title: Integration of clinical data collected at different times for virtual surgery in single ventricle patients: a case study.
abstract: Newborns with single ventricle physiology are usually palliated with a multi-staged procedure. When cardiovascular complications e.g., collateral vessel formation occur during the inter-stage periods, further treatments are required. An 8-month-old patient, who underwent second stage (i.e., bi-directional Glenn, BDG) surgery at 4 months, was diagnosed with a major veno-venous collateral vessel (VVC) which was endovascularly occluded to improve blood oxygen saturations. Few clinical data were collected at 8 months, whereas at 4 months a more detailed data set was available. The aim of this study is threefold: (i) to show how to build a patient-specific model describing the hemodynamics in the presence of VVC, using patient-specific clinical data collected at different times; (ii) to use this model to perform virtual VVC occlusion for quantitative hemodynamics prediction; and (iii) to compare predicted hemodynamics with post-operative measurements. The three-dimensional BDG geometry, resulting from the virtual surgery on the first stage model, was coupled with a lumped parameter model (LPM) of the 8-month patient's circulation. The latter was developed by scaling the 4-month LPM to account for changes in vascular impedances due to growth and adaptation. After virtual VVC closure, the model confirmed the 2 mmHg BDG pressure increase, as clinically observed, suggesting the importance of modeling vascular adaptation following the BDG procedure.
authors.affiliation: Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Corsini
authors.forename: Catriona
authors.initials: C
authors.lastname: Baker
authors.forename: Alessia
authors.initials: A
authors.lastname: Baretta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Biglino
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Hlavacek
authors.forename: Tain-Yen
authors.initials: TY
authors.lastname: Hsia
authors.forename: Ethan
authors.initials: E
authors.lastname: Kung
authors.forename: Alison
authors.initials: A
authors.lastname: Marsden
authors.forename: Francesco
authors.initials: F
authors.lastname: Migliavacca
authors.forename: Irene
authors.initials: I
authors.lastname: Vignon-Clementel
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pennati
mesh_terms: D006348:Cardiac Surgical Procedures; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D008955:Models, Cardiovascular; D014584:User-Computer Interface