lions, 75005 Paris, France
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10
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Corsini C, Baker C, Baretta A, Biglino G, Hlavacek AM, Hsia TY, Kung E, Marsden A, Migliavacca F, Vignon-Clementel I, Pennati G. Integration of Clinical Data Collected at Different Times for Virtual Surgery in Single Ventricle Patients: A Case Study. Ann Biomed Eng 2014; 43:1310-20. [DOI: 10.1007/s10439-014-1113-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
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Blanco PJ, Watanabe SM, Passos MARF, Lemos PA, Feijóo RA. An anatomically detailed arterial network model for one-dimensional computational hemodynamics. IEEE Trans Biomed Eng 2014; 62:736-53. [PMID: 25347874 DOI: 10.1109/tbme.2014.2364522] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Simulation platforms are increasingly becoming complementary tools for cutting-edge cardiovascular research. The interplay among structural properties of the arterial wall, morphometry, anatomy, wave propagation phenomena, and ultimately, cardiovascular diseases continues to be poorly understood. Accurate models are powerful tools to shed light on these open problems. We developed an anatomically detailed computational model of the arterial vasculature to conduct 1-D blood flow simulations to serve as simulation infrastructure to aid cardiovascular research. An average arterial vasculature of a man was outlined in 3-D space to serve as geometrical substrate for the mathematical model. The architecture of this model comprises almost every arterial vessel acknowledged in the medical/anatomical literature, with a resolution down to the luminal area of perforator arteries. Over 2000 arterial vessels compose the model. Anatomical, physiological, and mechanical considerations were employed for the set up of model parameters and to determine criteria for blood flow distribution. Computational fluid dynamics was used to simulate blood flow and wave propagation phenomena in such arterial network. A sensitivity analysis was developed to unveil the contributions of model parameters to the conformation of the pressure waveforms. In addition, parameters were modified to target model to a patient-specific scenario. On the light of the knowledge domain, we conclude that the present model features excellent descriptive and predictive capabilities in both patient-generic and patient-specific cases, presenting a new step toward integrating an unprecedented anatomical description, morphometric, and simulations data to help in understanding complex arterial blood flow phenomena and related cardiovascular diseases.
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Liang F, Sughimoto K, Matsuo K, Liu H, Takagi S. Patient-specific assessment of cardiovascular function by combination of clinical data and computational model with applications to patients undergoing Fontan operation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1000-1018. [PMID: 24753499 DOI: 10.1002/cnm.2641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 11/01/2013] [Accepted: 03/22/2014] [Indexed: 06/03/2023]
Abstract
The assessment of cardiovascular function is becoming increasingly important for the care of patients with single-ventricle defects. However, most measurement methods available in the clinical setting cannot provide a separate measure of cardiac function and loading conditions. In the present study, a numerical method has been proposed to compensate for the limitations of clinical measurements. The main idea was to estimate the parameters of a cardiovascular model by fitting model simulations to patient-specific clinical data via parameter optimization. Several strategies have been taken to establish a well-posed parameter optimization problem, including clinical data-matched model development, parameter selection based on an extensive sensitivity analysis, and proper choice of parameter optimization algorithm. The numerical experiments confirmed the ability of the proposed parameter optimization method to uniquely determine the model parameters given an arbitrary set of clinical data. The method was further tested in four patients undergoing the Fontan operation. Obtained results revealed a prevalence of ventricular abnormalities in the patient cohort and at the same time demonstrated the presence of marked inter-patient differences and preoperative to postoperative changes in cardiovascular function. Because the method allows a quick assessment and makes use of clinical data available in clinical practice, its clinical application is promising.
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Affiliation(s)
- Fuyou Liang
- SJTU-CU International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
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Liang F, Senzaki H, Kurishima C, Sughimoto K, Inuzuka R, Liu H. Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 2014; 307:H1056-72. [DOI: 10.1152/ajpheart.00245.2014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patient-specific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.
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Affiliation(s)
- Fuyou Liang
- Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hideaki Senzaki
- Department of Pediatrics and Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Clara Kurishima
- Department of Pediatrics and Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Koichi Sughimoto
- Department of Cardiac Surgery, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ryo Inuzuka
- Pediatrics, University Hospital University of Tokyo, Tokyo, Japan; and
| | - Hao Liu
- Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- Graduate School of Engineering, Chiba University, Inage, Chiba, Japan
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Abstract
The inherent structural and physiological complexity of congenital heart disease lends itself strongly to simulation. Complex hemodynamic and structural problems unique to congenital heart disease may be difficult to understand and the response to therapy or intervention uncertain. Methodologies borrowed from engineering, computing and mathematical sciences can be applied to such problems and used to inform clinical decisions. Therapy thus informed by modeling experiments has the potential to contribute significantly to improved clinical outcomes. This field remains in its infancy, and will only become used routinely if validation of current methods is carried out in the clinical setting.
