Computer dynamics to evaluate blood flow through the modified Blalock-Taussig shunt

Sant'Anna, João Ricardo Michielin; Pereira, Dimitrius Caloghero; Kalil, Renato; Horowitz, Estela Suzana Kleiman; Sant’Anna, Roberto T.; Prates, Paulo R.; Nesralla, Ivo A.

doi:10.1590/s0102-76382003000300010

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Sant'anna и соавт. рассматривался угол установки модифицированного шунта Блэлока -Тауссига [87]. Процент кровотока, полученного через шунт, возрастает по мере увеличения соотношения диаметров шунта и подключичной артерии.…”

Section: биомеханическое моделирование течения крови при применении модифицированного шунта блэлока -тауссигаunclassified

Application of mathematical modelling for the evaluation of the results of systemiс-pulmonary shunts formation

Sinelnikov¹,

Arutunyan²,

Porodikov³

et al. 2020

PKiK

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Surgical treatment of congenital heart defects with the obstruction of the outflow tract of the right ventricle can be performed in several stages. The first stage of surgical correction is the creation of a systemic-pulmonary shunt, followed by radical correction. The main complications of systemic-pulmonary shunts are associated with the development of shunt thrombosis and hypervolemia of the pulmonary circulation. Currently, considering the importance of individual selection of a shunt for effective functioning, the main scientific search is aimed at creating optimal methods that consider all the hemodynamic features of a particular patient. Recently, the direction of mathematical modelling and biomechanical analysis in medicine has been actively developing, facilitating the objective evaluation of the accumulated clinical experience and is one of the main tools in evidence-based medicine. The use of computational fluid dynamics methods for modified Blalock–Taussig shunt analysis allows us evaluate the hemodynamic parameters for various configurations of shunts and anastomosis angles and improve the understanding of pathophysiological processes in the cardiovascular system before or after an application of the modified Blalock–Taussig shunt. Here, we provide an overview of the work related to the use of modelling for the calculation of the currents in the aorta–shunt–pulmonary artery system. It is noteworthy that most studies consider the personalised characteristics of the patients and are therefore highly likely to be used in clinical practice. The main hemodynamic parameters that are analysed with the computer calculations are described. Part of the work is devoted to the stages of computer modelling and the limitations in the implementation of these stages. We believe that this manuscript will be of interest to specialists in cardiovascular surgery and to the several scholars working in areas related to the use of digital technologies in medicine, mathematical modelling in medicine and biomechanics.Received 30 January 2020. Revised 25 May 2020. Accepted 9 June 2020.Conflict of interest: Authors declare no conflict of interest.Funding: The work is supported by the program for the development of the Scientific and Educational Mathematical Center of the Volga Federal District (No. 075-02-2020-1478) and a grant for the development of the scientific school of the Perm Region “Computer biomechanics and digital technologies in biomedicine”.Author contributions Conception and design: Yu.S. Sinelnikov, V.B. Arutunyan, A.A. Porodikov, A.N. Biyanov, V.S. Tuktamyshev, M.I. Shmurak, A.R. Khairulin Drafting the article: A.A. Porodikov, A.N. Biyanov, A.G. Kuchumov Critical revision of the article: A.N. Biyanov, A.G. Kuchumov Final approval of the version to be published: Yu.S. Sinelnikov, V.B. Arutunyan, A.A. Porodikov, A.N. Biyanov, V.S. Tuktamyshev, M.I. Shmurak, A.R. Khairulin, A.G. Kuchumov

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Application of mathematical modelling for the evaluation of the results of systemiс-pulmonary shunts formation

Sinelnikov¹,

Arutunyan²,

Porodikov³

et al. 2020

PKiK

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“…The ideal angle is between 60° and 90°, with angles of approximately 110° associated with excessive pulmonary flow and angles of approximately 30° leading to significant pressure drops. [65][66][67]…”

Section: Modified Blalock-taussig Shunt: Geometrical Framework and Prmentioning

confidence: 99%

Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome: Review of the Literature and Implications for the Anesthesiologist

Pérez

Riveros

2017

Semin Cardiothorac Vasc Anesth

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The first stage of surgical treatment for hypoplastic left heart syndrome (HLHS) includes the creation of artificial systemic-to-pulmonary connections to provide pulmonary blood flow. The modified Blalock-Taussig (mBT) shunt has been the technique of choice for this procedure; however, a right ventricle-pulmonary artery (RV-PA) shunt has been introduced into clinical practice with encouraging but still conflicting outcomes when compared with the mBT shunt. The aim of this study is to explore mathematical modeling as a tool for describing physical profiles that could assist the surgical team in predicting complications related to stenosis and malfunction of grafts in an attempt to find correlations with clinical outcomes from clinical studies that compared both surgical techniques and to assist the anesthesiologist in making decisions to manage patients with this complex cardiac anatomy. Mathematical modeling to display the physical characteristics of the chosen surgical shunt is a valuable tool to predict flow patterns, shear stress, and rate distribution as well as energetic performance at the graft level and relative to ventricular efficiency. Such predictions will enable the surgical team to refine the technique so that hemodynamic complications be anticipated and prevented, and are also important for perioperative management by the anesthesia team.

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“…Computational fluid dynamics (CFD) has been increasingly used to study the effects of the diameter, curvature and angle of the conduits, and the hemodynamics of mBT procedures (Malota et al, 2007;Migliavacca et al, 2000;Sant'Anna et al, 2003;Waniewski et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

Pişkin

Altin

Yıldız

et al. 2017

Journal of Biomechanics

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Optimal hemodynamics in aorta-pulmonary shunt reconstruction is essential for improved post-operative recovery of the newborn congenital heart disease patient. However, prior to in vivo execution, the prediction of post-operative hemodynamics is extremely challenging due to the interplay of multiple confounding physiological factors. It is hypothesized that the post-operative performance of the surgical shunt can be predicted through computational blood flow simulations that consider patient size, shunt configuration, cardiac output and the complex three-dimensional disease anatomy. Utilizing only the routine patient-specific pre-surgery clinical data sets, we demonstrated an intelligent decision-making process for a real patient having pulmonary artery atresia and ventricular septal defect. For this patient, a total of 12 customized candidate shunt configurations are contemplated and reconstructed virtually using a sketch-based computer-aided anatomical editing tool. Candidate shunt configurations are evaluated based on the parameters that are computed from the flow simulations, which include 3D flow complexity, outlet flow splits, shunt patency, coronary perfusion and energy loss. Our results showed that the modified Blalock-Taussig (mBT) shunt has 12% higher right pulmonary artery (RPA) and 40% lower left pulmonary artery (LPA) flow compared to the central shunt configuration. Also, the RPA flow regime is distinct from the LPA, creating an uneven flow split at the pulmonary arteries. For all three shunt sizes, right mBT innominate and central configurations cause higher pulmonary artery (PA) flow and lower coronary artery pressure than right and left mBT subclavian configurations. While there is a trade-off between energy loss, flow split and coronary artery pressure, overall, the mBT shunts provide sufficient PA perfusion with higher coronary artery pressures and could be preferred for similar patients having PA overflow risk. Central shunts would be preferred otherwise particularly for cases with very low PA overflow risk.

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Computer dynamics to evaluate blood flow through the modified Blalock-Taussig shunt

Cited by 8 publications

References 18 publications

Application of mathematical modelling for the evaluation of the results of systemiс-pulmonary shunts formation

Application of mathematical modelling for the evaluation of the results of systemiс-pulmonary shunts formation

Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome: Review of the Literature and Implications for the Anesthesiologist

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

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