A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

Puelz, Charles; Acosta, Sebastián; Rivière, Béatrice; Penny, Daniel J.; Brady, Ken; Rusin, Craig G.

doi:10.1016/j.compbiomed.2017.08.024

Cited by 16 publications

(18 citation statements)

References 70 publications

(88 reference statements)

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“…The model type used in this study is not new, and even though previous studies, e.g. [72,73,74,75] involve more complex interactions (e.g. nonlinear venous compliance, systemic and pulmonary sub-circuits, inductors, etc.…”

Section: Discussionmentioning

confidence: 99%

Practical identifiability and uncertainty quantification of a pulsatile cardiovascular model

Marquis

Arnold

Dean-Bernhoft

et al. 2018

Mathematical Biosciences

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Mathematical models are essential tools to study how the cardiovascular system maintains homeostasis. The utility of such models is limited by the accuracy of their predictions, which can be determined by uncertainty quantification (UQ). A challenge associated with the use of UQ is that many published methods assume that the underlying model is identifiable (e.g. that a one-to-one mapping exists from the parameter space to the model output). In this study we present a novel workflow to calibrate a lumped-parameter model to left ventricular pressure and volume time series data. Key steps include using (1) literature and available data to determine nominal parameter values; (2) sensitivity analysis and subset selection to determine a set of identifiable parameters; (3) optimization to find a point estimate for identifiable parameters; and (4) frequentist and Bayesian UQ calculations to assess the predictive capability of the model. Our results show that it is possible to determine 5 identifiable model parameters that can be estimated to our experimental data from three rats, and that computed UQ intervals capture the measurement and model error.

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Section: Discussionmentioning

confidence: 99%

Practical identifiability and uncertainty quantification of a pulsatile cardiovascular model

Marquis

Arnold

Dean-Bernhoft

et al. 2018

Mathematical Biosciences

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“…works of Suga et al [18]. Closed-loop models of this type, based on population trends, have given an insight into the (patho)physiology of Fontan circulation [19,20]. However, the limited amount of detailed patient-specific biophysical components reduces the predictions for individual patients.…”

Section: Modeling Fontan Physiologymentioning

confidence: 99%

Dobutamine stress testing in patients with Fontan circulation augmented by biomechanical modeling

et al. 2020

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Understanding (patho)physiological phenomena and mechanisms of failure in patients with Fontan circulation-a surgically established circulation for patients born with a functionally single ventricle-remains challenging due to the complex hemodynamics and high interpatient variations in anatomy and function. In this work, we present a biomechanical model of the heart and circulation to augment the diagnostic evaluation of Fontan patients with early-stage heart failure. The proposed framework employs a reduced-order model of heart coupled with a simplified circulation including venous return, creating a closed-loop system. We deploy this framework to augment the information from data obtained during combined cardiac catheterization and magnetic resonance exams (XMR), performed at rest and during dobutamine stress in 9 children with Fontan circulation and 2 biventricular controls. We demonstrate that our modeling framework enables patient-specific investigation of myocardial stiffness, contractility at rest, contractile reserve during stress and changes in vascular resistance. Hereby, the model allows to identify key factors underlying the pathophysiological response to stress in these patients. In addition, the rapid personalization of the model to patient data and fast simulation of cardiac cycles make our framework directly applicable in a clinical workflow. We conclude that the proposed modeling framework is a valuable addition to the current clinical diagnostic XMR exam that helps to explain patient-specific stress hemodynamics and can identify potential mechanisms of failure in patients with Fontan circulation.

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“…There has also been work using lower dimensional models that include one-dimensional or compartmental descriptions for fluid mechanics. Puelz et al developed a one-dimensional/compartmental model of the Fontan physiology with a fenestration that was combined with a non-pulsatile description of oxygen transport [19]. Conover et al used compartmental modeling to study the surgical stages for hypoplastic left heart syndrome, including the Fontan physiology [3].…”

Section: Introductionmentioning

confidence: 99%

Optimal fenestration of the Fontan circulation

Ahmad¹,

Jin²,

Penny³

et al. 2022

Preprint

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In this paper, we develop a pulsatile compartmental model of the Fontan circulation and use it to explore the effects of a fenestration added to this physiology. A fenestration is a shunt between the systemic and pulmonary veins that is added either at the time of Fontan conversion or at a later time for the treatment of complications. This shunt increases cardiac output and decreases systemic venous pressure. However, these hemodynamic benefits are achieved at the expense of a decrease in the arterial oxygen saturation. The model developed this paper incorporates fenestration size as a parameter and describes both blood flow and oxygen transport. It is calibrated to clinical data from Fontan patients, and we use it to study the impact of a fenestration on several hemodynamic variables. In certain scenarios corresponding to high-risk Fontan physiology, we demonstrate the existence of an optimal fenestration size that maximizes oxygen delivery to the systemic tissues.

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A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

Cited by 16 publications

References 70 publications

Practical identifiability and uncertainty quantification of a pulsatile cardiovascular model

Practical identifiability and uncertainty quantification of a pulsatile cardiovascular model

Dobutamine stress testing in patients with Fontan circulation augmented by biomechanical modeling

Optimal fenestration of the Fontan circulation

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