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Aramburu J, Ruijsink B, Chabiniok R, Pushparajah K, Alastruey J. Patient-specific closed-loop model of the fontan circulation: Calibration and validation. Heliyon 2024; 10:e30404. [PMID: 38742066 PMCID: PMC11089314 DOI: 10.1016/j.heliyon.2024.e30404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
The Fontan circulation, designed for managing patients with a single functional ventricle, presents challenges in long-term outcomes. Computational methods offer potential solutions, yet their application in cardiology practice remains largely unexplored. Our aim was to assess the ability of a patient-specific, closed-loop, reduced-order blood flow model to simulate pulsatile blood flow in the Fontan circulation. Using one-dimensional models, we simulated the aorta, superior and inferior venae cavae, and right and left pulmonary arteries, while lumping heart chambers and remaining vessels into zero-dimensional models. The model was calibrated with patient-specific haemodynamic data from combined cardiac catheterisation and magnetic resonance exams, using a novel physics-based stepwise methodology involving simpler open-loop models. Testing on a 10-year-old, anesthetised patient, demonstrated the model's capability to replicate pulsatile pressure and flow in the larger vessels and ventricular pressure. Average relative errors in mean pressure and flow were 2.9 % and 3.6 %, with average relative point-to-point errors (RPPE) in pressure and flow at 5.2 % and 16.0 %. Comparing simulation results to measurements, mean aortic pressure and flow values were 50.7 vs. 50.4 mmHg and 41.6 vs. 41.9 ml/s, respectively, while ventricular pressure values were 28.7 vs. 27.4 mmHg. The model accurately described time-varying ventricular volume with a RPPE of 2.9 %, with mean, minimum, and maximum ventricular volume values for simulation results vs. measurements at 59.2 vs. 58.2 ml, 38.0 vs. 37.6 ml, and 76.0 vs. 74.4 ml, respectively. It provided physiologically realistic predictions of haemodynamic changes from pulmonary vasodilation and atrial fenestration opening. The new model and calibration methodology are freely available, offering a platform to virtually investigate the Fontan circulation's response to clinical interventions and explore potential mechanisms of Fontan failure. Future efforts will concentrate on broadening the model's applicability to a wider range of patient populations and clinical scenarios, as well as testing its effectiveness.
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Affiliation(s)
- Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingeniería, P° Manuel Lardizabal 13, 20018, Donostia/San Sebastián, Spain
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, SE1 7EH, London, UK
| | - Radomir Chabiniok
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, SE1 7EH, London, UK
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, SE1 7EH, London, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, SE1 7EH, London, UK
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, SE1 7EH, London, UK
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2
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Chapelle D, Le Gall A. A biomechanics-based parametrized cardiac end-diastolic pressure-volume relationship for accurate patient-specific calibration and estimation. Sci Rep 2023; 13:11232. [PMID: 37433813 DOI: 10.1038/s41598-023-38196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
A simple power law has been proposed in the pioneering work of Klotz et al. (Am J Physiol Heart Circ Physiol 291(1):H403-H412, 2006) to approximate the end-diastolic pressure-volume relationship of the left cardiac ventricle, with limited inter-individual variability provided the volume is adequately normalized. Nevertheless, we use here a biomechanical model to investigate the sources of the remaining data dispersion observed in the normalized space, and we show that variations of the parameters of the biomechanical model realistically account for a substantial part of this dispersion. We therefore propose an alternative law based on the biomechanical model that embeds some intrinsic physical parameters, which directly enables personalization capabilities, and paves the way for related estimation approaches.
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Affiliation(s)
- Dominique Chapelle
- Inria, Palaiseau, France.
- LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France.
| | - Arthur Le Gall
- Inria, Palaiseau, France
- LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
- AP-HP, Hôpital Lariboisière, Paris, France
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3
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Evaluation of Different Cannulation Strategies for Aortic Arch Surgery Using a Cardiovascular Numerical Simulator. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010060. [PMID: 36671632 PMCID: PMC9854437 DOI: 10.3390/bioengineering10010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Aortic disease has a significant impact on quality of life. The involvement of the aortic arch requires the preservation of blood supply to the brain during surgery. Deep hypothermic circulatory arrest is an established technique for this purpose, although neurological injury remains high. Additional techniques have been used to reduce risk, although controversy still remains. A three-way cannulation approach, including both carotid arteries and the femoral artery or the ascending aorta, has been used successfully for aortic arch replacement and redo procedures. We developed circuits of the circulation to simulate blood flow during this type of cannulation set up. The CARDIOSIM© cardiovascular simulation platform was used to analyse the effect on haemodynamic and energetic parameters and the benefit derived in terms of organ perfusion pressure and flow. Our simulation approach based on lumped-parameter modelling, pressure-volume analysis and modified time-varying elastance provides a theoretical background to a three-way cannulation strategy for aortic arch surgery with correlation to the observed clinical practice.
