Computer simulation of hemodynamic changes after right lobectomy in a liver with intrahepatic portal vein aneurysm.
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.
Ho
Cheng-Maw
CM
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Tsai
Shun-Feng
SF
Lin
Reui-Kuo
RK
Liang
Po-Chin
PC
Sheu
Tony Wen-Hann
TW
Hu
Rey-Heng
RH
Lee
Po-Huang
PH
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