title: Computer simulation of hemodynamic changes after right lobectomy in a liver with intrahepatic portal vein aneurysm.
abstract: OBJECTIVE
  Intrahepatic portal vein aneurysm is rare and its natural history is unknown. A 22-year-old healthy man, who wished to donate part of his liver to his diseased father, was incidentally diagnosed to have an intrahepatic portal vein aneurysm. The surgical decision of performing live donor hepatectomy for such a patient is normally difficult. We combined modern imaging reconstruction technologies with scientific computing as a new modality to foresee the risks of surgical complications.
  
  
  METHODS
  Cross-sectional computed tomography images were used to reconstruct the three-dimensional image of portal vein distribution using the 3D-Doctor v3.5 software. The reconstructed images were further employed to generate surface and interior meshes with CFX software. Simulated hemodynamic changes in velocity, pressure, and wall stress were determined for the right lobectomy case pre- and postoperatively.
  
  
  RESULTS
  The simulation results indicated that aneurismal pressure would be elevated significantly to 12.03 mmHg after operation. The left segmental portal venous blood flow would increase from 2.95- to 4.25-fold. The area near the branch point of one left segmental portal vein, which supplies blood to liver segment 4, and the portal vein aneurysm would endure high shear stress gradient. The resulting elevated aneurismal pressure may cause the thin wall to enlarge and rupture, while the high shear stress gradient would lead to vascular endothelial cell injury. Living donor surgery was not recommended hemodynamically based on the simulated results.
  
  
  CONCLUSIONS
  Scientific computing and modern imaging technologies can be applied together to aid surgeons to make the best decision in difficult clinical situations.
authors: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors: Cheng-Maw
authors: CM
authors: Ho
authors: Shun-Feng
authors: SF
authors: Tsai
authors: Reui-Kuo
authors: RK
authors: Lin
authors: Po-Chin
authors: PC
authors: Liang
authors: Tony Wen-Hann
authors: TW
authors: Sheu
authors: Rey-Heng
authors: RH
authors: Hu
authors: Po-Huang
authors: PH
authors: Lee
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000503:physiopathology*; D003198:Computer Simulation; D006498:Hepatectomy; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008297:Male; D011169:Portal Vein; D014019:Tissue Donors