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15
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Fogel MA, Khiabani RH, Yoganathan A. Imaging for preintervention planning: pre- and post-Fontan procedures. Circ Cardiovasc Imaging 2014; 6:1092-101. [PMID: 24254479 DOI: 10.1161/circimaging.113.000335] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark A Fogel
- Division of Cardiology, Departments of Pediatrics and Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
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16
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Abstract
The Fontan procedure, although an imperfect solution for children born with a single functional ventricle, is the only reconstruction at present short of transplantation. The haemodynamics associated with the total cavopulmonary connection, the modern approach to Fontan, are severely altered from the normal biventricular circulation and may contribute to the long-term complications that are frequently noted. Through recent technological advances, spear-headed by advances in medical imaging, it is now possible to virtually model these surgical procedures and evaluate the patient-specific haemodynamics as part of the pre-operative planning process. This is a novel paradigm with the potential to revolutionise the approach to Fontan surgery, help to optimise the haemodynamic results, and improve patient outcomes. This review provides a brief overview of these methods, presents preliminary results of their clinical usage, and offers insights into its potential future directions.
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17
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Pennati G, Corsini C, Hsia TY, Migliavacca F. Computational fluid dynamics models and congenital heart diseases. Front Pediatr 2013; 1:4. [PMID: 24432298 PMCID: PMC3882907 DOI: 10.3389/fped.2013.00004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/01/2013] [Indexed: 11/13/2022] Open
Abstract
Mathematical modeling is a powerful tool to investigate hemodynamics of the circulatory system. With improving imaging techniques and detailed clinical investigations, it is now possible to construct patient-specific models of reconstructive surgeries for the treatment of congenital heart diseases. These models can help clinicians to better understand the hemodynamic behavior of different surgical options for a treated patient. This review outlines recent advances in mathematical modeling in congenital heart diseases, the discoveries and limitations these models present, and future directions that are on the horizon.
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Affiliation(s)
- Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano Milano, Italy
| | - Chiara Corsini
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano Milano, Italy
| | - Tain-Yen Hsia
- Cardiac Unit, Great Ormond Street Hospital for Children London, UK
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano Milano, Italy
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Leinan PR, Kiserud T, Hellevik LR. Human Ductus Venosus Velocity Profiles in the First Trimester. Cardiovasc Eng Technol 2013; 4:257-266. [DOI: 10.1007/s13239-013-0133-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
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Corsini C, Baker C, Kung E, Schievano S, Arbia G, Baretta A, Biglino G, Migliavacca F, Dubini G, Pennati G, Marsden A, Vignon-Clementel I, Taylor A, Hsia TY, Dorfman A. An integrated approach to patient-specific predictive modeling for single ventricle heart palliation. Comput Methods Biomech Biomed Engin 2013; 17:1572-89. [PMID: 23343002 DOI: 10.1080/10255842.2012.758254] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In patients with congenital heart disease and a single ventricle (SV), ventricular support of the circulation is inadequate, and staged palliative surgery (usually 3 stages) is needed for treatment. In the various palliative surgical stages individual differences in the circulation are important and patient-specific surgical planning is ideal. In this study, an integrated approach between clinicians and engineers has been developed, based on patient-specific multi-scale models, and is here applied to predict stage 2 surgical outcomes. This approach involves four distinct steps: (1) collection of pre-operative clinical data from a patient presenting for SV palliation, (2) construction of the pre-operative model, (3) creation of feasible virtual surgical options which couple a three-dimensional model of the surgical anatomy with a lumped parameter model (LPM) of the remainder of the circulation and (4) performance of post-operative simulations to aid clinical decision making. The pre-operative model is described, agreeing well with clinical flow tracings and mean pressures. Two surgical options (bi-directional Glenn and hemi-Fontan operations) are virtually performed and coupled to the pre-operative LPM, with the hemodynamics of both options reported. Results are validated against postoperative clinical data. Ultimately, this work represents the first patient-specific predictive modeling of stage 2 palliation using virtual surgery and closed-loop multi-scale modeling.