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4
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Gusseva M, Castellanos DA, Greer JS, Hussein MA, Hasbani K, Greil G, Veeram Reddy SR, Hussain T, Chapelle D, Chabiniok R. Time-Synchronization of Interventional Cardiovascular Magnetic Resonance Data Using a Biomechanical Model for Pressure-Volume Loop Analysis. J Magn Reson Imaging 2023; 57:320-323. [PMID: 35567583 DOI: 10.1002/jmri.28216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Maria Gusseva
- Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Daniel A Castellanos
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joshua S Greer
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mohamed Abdelghafar Hussein
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.,Pediatric Department, Kafrelsheikh University, Kafr Elsheikh, Egypt
| | - Keren Hasbani
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Medical School, UT Austin, Texas, USA
| | - Gerald Greil
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Surendranath R Veeram Reddy
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dominique Chapelle
- Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Radomír Chabiniok
- Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France.,Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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5
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Marlevi D, Mariscal-Harana J, Burris NS, Sotelo J, Ruijsink B, Hadjicharalambous M, Asner L, Sammut E, Chabiniok R, Uribe S, Winter R, Lamata P, Alastruey J, Nordsletten D. Altered Aortic Hemodynamics and Relative Pressure in Patients with Dilated Cardiomyopathy. J Cardiovasc Transl Res 2022; 15:692-707. [PMID: 34882286 PMCID: PMC9622552 DOI: 10.1007/s12265-021-10181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/20/2021] [Indexed: 12/05/2022]
Abstract
Ventricular-vascular interaction is central in the adaptation to cardiovascular disease. However, cardiomyopathy patients are predominantly monitored using cardiac biomarkers. The aim of this study is therefore to explore aortic function in dilated cardiomyopathy (DCM). Fourteen idiopathic DCM patients and 16 controls underwent cardiac magnetic resonance imaging, with aortic relative pressure derived using physics-based image processing and a virtual cohort utilized to assess the impact of cardiovascular properties on aortic behaviour. Subjects with reduced left ventricular systolic function had significantly reduced aortic relative pressure, increased aortic stiffness, and significantly delayed time-to-pressure peak duration. From the virtual cohort, aortic stiffness and aortic volumetric size were identified as key determinants of aortic relative pressure. As such, this study shows how advanced flow imaging and aortic hemodynamic evaluation could provide novel insights into the manifestation of DCM, with signs of both altered aortic structure and function derived in DCM using our proposed imaging protocol.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Danderyd, Sweden
| | - Jorge Mariscal-Harana
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, Cardio MR, Chile
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Myrianthi Hadjicharalambous
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Liya Asner
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eva Sammut
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Faculty of Health Science, Bristol Heart Institute and Translational Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Radomir Chabiniok
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Inria, Palaiseau, France
- LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, , Prague, Czech Republic
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, Cardio MR, Chile
- Department of Radiology, School of Medicine, Pontifica Universidad Católica de Chile, Santiago, Chile
| | - Reidar Winter
- Department of Clinical Sciences, Karolinska Institutet, Danderyd, Sweden
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- World-Class Research Center "Digital Biodesign and Personlized Healthcare", Sechenov University, Moscow, Russia
| | - David Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Cardiac Surgery and Biomedical Engineering, University of Michigan, Plymouth Rd, Ann Arbor, MI, 48109, USA.
