An integrated approach to patient-specific predictive modeling for single ventricle heart palliation.
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.
a Laboratory of Biological Structure Mechanics, Department of Structural Engineering , Politecnico di Milano, Piazza Leonardo da Vinci , 32, 20133, Milano , Italy.
Chiara
C
Corsini
Catriona
C
Baker
Ethan
E
Kung
Silvia
S
Schievano
Gregory
G
Arbia
Alessia
A
Baretta
Giovanni
G
Biglino
Francesco
F
Migliavacca
Gabriele
G
Dubini
Giancarlo
G
Pennati
Alison
A
Marsden
Irene
I
Vignon-Clementel
Andrew
A
Taylor
Tain-Yen
TY
Hsia
Adam
A
Dorfman
D003198:Computer Simulation; D018729:Fontan Procedure; D006352:Heart Ventricles / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008955:Models, Cardiovascular; D010166:Palliative Care
computational fluid dynamics; congenital heart disease; lumped parameter network; multi-scale model; virtual surgery