Comparison of Fontan Surgical Options for Patients with Apicocaval Juxtaposition

Wei, Zhenglun Alan; Johnson, Camille C.; Trusty, Phillip M.; Stephens, M.R.; Wu, Wenjun; Sharon, Ritchie; Srimurugan, Balaji; Kottayil, Brijesh P; Sunil, Gopalraj Sumangala; Fogel, Mark A.; Yoganathan, Ajit P.; Kappanayil, Mahesh

doi:10.1007/s00246-020-02353-8

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…Patient-specific flow conditions were obtained by segmenting phase-contrast MR images at the inlet's cross-section [34,35]) (Figure 1b). The change in vessel cross-sectional area was also obtained from the segmented phase-contrast MRI slices [36] (Figure 2a,b). The approximate location of the phase-contrast MRI slice relative to the anatomy is shown in (Figure 2c).…”

Section: Patient Image Acquisition and Reconstructionmentioning

confidence: 99%

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Tang

Wei

Fogel

et al. 2020

Biology

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Total cavopulmonary connection (TCPC) hemodynamics has been hypothesized to be associated with long-term complications in single ventricle heart defect patients. Rigid wall assumption has been commonly used when evaluating TCPC hemodynamics using computational fluid dynamics (CFD) simulation. Previous study has evaluated impact of wall compliance on extra-cardiac TCPC hemodynamics using fluid-structure interaction (FSI) simulation. However, the impact of ignoring wall compliance on the presumably more compliant intra-atrial TCPC hemodynamics is not fully understood. To narrow this knowledge gap, this study aims to investigate impact of wall compliance on an intra-atrial TCPC hemodynamics. A patient-specific model of an intra-atrial TCPC is simulated with an FSI model. Patient-specific 3D TCPC anatomies were reconstructed from transverse cardiovascular magnetic resonance images. Patient-specific vessel flow rate from phase-contrast magnetic resonance imaging (MRI) at the Fontan pathway and the superior vena cava under resting condition were prescribed at the inlets. From the FSI simulation, the degree of wall deformation was compared with in vivo wall deformation from phase-contrast MRI data as validation of the FSI model. Then, TCPC flow structure, power loss and hepatic flow distribution (HFD) were compared between rigid wall and FSI simulation. There were differences in instantaneous pressure drop, power loss and HFD between rigid wall and FSI simulations, but no difference in the time-averaged quantities. The findings of this study support the use of a rigid wall assumption on evaluation of time-averaged intra-atrial TCPC hemodynamic metric under resting breath-held condition.

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Section: Patient Image Acquisition and Reconstructionmentioning

confidence: 99%

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Tang

Wei

Fogel

et al. 2020

Biology

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“…In [ 4 ], although they do not perform a cost-effectiveness analysis, they recognise this as a limitation. In other cases, it is mentioned that in-silico trials are a cost-effective alternative or complement to experiments [ 40 , 66 ]. Cost-effectiveness has also been used as motivation in [ 6 ], to justify the use modelling, and in [ 25 ] to motivate the use of simplifications in the model.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in [ 36 ] a device was implanted in patients and CFD used to assess endothelial shear stress. On the other hand, in [ 66 ] a virtual surgery was performed to explore potential hemodynamic improvements in patients with apicocaval juxtaposition.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of cardiac in-silico clinical trials

et al. 2023

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Computational models of the heart are now being used to assess the effectiveness and feasibility of interventions through in-silico clinical trials (ISCTs). As the adoption and acceptance of ISCTs increases, best practices for reporting the methodology and analysing the results will emerge. Focusing in the area of cardiology, we aim to evaluate the types of ISCTs, their analysis methods and their reporting standards. To this end, we conducted a systematic review of cardiac ISCTs over the period of January 1st 2012 to January 1st 2022, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). We considered cardiac ISCTs of human patient cohorts, and excluded studies of single individuals and those in which models were used to guide a procedure without comparing against a control group. We identified 36 publications that described cardiac ISCTs, with most of the studies coming from the US and the UK. In 75% of the studies, a validation step was performed, although the specific type of validation varied between the studies. ANSYS FLUENT was the most commonly used software in 19% of ISCTs. The specific software used was not reported in 14% of the studies.Unlike clinical trials, we found a lack of consistent reporting of patient demographics, with 28% of the studies not reporting them. Uncertainty quantification was limited, with sensitivity analysis performed in only 19% of the studies. In 97% of the ISCTs, no link was provided to provide easy access to the data or models used in the study. There was no consistent naming of study types with a wide range of studies that could potentially be considered ISCTs. There is a clear need for community agreement on minimal reporting standards on patient demographics, accepted standards for ISCT cohort quality control, uncertainty quantification, and increased model and data sharing.

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“…Prospective observational study conducted over 20 months (November 2021-June 2023) at a high volume pediatric cardiac unit that regularly performs wide range of cardiac surgical procedures including neonatal surgeries, complex biventricular repairs and univentricular palliations with excel-lent outcomes [9][10][11] . Tomographic cardiac imaging is supported by dedicated cardiac radiology service.…”

Section: I) Setting and Participantsmentioning

confidence: 99%

Immersive 3D Visualisation (3D Printing, Virtual Reality) enhances spatial understanding of complex congenital heart defects

Kappanayil,

Gurav,

Xavier

et al. 2024

Preprint

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Background: Diagnosing, managing complex CHD demands excellent morphological understanding. Individual differences in visuospatial skills, training and experience can impact spatial interpretation of volumetric cardiac imaging. Immersive 3D visualisation may help overcome these challenges, but evidence of clinical benefit is lacking. This study explores variability in visuospatial abilities and interpretation of conventionally viewed volumetric cardiac imaging data among members of a pediatric cardiac unit, and impact of using immersive 3D formats (3D-prints, Virtual Reality) on spatial understanding of complex CHD morphology. Methods: Prospective cohort study involving 9 heterogenous members of an advanced pediatric cardiac program [3 consultant cardiologists, 2 cardiothoracic surgeons, 1 cardiac radiologist, 3 cardiology trainees]. Participants visuospatial abilities were quantified using a validated test (Revised PSVT:R). Understanding of spatial relationships was assessed using structured questionnaires for 17 unique anonymised volumetric cardiac scans (15 CT, 2 MRI) of complex CHD visualised in three formats 1). conventional DICOM (CDICOM); 2). 3D prints (3DP); 3). Virtual Reality (VR). Accuracy, time taken, perceived level of difficulty, and confidence in interpretation were assessed and compared. Results : Spatial abilities varied widely (median 8, IQR 6-30), independent of expertise/experience. Limitations in conventional reading were significantly overcome with immersive 3D. Mean accuracy score of 60.48% +/- 17.13% with CDICOM increased to 83.93% +/- 7.84% with 3DP, and 90.81% +/- 5.03% with VR (p<0.001). 3DP and VR permitted significantly faster interpretation (p<0.001), with significantly better ease and confidence. Immersive 3D significantly narrowed gap between consultants and trainees. Conclusion: Immersive 3D visualisation of volumetric cardiovascular imaging can enhance spatial understanding of complex CHD morphology, overcoming challenges in spatial ability, experience, expertise.

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Comparison of Fontan Surgical Options for Patients with Apicocaval Juxtaposition

Cited by 9 publications

References 33 publications

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

A systematic review of cardiac in-silico clinical trials

Immersive 3D Visualisation (3D Printing, Virtual Reality) enhances spatial understanding of complex congenital heart defects

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