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6
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Prediction of Ventricular Mechanics After Pulmonary Valve Replacement in Tetralogy of Fallot by Biomechanical Modeling: A Step Towards Precision Healthcare. Ann Biomed Eng 2021; 49:3339-3348. [PMID: 34853921 DOI: 10.1007/s10439-021-02895-9] [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: 09/28/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Clinical indicators of heart function are often limited in their ability to accurately evaluate the current mechanical state of the myocardium. Biomechanical modeling has been shown to be a promising tool in addition to clinical indicators. By providing a patient-specific measure of myocardial active stress (contractility), biomechanical modeling can enhance the precision of the description of patient's pathophysiology at any given point in time. In this work we aim to explore the ability of biomechanical modeling to predict the response of ventricular mechanics to the progressively decreasing afterload in repaired tetralogy of Fallot (rTOF) patients undergoing pulmonary valve replacement (PVR) for significant residual right ventricular outflow tract obstruction (RVOTO). We used 19 patient-specific models of patients with rTOF prior to pulmonary valve replacement (PVR), denoted as PSMpre, and patient-specific models of the same patients created post-PVR (PSMpost)-both created in our previous published work. Using the PSMpre and assuming cessation of the pulmonary regurgitation and a progressive decrease of RVOT resistance, we built relationships between the contractility and RVOT resistance post-PVR. The predictive value of such in silico obtained relationships were tested against the PSMpost, i.e. the models created from the actual post-PVR datasets. Our results show a linear 1-dimensional relationship between the in silico predicted contractility post-PVR and the RVOT resistance. The predicted contractility was close to the contractility in the PSMpost model with a mean (± SD) difference of 6.5 (± 3.0)%. The relationships between the contractility predicted by in silico PVR vs. RVOT resistance have a potential to inform clinicians about hypothetical mechanical response of the ventricle based on the degree of pre-operative RVOTO.
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Gusseva M, Hussain T, Friesen CH, Moireau P, Tandon A, Patte C, Genet M, Hasbani K, Greil G, Chapelle D, Chabiniok R. Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients After Complete Repair. Can J Cardiol 2021; 37:1798-1807. [PMID: 34216743 PMCID: PMC9810481 DOI: 10.1016/j.cjca.2021.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/05/2021] [Accepted: 06/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. METHODS Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. RESULTS RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff-both in line with published data. CONCLUSIONS This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.
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Affiliation(s)
- Maria Gusseva
- Inria, Palaiseau, France,LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Camille Hancock Friesen
- Division of Pediatric Cardiothoracic Surgery, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Philippe Moireau
- Inria, Palaiseau, France,LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Animesh Tandon
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Cécile Patte
- Inria, Palaiseau, France,LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Martin Genet
- Inria, Palaiseau, France,LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Keren Hasbani
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Gerald Greil
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dominique Chapelle
- Inria, Palaiseau, France,LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Radomír Chabiniok
- Inria, Palaiseau, France,LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France,Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA,School of Biomedical Engineering & Imaging Sciences, St Thomas’ Hospital, King’s College London, London, United Kingdom,Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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8
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Left Ventricular Torsion Obtained Using Equilibrated Warping in Patients with Repaired Tetralogy of Fallot. Pediatr Cardiol 2021; 42:1275-1283. [PMID: 33900430 PMCID: PMC9753563 DOI: 10.1007/s00246-021-02608-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Patients after surgical repair of Tetralogy of Fallot (rTOF) may suffer a decrease in left ventricular (LV) function. The aim of our study is to evaluate a novel method of assessing LV torsion in patients with rTOF, as an early indicator of systolic LV dysfunction. Motion tracking based on image registration regularized by the equilibrium gap principle, known as equilibrated warping, was employed to assess LV torsion. Seventy-six cases of rTOF and ten normal controls were included. The group of controls was assessed for reproducibility using both equilibrated warping and standard clinical tissue tracking software (CVI42, version 5.10.1, Calgary, Canada). Patients were dichotomized into two groups: normal vs. loss of torsion. Torsion by equilibrated warping was successfully obtained in 68 of 76 (89%) patients and 9 of 10 (90%) controls. For equilibrated warping, the intra- and interobserver coefficients of variation were 0.095 and 0.117, respectively, compared to 0.260 and 0.831 for tissue tracking by standard clinical software. The intra- and inter-observer intraclass correlation coefficients for equilibrated warping were 0.862 and 0.831, respectively, compared to 0.992 and 0.648 for tissue tracking. Loss of torsion was noted in 32 of the 68 (47%) patients with rTOF. There was no difference in LV or RV volumes or ejection fraction between these groups. The assessment of LV torsion by equilibrated warping is feasible and shows good reliability. Loss of torsion is common in patients with rTOF and its robust assessment might contribute into uncovering heart failure in an earlier stage.
