title: Hemodynamic study of TCPC using in vivo and in vitro 4D Flow MRI and numerical simulation.
abstract: Altered total cavopulmonary connection (TCPC) hemodynamics can cause long-term complications. Patient-specific anatomy hinders generalized solutions. 4D Flow MRI allows in vivo assessment, but not predictions under varying conditions and surgical approaches. Computational fluid dynamics (CFD) improves understanding and explores varying physiological conditions. This study investigated a combination of 4D Flow MRI and CFD to assess TCPC hemodynamics, accompanied with in vitro measurements as CFD validation. 4D Flow MRI was performed in extracardiac and atriopulmonary TCPC subjects. Data was processed for visualization and quantification of velocity and flow. Three-dimensional (3D) geometries were generated from angiography scans and used for CFD and a physical model construction through additive manufacturing. These models were connected to a perfusion system, circulating water through the vena cavae and exiting through the pulmonary arteries at two flow rates. Models underwent 4D Flow MRI and image processing. CFD simulated the in vitro system, applying two different inlet conditions from in vitro 4D Flow MRI measurements; no-slip was implemented at rigid walls. Velocity and flow were obtained and analyzed. The three approaches showed similar velocities, increasing proportionally with high inflow. Atriopulmonary TCPC presented higher vorticity compared to extracardiac at both inflow rates. Increased inflow balanced flow distribution in both TCPC cases. Atriopulmonary IVC flow participated in atrium recirculation, contributing to RPA outflow; at baseline, IVC flow preferentially traveled through the LPA. The combination of patient-specific in vitro and CFD allows hemodynamic parameter control, impossible in vivo. Physical models serve as CFD verification and fine-tuning tools.
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, USA. Electronic address: roldan@wisc.edu.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Roldán-Alzate
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, USA.
authors.forename: Sylvana
authors.initials: S
authors.lastname: García-Rodríguez
authors.affiliation: Department of Pediatric Cardiology, University of Wisconsin-Madison, USA; Department of Pediatric Cardiothoracic Surgery, University of Wisconsin-Madison, USA.
authors.forename: Petros V
authors.initials: PV
authors.lastname: Anagnostopoulos
authors.affiliation: Department of Pediatric Cardiology, University of Wisconsin-Madison, USA.
authors.forename: Shardha
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, USA; Department of Medical Physics, University of Wisconsin-Madison, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Wieben
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: François
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D008279:Magnetic Resonance Imaging; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery
keywords: 4D Flow; Additive manufacturing; Congenital heart disease; Magnetic resonance imaging; Numerical simulation; Total cavopulmonary connection
references.citation: J Thorac Cardiovasc Surg. 2009 Mar;137(3):560-4
references.pmid: 19258065
references.citation: Circulation. 1998 Dec 22-29;98(25):2873-82
references.pmid: 9860790
references.citation: J Am Coll Cardiol. 2004 Nov 16;44(10):2065-72
references.pmid: 15542293
references.citation: Ann Biomed Eng. 2012 Dec;40(12):2639-51
references.pmid: 22777126
references.citation: Conf Proc IEEE Eng Med Biol Soc. 2004;2:1144-7
references.pmid: 17271886
references.citation: Circulation. 2007 Sep 11;116(11 Suppl):I165-71
references.pmid: 17846299
references.citation: Magn Reson Imaging. 2007 Jan;25(1):101-9
references.pmid: 17222721
references.citation: Prog Pediatr Cardiol. 2010 Dec 1;30(1-2):71-80
references.pmid: 21218147
references.citation: Ann Thorac Surg. 2008 Mar;85(3):810-7
references.pmid: 18291147
references.citation: Magn Reson Med. 2008 Nov;60(5):1218-31
references.pmid: 18956416
references.citation: J Magn Reson Imaging. 2014 Apr;39(4):819-26
references.pmid: 24395121
references.citation: J Am Coll Cardiol. 1996 Apr;27(5):1264-9
references.pmid: 8609354
references.citation: J Biomech Eng. 1995 Nov;117(4):423-8
references.pmid: 8748524
references.citation: J Thorac Cardiovasc Surg. 2013 Mar;145(3):663-70
references.pmid: 22560957
references.citation: J Thorac Cardiovasc Surg. 1999 Apr;117(4):697-704
references.pmid: 10096964
references.citation: J Biomech Eng. 2010 Mar;132(3):031012
references.pmid: 20459200
references.citation: Eur J Cardiothorac Surg. 2003 Nov;24(5):716-22
references.pmid: 14583304
references.citation: Ann Thorac Surg. 2002 Dec;74(6):1967-77; discussion 1978
references.pmid: 12643382
references.citation: J Biomech. 2008 Jul 19;41(10):2246-52
references.pmid: 18508062
references.citation: J Biomech. 1996 Jan;29(1):111-21
references.pmid: 8839024
references.citation: Congenit Heart Dis. 2007 May-Jun;2(3):179-84
references.pmid: 18377462
references.citation: J Thorac Cardiovasc Surg. 2012 Aug;144(2):383-9
references.pmid: 22698555
references.citation: Prog Pediatr Cardiol. 2010 Dec 1;30(1-2):31-44
references.pmid: 25620865
references.citation: Ann Thorac Surg. 2004 Aug;78(2):697-9
references.pmid: 15276554
references.citation: Curr Opin Pediatr. 2002 Oct;14(5):620-6
references.pmid: 12352258
references.citation: Radiology. 2013 Apr;267(1):67-75
references.pmid: 23297331
references.citation: Magn Reson Med. 2010 Feb;63(2):349-55
references.pmid: 20099326
references.citation: Int J Numer Method Biomed Eng. 2013 Mar;29(3):351-62
references.pmid: 23345174
references.citation: Am Heart J. 2004 Mar;147(3):425-39
references.pmid: 14999190