Boundary conditions of patient-specific fluid dynamics modelling of cavopulmonary connections: possible adaptation of pulmonary resistances results in a critical issue for a virtual surgical planning

Pennati, Giancarlo; Corsini, Chiara; Cosentino, Daria; Hsia, Tain‐Yen; Luisi, Vincenzo Stefano; Dubini, Gabriele; Migliavacca, Francesco

doi:10.1098/rsfs.2010.0021

Cited by 31 publications

(31 citation statements)

References 30 publications

(51 reference statements)

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“…To predict the hemodynamic impacts of certain operations in a specific patient, the model should be tuned to the patient by optimizing model parameters based on patient-specific clinical data. This issue has been addressed elsewhere, such as in recent studies on surgical planning (40,63) and those from our group (46,82).…”

Section: Limitationsmentioning

confidence: 95%

“…However, the majority of existing studies focused on local hemodynamic phenomena, such as flow patterns, wall shear stress distribution in a cavopulmonary anastomosis, or associated energy loss (19,32,36,83,85,87). In studies where systemic hemodynamics was addressed, cardiovascular properties were usually fixed (55a), tuned to specific patients (40,54,63,64), or adjusted to represent certain physiological conditions (41,51). So far, little effort has been taken to comprehensively study the hemodynamic performance of the Fontan circulation in a wide range of cardiovascular conditions.…”

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confidence: 99%

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Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Liang

Senzaki

Kurishima

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 307: H1056 -H1072, 2014. First published July 25, 2014 doi:10.1152/ajpheart.00245.2014The 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 patientspecific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.

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Section: Limitationsmentioning

confidence: 95%

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confidence: 99%

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Liang

Senzaki

Kurishima

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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“…In fact, the 1-D model is starting to be used as baseline model to test data assimilation techniques for parameter estimation [37]. Should this combination is proved successful, it can be a powerful tool for the development of accurate patient-specific models for surgical procedures (see, for instance, [9], [10] and [38]). …”

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confidence: 99%

An Anatomically Detailed Arterial Network Model for One-Dimensional Computational Hemodynamics

Blanco

Watanabe

Passos

et al. 2015

IEEE Trans. Biomed. Eng.

129

170

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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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“…However, the potential change of cardiovascular parameters due to vascular self-regulation and adaptation to new local hemodynamics following the operation was not taken into account, posing a severe threat to reliability of virtual surgical predictions (Pennati et al 2011). Moreover, the effects of different surgical options on the global hemodynamic variables were here compared only at rest (i.e.…”

Section: Discussionmentioning

confidence: 99%

An integrated approach to patient-specific predictive modeling for single ventricle heart palliation

Corsini

Baker

Kung

et al. 2013

Computer Methods in Biomechanics and Biomedical Engineering

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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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Boundary conditions of patient-specific fluid dynamics modelling of cavopulmonary connections: possible adaptation of pulmonary resistances results in a critical issue for a virtual surgical planning

Cited by 31 publications

References 30 publications

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

An Anatomically Detailed Arterial Network Model for One-Dimensional Computational Hemodynamics

An integrated approach to patient-specific predictive modeling for single ventricle heart palliation

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