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A Tribute to Ajit Yoganathan's Cardiovascular Fluid Mechanics Lab: A Survey of Its Contributions to Our Understanding of the Physiology and Management of Single-Ventricle Patients. Cardiovasc Eng Technol 2021; 12:631-639. [PMID: 34018153 DOI: 10.1007/s13239-021-00540-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/30/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Among patients with congenital heart disease, those born with only a single working ventricle represent a particularly complex sub-population, typically requiring multiple surgeries and suffering from high levels of mortality and morbidity. Their cardiac care is complex and has evolved considerably since surgical palliation was first introduced more than 50 years ago. Improvements in treatment have been driven both by growing clinical experience and by knowledge gained through experimental and computational studies of blood flow in these patients. The Cardiovascular Fluid Mechanics Lab at the Georgia Institute of Technology, founded 30 years ago by Dr. Ajit Yoganathan, has pioneered work in this field. METHODS In this review, key contributions of Dr. Yoganathan's Cardiovascular Fluid Dynamics Lab are surveyed, including experimental flow loop studies as well as computational fluid dynamics analyses that address many of the critical challenges that cardiologists and surgeons face in treating these patients, including how to reconstruct cardiovascular anatomy to minimize power loss, balance blood flow distribution at key bifurcation points, and avoid other unfavorable hemodynamic conditions. CONCLUSIONS Among many contributions in this field, work from the Cardiovascular Fluid Mechanics Lab has led to novel medical devices and patient-specific computational modeling workflows and software tools. These key contributions from this group have enhanced our understanding of the physiology and management of single-ventricle patients.
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10
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Ordoñez MV, Biglino G, Caputo M, Curtis SL. Pregnancy in the FONTAN palliation: physiology, management and new insights from bioengineering. JOURNAL OF CONGENITAL CARDIOLOGY 2021. [DOI: 10.1186/s40949-021-00058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractFontan palliation for the single ventricle results in a challenging and delicate physiological state. At rest, the body adapts to a low cardiac output and high systemic venous pressure. However, when physiological demands increase, such as in the case of exercise or pregnancy, this delicate physiology struggles to adapt due to the inability of the heart to pump blood into the lungs and the consequent lack of augmentation of the cardiac output.Due to the advances in paediatric cardiology, surgery and intensive care, today most patients born with congenital heart disease reach adulthood. Consequently, many women with a Fontan circulation are becoming pregnant and so far data suggest that, although maternal risk is not high, the outcomes are poor for the foetus. Little is known about the reasons for this disparity and how the Fontan circulation adapts to the physiological demands of pregnancy.Here we review current knowledge about pregnancy in Fontan patients and explore the potential role of computational modelling as a means of better understanding this complex physiology in order to potentially improve outcomes, particularly for the foetus.
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11
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Le Gall A, Vallée F, Pushparajah K, Hussain T, Mebazaa A, Chapelle D, Gayat É, Chabiniok R. Monitoring of cardiovascular physiology augmented by a patient-specific biomechanical model during general anesthesia. A proof of concept study. PLoS One 2020; 15:e0232830. [PMID: 32407353 PMCID: PMC7224549 DOI: 10.1371/journal.pone.0232830] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022] Open
Abstract
During general anesthesia (GA), direct analysis of arterial pressure or aortic flow waveforms may be inconclusive in complex situations. Patient-specific biomechanical models, based on data obtained during GA and capable to perform fast simulations of cardiac cycles, have the potential to augment hemodynamic monitoring. Such models allow to simulate Pressure-Volume (PV) loops and estimate functional indicators of cardiovascular (CV) system, e.g. ventricular-arterial coupling (Vva), cardiac efficiency (CE) or myocardial contractility, evolving throughout GA. In this prospective observational study, we created patient-specific biomechanical models of heart and vasculature of a reduced geometric complexity for n = 45 patients undergoing GA, while using transthoracic echocardiography and aortic pressure and flow signals acquired in the beginning of GA (baseline condition). If intraoperative hypotension (IOH) appeared, diluted norepinephrine (NOR) was administered and the model readjusted according to the measured aortic pressure and flow signals. Such patients were a posteriori assigned into a so-called hypotensive group. The accuracy of simulated mean aortic pressure (MAP) and stroke volume (SV) at baseline were in accordance with the guidelines for the validation of new devices or reference measurement methods in all patients. After NOR administration in the hypotensive group, the percentage of concordance with 10% exclusion zone between measurement and simulation was >95% for both MAP and SV. The modeling results showed a decreased Vva (0.64±0.37 vs 0.88±0.43; p = 0.039) and an increased CE (0.8±0.1 vs 0.73±0.11; p = 0.042) in hypotensive vs normotensive patients. Furthermore, Vva increased by 92±101%, CE decreased by 13±11% (p < 0.001 for both) and contractility increased by 14±11% (p = 0.002) in the hypotensive group post-NOR administration. In this work we demonstrated the application of fast-running patient-specific biophysical models to estimate PV loops and functional indicators of CV system using clinical data available during GA. The work paves the way for model-augmented hemodynamic monitoring at operating theatres or intensive care units to enhance the information on patient-specific physiology.