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Affiliation(s)
- Chiara Corsini
- a Laboratory of Biological Structure Mechanics, Department of Structural Engineering , Politecnico di Milano, Piazza Leonardo da Vinci , 32, 20133, Milano , Italy
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Haggerty CM, de Zélicourt DA, Restrepo M, Rossignac J, Spray TL, Kanter KR, Fogel MA, Yoganathan AP. Comparing pre- and post-operative Fontan hemodynamic simulations: implications for the reliability of surgical planning. Ann Biomed Eng 2012; 40:2639-51. [PMID: 22777126 DOI: 10.1007/s10439-012-0614-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 06/27/2012] [Indexed: 11/25/2022]
Abstract
Virtual modeling of cardiothoracic surgery is a new paradigm that allows for systematic exploration of various operative strategies and uses engineering principles to predict the optimal patient-specific plan. This study investigates the predictive accuracy of such methods for the surgical palliation of single ventricle heart defects. Computational fluid dynamics (CFD)-based surgical planning was used to model the Fontan procedure for four patients prior to surgery. The objective for each was to identify the operative strategy that best distributed hepatic blood flow to the pulmonary arteries. Post-operative magnetic resonance data were acquired to compare (via CFD) the post-operative hemodynamics with predictions. Despite variations in physiologic boundary conditions (e.g., cardiac output, venous flows) and the exact geometry of the surgical baffle, sufficient agreement was observed with respect to hepatic flow distribution (90% confidence interval-14 ± 4.3% difference). There was also good agreement of flow-normalized energetic efficiency predictions (19 ± 4.8% error). The hemodynamic outcomes of prospective patient-specific surgical planning of the Fontan procedure are described for the first time with good quantitative comparisons between preoperatively predicted and postoperative simulations. These results demonstrate that surgical planning can be a useful tool for single ventricle cardiothoracic surgery with the ability to deliver significant clinical impact.
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Affiliation(s)
- Christopher M Haggerty
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA 30332, USA
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Long CC, Hsu MC, Bazilevs Y, Feinstein JA, Marsden AL. Fluid-structure interaction simulations of the Fontan procedure using variable wall properties. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2012; 28:513-527. [PMID: 25099455 DOI: 10.1002/cnm.1485] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/25/2011] [Accepted: 10/28/2011] [Indexed: 05/29/2023]
Abstract
Children born with single ventricle heart defects typically undergo a staged surgical procedure culminating in a total cavopulmonary connection (TCPC) or Fontan surgery. The goal of this work was to perform physiologic, patient-specific hemodynamic simulations of two post-operative TCPC patients by using fluid-structure interaction (FSI) simulations. Data from two patients are presented, and post-op anatomy is reconstructed from MRI data. Respiration rate, heart rate, and venous pressures are obtained from catheterization data, and inflow rates are obtained from phase contrast MRI data and are used together with a respiratory model. Lumped parameter (Windkessel) boundary conditions are used at the outlets. We perform FSI simulations by using an arbitrary Lagrangian-Eulerian finite element framework to account for motion of the blood vessel walls in the TCPC. This study is the first to introduce variable elastic properties for the different areas of the TCPC, including a Gore-Tex conduit. Quantities such as wall shear stresses and pressures at critical locations are extracted from the simulation and are compared with pressure tracings from clinical data as well as with rigid wall simulations. Hepatic flow distribution and energy efficiency are also calculated and compared for all cases. There is little effect of FSI on pressure tracings, hepatic flow distribution, and time-averaged energy efficiency. However, the effect of FSI on wall shear stress, instantaneous energy efficiency, and wall motion is significant and should be considered in future work, particularly for accurate prediction of thrombus formation.
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Affiliation(s)
- C C Long
- University of California, San Diego, 9500 Gilman Drive, Mail Code 0411, La Jolla, CA, 92093-0411, USA
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Troianowski G, Taylor CA, Feinstein JA, Vignon-Clementel IE. Three-dimensional simulations in Glenn patients: clinically based boundary conditions, hemodynamic results and sensitivity to input data. J Biomech Eng 2012; 133:111006. [PMID: 22168738 DOI: 10.1115/1.4005377] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While many congenital heart defects can be treated without significant long term sequelae, some achieve successful palliation as their definitive endpoints. The single-ventricle defect is one such defect and leaves the child with only one operational ventricle, requiring the systemic and the pulmonary circulations to be placed in series through several operations performed during early childhood. Numerical simulations may be used to investigate these hemodynamic conditions and their relation to post-operative sequelae; however, they rely heavily on boundary condition prescription. In this study, we investigate the impact of hemodynamic input data uncertainties on simulation results. Imaged-based patient-specific models of the multi-branched pulmonary arteries and superior vena cava were built for five cavopulmonary connection (i.e. Glenn) patients. Magnetic resonance imaging and catheterization data were acquired for each patient prior to their Fontan surgery. Inflow and outflow boundary conditions were constructed to match available clinical data and resulted in the development of a framework to incorporate these types of clinical data into patient-specific simulations. Three-dimensional computational fluid dynamics simulations were run and hemodynamic indicators were computed. Power loss was low (and efficiency very high) and a linear correlation was found between power loss and cardiac index among the five patients. Other indicators such as low wall shear stress were considered to better characterize these patients. Flow was complex and oscillatory near the anastomosis, and laminar in the smaller branches. While common trends were seen among patients, results showed differences among patients, especially in the 3D maps, strengthening the importance of patient-specific simulations. A sensitivity analysis was performed to investigate the impact of input data (clinical and modeling) to construct boundary conditions on several indicators. Overall, the sensitivity of the output indicators to the input data was small but non-negligible. The sensitivity of commonly used hemodynamic indicators to compare patients is discussed in this context. Power efficiency was much more sensitive to pressure variation than power loss. To increase the precision of such indicators, mean flow split between right and left lungs needs to be measured with more accuracy with higher priority than refining the model of how the flow is distributed on average among the smaller branches. Although ± 10% flow split imprecision seemed reasonable in terms of patient comparison, this study suggests that the common practice of imposing a right pulmonary artery/left pulmonary artery flow split of 55%/45% when performing patient specific simulations should be avoided. This study constitutes a first step towards understanding the hemodynamic differences between pre- and post Fontan surgery, predicting these differences, and evaluating surgical outcomes based on preoperative data.
