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Sommer KN, Shepard LM, Mitsouras D, Iyer V, Angel E, Wilson MF, Rybicki FJ, Kumamaru KK, Sharma UC, Reddy A, Fujimoto S, Ionita CN. Patient-specific 3D-printed coronary models based on coronary computed tomography angiography volumes to investigate flow conditions in coronary artery disease. Biomed Phys Eng Express 2020; 6:045007. [PMID: 33444268 DOI: 10.1088/2057-1976/ab8f6e] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND 3D printed patient-specific coronary models have the ability to enable repeatable benchtop experiments under controlled blood flow conditions. This approach can be applied to CT-derived patient geometries to emulate coronary flow and related parameters such as Fractional Flow Reserve (FFR). METHODS This study uses 3D printing to compare such benchtop FFR results with a non-invasive CT-FFR research software algorithm and catheter based invasive FFR (I-FFR) measurements. Fifty-two patients with a clinical indication for I-FFR underwent a research Coronary CT Angiography (CCTA) prior to catheterization. CT images were used to measure CT-FFR and to generate patient-specific 3D printed models of the aortic root and three main coronary arteries. Each patient-specific model was connected to a programmable pulsatile pump and benchtop FFR (B-FFR) was derived from pressures measured proximal and distal to coronary stenosis using pressure transducers. B-FFR was measured for two coronary outflow rates ('normal', 250 ml min-1; and 'hyperemic', 500 ml min-1) by adjusting the model's distal coronary resistance. RESULTS Pearson correlations and ROC AUC were calculated using invasive I-FFR as reference. The Pearson correlation factor of CT-FFR and B-FFR-500 was 0.75 and 0.71, respectively. Areas under the ROCs for CT-FFR and B-FFR-500 were 0.80 (95%CI: 0.70-0.87) and 0.81 (95%CI: 0.64-0.91) respectively. CONCLUSION Benchtop flow simulations with 3D printed models provide the capability to measure pressure changes at any location in the model, for ultimately emulating the FFR at several simulated physiological blood flow conditions. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/show/NCT03149042.
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Affiliation(s)
- Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228, United States of America. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, United States of America
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Caimi A, Sturla F, Pluchinotta FR, Giugno L, Secchi F, Votta E, Carminati M, Redaelli A. Prediction of stenting related adverse events through patient-specific finite element modelling. J Biomech 2018; 79:135-146. [PMID: 30139536 DOI: 10.1016/j.jbiomech.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/03/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
Right ventricular outflow tract (RVOT) calcific obstruction is frequent after homograft conduit implantation to treat congenital heart disease. Stenting and percutaneous pulmonary valve implantation (PPVI) can relieve the obstruction and prolong the conduit lifespan, but require accurate pre-procedural evaluation to minimize the risk of coronary artery (CA) compression, stent fracture, conduit injury or arterial distortion. Herein, we test patient-specific finite element (FE) modeling as a tool to assess stenting feasibility and investigate clinically relevant risks associated to the percutaneous intervention. Three patients undergoing attempted PPVI due to calcific RVOT conduit failure were enrolled; the calcific RVOT, the aortic root and the proximal CA were segmented on CT scans for each patient. We numerically reproduced RVOT balloon angioplasty to test procedure feasibility and the subsequent RVOT pre-stenting expanding the stent through a balloon-in-balloon delivery system. Our FE framework predicted the occurrence of CA compression in the patient excluded from the real procedure. In the two patients undergoing RVOT stenting, numerical results were consistent with intraprocedural in-vivo fluoroscopic evidences. Furthermore, it quantified the stresses on the stent and on the relevant native structures, highlighting their marked dependence on the extent, shape and location of the calcific deposits. Stent deployment induced displacement and mechanical loading of the calcific deposits, also impacting on the adjacent anatomical structures. This novel workflow has the potential to tackle the analysis of complex RVOT clinical scenarios, pinpointing the procedure impact on the dysfunctional anatomy and elucidating potential periprocedural complications.
