Hemodynamic effects of left pulmonary artery stenosis after superior cavopulmonary connection: A patient-specific multiscale modeling study

Schiavazzi, Daniele E.; Kung, Ethan; Marsden, Alison L.; Baker, Catriona; Pennati, Giancarlo; Hsia, Tain Yen; Hlavacek, Anthony M.; Dorfman, Adam L.

doi:10.1016/j.jtcvs.2014.12.040

Cited by 35 publications

(19 citation statements)

References 26 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Larger numbers of Fontan patients with KE are needed to see if the diastolic plateau pattern is related to other clinical parameters than APC flow. Recently, Schiavazzi et al used modeling to calculate the effects of left pulmonary artery stenosis on hemodynamics in single ventricles stage II surgery and found that the stenosis needed to be quite severe, >65% of the diameter, to be hemodynamically significant [33]. This is in line with the findings of unchanged ventricular KE pattern before and after stenting of a left pulmonary stenosis in one of our study patients.…”

Section: Discussionsupporting

confidence: 87%

Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

et al. 2017

View full text Add to dashboard Cite

Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3–29) and eight healthy volunteers (median age 26 years, range 23–36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of the controls’ left ventricle (LV) or right ventricle (RV) depending on the patients’ ventricular morphology (Cohen´s κ = 1.0). Peak systolic KE/SV did not differ in patients compared to the LV in controls (0.016 ± 0.006 mJ/ml vs 0.020 ± 0.004 mJ/ml, p = 0.09). Peak diastolic KE/SV in Fontan patients was lower than in the LV of the control group (0.028 ± 0.010 mJ/ml vs 0.057 ± 0.011 mJ/ml, p < 0.0001). The KE during diastole showed a plateau in patients with aortopulmonary collaterals. This is to our knowledge the first study that quantifies the intraventricular KE of Fontan patients. KE is dependent on the morphology of the ventricle, and diastolic KE indexed to SV in patients is decreased compared to controls. The lower KE in Fontan patients may be a result of impaired ventricular filling.Electronic supplementary materialThe online version of this article (doi:10.1007/s00246-016-1565-6) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 87%

Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This is likely due to the abundance of target quantities available in the proximity of the aortic capacitor (i.e., cardiac output, minimum, average and maximum aortic pressures). Values of C ao estimated by DREAM were also found to be compatible to those determined from manual tuning in previous work from our research group [57]. …”

Section: Resultssupporting

confidence: 84%

Patient‐specific parameter estimation in single‐ventricle lumped circulation models under uncertainty

Schiavazzi

Baretta

Pennati

et al. 2016

Numer Methods Biomed Eng

Self Cite

View full text Add to dashboard Cite

Summary Computational models of cardiovascular physiology can inform clinical decision-making, providing a physically consistent framework to assess vascular pressures and flow distributions, and aiding in treatment planning. In particular, lumped parameter network (LPN) models that make an analogy to electrical circuits offer a fast and surprisingly realistic method to reproduce the circulatory physiology. The complexity of LPN models can vary significantly to account, for example, for cardiac and valve function, respiration, autoregulation, and time-dependent hemodynamics. More complex models provide insight into detailed physiological mechanisms, but their utility is maximized if one can quickly identify patient specific parameters. The clinical utility of LPN models with many parameters will be greatly enhanced by automated parameter identification, particularly if parameter tuning can match non-invasively obtained clinical data. We present a framework for automated tuning of 0D lumped model parameters to match clinical data. We demonstrate the utility of this framework through application to single ventricle pediatric patients with Norwood physiology. Through a combination of local identifiability, Bayesian estimation and maximum a posteriori simplex optimization, we show the ability to automatically determine physiologically consistent point estimates of the parameters and to quantify uncertainty induced by errors and assumptions in the collected clinical data. We show that multi-level estimation, that is, updating the parameter prior information through sub-model analysis, can lead to a significant reduction in the parameter marginal posterior variance. We first consider virtual patient conditions, with clinical targets generated through model solutions, and second application to a cohort of four single-ventricle patients with Norwood physiology.

show abstract

“…For such couplings, SimVascular contains an efficient and stable numerical scheme for implicitly coupling ODE models with the flowsolver for the 3D domain without significantly increasing the overall simulation cost, 18,35 which has been used in several recent applications. 25,54 …”

Section: Methodsmentioning

confidence: 99%

SimVascular: An Open Source Pipeline for Cardiovascular Simulation

et al. 2016

Self Cite

View full text Add to dashboard Cite

Patient-specific cardiovascular simulation has become a paradigm in cardiovascular research and is emerging as a powerful tool in basic, translational and clinical research. In this paper we discuss the recent development of a fully open-source SimVascular software package, which provides a complete pipeline from medical image data segmentation to patient-specific blood flow simulation and analysis. This package serves as a research tool for cardiovascular modeling and simulation, and has contributed to numerous advances in personalized medicine, surgical planning and medical device design. The SimVascular software has recently been refactored and expanded to enhance functionality, usability, efficiency and accuracy of image-based patient-specific modeling tools. Moreover, SimVascular previously required several licensed components that hindered new user adoption and code management and our recent developments have replaced these commercial components to create a fully open source pipeline. These developments foster advances in cardiovascular modeling research, increased collaboration, standardization of methods, and a growing developer community.

show abstract

Hemodynamic effects of left pulmonary artery stenosis after superior cavopulmonary connection: A patient-specific multiscale modeling study

Cited by 35 publications

References 26 publications

Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

Patient‐specific parameter estimation in single‐ventricle lumped circulation models under uncertainty

SimVascular: An Open Source Pipeline for Cardiovascular Simulation

Contact Info

Product

Resources

About