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Affiliation(s)
- G. Troianowski
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA 94305
| | - C. A. Taylor
- Bioengineering Department, Stanford University, Stanford, CA 94305; Surgery Department, Stanford University, Stanford, CA 94305
| | - J. A. Feinstein
- Bioengineering Department, Stanford University, Stanford, CA 94305; Pediatrics Department, Stanford University, Stanford, CA 94305
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Baretta A, Corsini C, Yang W, Vignon-Clementel IE, Marsden AL, Feinstein JA, Hsia TY, Dubini G, Migliavacca F, Pennati G. Virtual surgeries in patients with congenital heart disease: a multi-scale modelling test case. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4316-4330. [PMID: 21969678 DOI: 10.1098/rsta.2011.0130] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objective of this work is to perform a virtual planning of surgical repairs in patients with congenital heart diseases--to test the predictive capability of a closed-loop multi-scale model. As a first step, we reproduced the pre-operative state of a specific patient with a univentricular circulation and a bidirectional cavopulmonary anastomosis (BCPA), starting from the patient's clinical data. Namely, by adopting a closed-loop multi-scale approach, the boundary conditions at the inlet and outlet sections of the three-dimensional model were automatically calculated by a lumped parameter network. Successively, we simulated three alternative surgical designs of the total cavopulmonary connection (TCPC). In particular, a T-junction of the venae cavae to the pulmonary arteries (T-TCPC), a design with an offset between the venae cavae (O-TCPC) and a Y-graft design (Y-TCPC) were compared. A multi-scale closed-loop model consisting of a lumped parameter network representing the whole circulation and a patient-specific three-dimensional finite volume model of the BCPA with detailed pulmonary anatomy was built. The three TCPC alternatives were investigated in terms of energetics and haemodynamics. Effects of exercise were also investigated. Results showed that the pre-operative caval flows should not be used as boundary conditions in post-operative simulations owing to changes in the flow waveforms post-operatively. The multi-scale approach is a possible solution to overcome this incongruence. Power losses of the Y-TCPC were lower than all other TCPC models both at rest and under exercise conditions and it distributed the inferior vena cava flow evenly to both lungs. Further work is needed to correlate results from these simulations with clinical outcomes.
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MESH Headings
- Anastomosis, Surgical
- Blood Flow Velocity
- Cardiology/methods
- Child, Preschool
- Computer Simulation
- Computers
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Male
- Models, Anatomic
- Models, Cardiovascular
- Models, Theoretical
- Pulmonary Artery/abnormalities
- Pulmonary Artery/surgery
- Vena Cava, Inferior/abnormalities
- Vena Cava, Inferior/surgery
- Vena Cava, Superior/abnormalities
- Vena Cava, Superior/surgery
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Affiliation(s)
- A Baretta
- Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Milan, Italy
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Abstract
The Virtual Physiological Human is synonymous with a programme in computational biomedicine that aims to develop a framework of methods and technologies to investigate the human body as a whole. It is predicated on the transformational character of information technology, brought to bear on that most crucial of human concerns, our own health and well-being.
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Affiliation(s)
- Peter V. Coveney
- Centre for Computational Science, University College London, 20 Gordon Street, London WC1H 0AJ, UK
| | - Vanessa Diaz
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Peter Hunter
- Auckland Bioengineering Institute, The University of Auckland, Auckland 1142, New Zealand
| | - Peter Kohl
- Heart Science Centre, Imperial College, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK
| | - Marco Viceconti
- Medical Technology Laboratory, Instituto Orthopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
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