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Affiliation(s)
- Alessandro Caimi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesca Romana Pluchinotta
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Giugno
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Mario Carminati
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Capelli C, Sauvage E, Giusti G, Bosi GM, Ntsinjana H, Carminati M, Derrick G, Marek J, Khambadkone S, Taylor AM, Schievano S. Patient-specific simulations for planning treatment in congenital heart disease. Interface Focus 2017; 8:20170021. [PMID: 29285347 PMCID: PMC5740223 DOI: 10.1098/rsfs.2017.0021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Patient-specific computational models have been extensively developed over the last decades and applied to investigate a wide range of cardiovascular problems. However, translation of these technologies into clinical applications, such as planning of medical procedures, has been limited to a few single case reports. Hence, the use of patient-specific models is still far from becoming a standard of care in clinical practice. The aim of this study is to describe our experience with a modelling framework that allows patient-specific simulations to be used for prediction of clinical outcomes. A cohort of 12 patients with congenital heart disease who were referred for percutaneous pulmonary valve implantation, stenting of aortic coarctation and surgical repair of double-outlet right ventricle was included in this study. Image data routinely acquired for clinical assessment were post-processed to set up patient-specific models and test device implantation and surgery. Finite-element and computational fluid dynamics analyses were run to assess feasibility of each intervention and provide some guidance. Results showed good agreement between simulations and clinical decision including feasibility, device choice and fluid-dynamic parameters. The promising results of this pilot study support translation of computer simulations as tools for personalization of cardiovascular treatments.
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Affiliation(s)
- Claudio Capelli
- UCL Institute of Cardiovascular Science, London, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Emilie Sauvage
- UCL Institute of Cardiovascular Science, London, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Giuliano Giusti
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS-Policlinico San Donato, San Donato, Milanese, Italy
| | - Giorgia M Bosi
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,UCL Department of Mechanical Engineering, London, UK
| | - Hopewell Ntsinjana
- CH Baragwanath Hospital University of the Witwatersrand, Johannesburg, South Africa
| | - Mario Carminati
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, IRCCS-Policlinico San Donato, San Donato, Milanese, Italy
| | - Graham Derrick
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Jan Marek
- UCL Institute of Cardiovascular Science, London, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sachin Khambadkone
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Andrew M Taylor
- UCL Institute of Cardiovascular Science, London, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science, London, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Bosi GM, Biffi B, Biglino G, Lintas V, Jones R, Tzamtzis S, Burriesci G, Migliavacca F, Khambadkone S, Taylor AM, Schievano S. Can finite element models of ballooning procedures yield mechanical response of the cardiovascular site to overexpansion? J Biomech 2016; 49:2778-2784. [PMID: 27395759 PMCID: PMC5522534 DOI: 10.1016/j.jbiomech.2016.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 11/23/2022]
Abstract
Patient-specific numerical models could aid the decision-making process for percutaneous valve selection; in order to be fully informative, they should include patient-specific data of both anatomy and mechanics of the implantation site. This information can be derived from routine clinical imaging during the cardiac cycle, but data on the implantation site mechanical response to device expansion are not routinely available. We aim to derive the implantation site response to overexpansion by monitoring pressure/dimensional changes during balloon sizing procedures and by applying a reverse engineering approach using a validated computational balloon model. This study presents the proof of concept for such computational framework tested in-vitro. A finite element (FE) model of a PTS-X405 sizing balloon (NuMed, Inc., USA) was created and validated against bench tests carried out on an ad hoc experimental apparatus: first on the balloon alone to replicate free expansion; second on the inflation of the balloon in a rapid prototyped cylinder with material deemed suitable for replicating pulmonary arteries in order to validate balloon/implantation site interaction algorithm. Finally, the balloon was inflated inside a compliant rapid prototyped patient-specific right ventricular outflow tract to test the validity of the approach. The corresponding FE simulation was set up to iteratively infer the mechanical response of the anatomical model. The test in this simplified condition confirmed the feasibility of the proposed approach and the potential for this methodology to provide patient-specific information on mechanical response of the implantation site when overexpanded, ultimately for more realistic computational simulations in patient-specific settings.
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Affiliation(s)
- Giorgia M Bosi
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK.
| | - Benedetta Biffi
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK; Department of Medical Physics & Biomedical Engineering, UCL, London, UK
| | - Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Valentina Lintas
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy
| | - Rod Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Spyros Tzamtzis
- UCL Mechanical Engineering, Cardiovascular Engineering Laboratory, University College London, UK
| | - Gaetano Burriesci
- UCL Mechanical Engineering, Cardiovascular Engineering Laboratory, University College London, UK
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy
| | - Sachin Khambadkone
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
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