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Affiliation(s)
- Arthur Le Gall
- Inria, Paris, France
- LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France
- Anesthesiology and Intensive Care Department, Lariboisière - Saint Louis - Fernand Widal University Hospitals, Paris, France
- INSERM, Paris, France
| | - Fabrice Vallée
- Inria, Paris, France
- LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France
- Anesthesiology and Intensive Care Department, Lariboisière - Saint Louis - Fernand Widal University Hospitals, Paris, France
- INSERM, Paris, France
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, St Thomas’ Hospital, King’s College London, London, United Kingdom
| | - Tarique Hussain
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Alexandre Mebazaa
- Anesthesiology and Intensive Care Department, Lariboisière - Saint Louis - Fernand Widal University Hospitals, Paris, France
- INSERM, Paris, France
| | - Dominique Chapelle
- Inria, Paris, France
- LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France
| | - Étienne Gayat
- Anesthesiology and Intensive Care Department, Lariboisière - Saint Louis - Fernand Widal University Hospitals, Paris, France
- INSERM, Paris, France
| | - Radomír Chabiniok
- Inria, Paris, France
- LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France
- School of Biomedical Engineering & Imaging Sciences, St Thomas’ Hospital, King’s College London, London, United Kingdom
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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12
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Fučík R, Galabov R, Pauš P, Eichler P, Klinkovský J, Straka R, Tintěra J, Chabiniok R. Investigation of phase-contrast magnetic resonance imaging underestimation of turbulent flow through the aortic valve phantom: experimental and computational study using lattice Boltzmann method. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:649-662. [PMID: 32108906 DOI: 10.1007/s10334-020-00837-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/20/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The accuracy of phase-contrast magnetic resonance imaging (PC-MRI) measurement is investigated using a computational fluid dynamics (CFD) model with the objective to determine the magnitude of the flow underestimation due to turbulence behind a narrowed valve in a phantom experiment. MATERIALS AND METHODS An acrylic stationary flow phantom is used with three insertable plates mimicking aortic valvular stenoses of varying degrees. Positive and negative horizontal fluxes are measured at equidistant slices using standard PC-MRI sequences by 1.5T and 3T systems. The CFD model is based on the 3D lattice Boltzmann method (LBM). The experimental and simulated data are compared using the Bland-Altman-derived limits of agreement. Based on the LBM results, the turbulence is quantified and confronted with the level of flow underestimation. RESULTS LBM gives comparable results to PC-MRI for valves up to moderate stenosis on both field strengths. The flow magnitude through a severely stenotic valve was underestimated due to signal void in the regions of turbulent flow behind the valve, consistently with the level of quantified turbulence intensity. DISCUSSION Flow measured by PC-MRI is affected by noise and turbulence. LBM can simulate turbulent flow efficiently and accurately, it has therefore the potential to improve clinical interpretation of PC-MRI.
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Affiliation(s)
- Radek Fučík
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic.
| | - Radek Galabov
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic.,Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Pauš
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic
| | - Pavel Eichler
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic
| | - Jakub Klinkovský
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic
| | - Robert Straka
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic.,Department of Heat Engineering and Environment Protection, AGH University of Science and Technology, Kraków, Poland
| | - Jaroslav Tintěra
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Radomír Chabiniok
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Trojanova 13, 120 00 Praha 2, Prague, Czech Republic.,Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France.,School of Biomedical Engineering & Imaging Sciences (BMEIS), St Thomas' Hospital, King's College London, London, UK.,Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, 75235-7701, USA
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