Alagille’s syndrome (ALGS) is a rare multisystemic disorder that usually presents in the first year of life with progressive and debilitating liver failure symptoms. Approximately 20 to 30% of ALGS children require liver transplantation in early infancy for end-stage liver disease. When compared to other paediatric indications for liver transplantation, ALGS patients have worst post-operative outcomes. These have been ascribed to concomitant congenital heart disease (CHD) and in particularly to peripheral pulmonary artery stenosis (PPS), which is present in the majority of patients. PPS, particularly if not treated appropriately and in a timely fashion, results in persistent right ventricular (RV) hypertension and progressive maladaptive ventricular as well as vascular remodelling (i.e. initially RV hypertrophy, and later RV dilation and systolic impairment as well as increased pulmonary stiffness). In turn, this may place these patients at high risk of RV ischaemia and pump failure particularly during the critical stage of the liver graft reperfusion, which is often accompanied with a marked systemic hypotension and corresponding coronary perfusion pressure drop. Currently, an hybrid X-ray/magnetic resonance guided catheterisation study (XMR) with dobutamine stress is used, pre-operatively, to identify those ALGS patients that are deemed to be at high risk of right heart failure (RHF). By measuring the systemic/pulmonary pressures and resistance, as well as the cardiac output response to dobutamine, clinicians hope to replicate some of the haemodynamics events of liver transplantation, such as the expected increase in heart rate and myocardial metabolic demand. While the adequate response do dobutamine stress has been described to be an increase in cardiac output of at least 40%, a key limitation of this workup is a failure to account for the systemic hypotension and corresponding coronary perfusion pressure drop that occurs during liver transplantation. By neglecting this, the risk of RV ischaemia leading to RHF might not be adequately predicted. However, studying the coronary responses in AGLS children to identify those deemed to be at high risk of RV ischaemia during liver transplantation presents several ethical and methodological challenges. In this PhD research we have designed an innovative experimental setup using recently developed imaging and computational modelling techniques that could be used to reproduce in silico some of the haemodynamic events of liver transplantation and investigate coronary autoregulation in ALGS patients. Two main computational methods were used: (1) the coupled multidomain momentum method to combine a three-dimensional (3D) portion of the vascular anatomy (i.e. the aorta, coronaries and proximal pulmonary arteries branches) segmented from the XMR, to zero-dimensional (0D) lumped parameter networks (LPNs) representing the heart chambers and the non-segmented systemic and pulmonary vasculature; and (2) a coronary autoregulation control method that adjusted the coronary microcirculation resistance to increase the coronary blood flow (CBF) and thus matched the left and right ventricular metabolic demands, which in turn were computed from the patient-specific ventricular pressure-volume (PV) loops extracted from the XMR data. As highly detailed images of the small coronaries of an ALGS child were to be segmented to create the 3D systemic domain of the patient-specific computational model (PSCM), several studies were concomitantly conducted aiming to improve the conventional one-dimensional (1D) respiratory-navigated (NAV) T2-prepared coronary magnetic resonance angiography (CMRA) sequence. We first tested the feasibility of a recently developed two-dimensional (2D) image-navigated (iNAV) CMRA sequence (Study 1) in healthy volunteers and in an adult patient cohort with CHD. We showed that the novel navigation scheme resulted in faster scan acquisitions and improved coronary image quality compared to the conventional 1D NAV. This was followed by a validation of the technique against gold standard invasive X-ray coronary angiography for screening significant coronary artery disease in an adult patient cohort (Study 2). We then replaced the conventional T2 preparation magnetisation scheme by an inversion recovery (IR) approach to improved blood-background differentiation, and acquired the 2D iNAV CMRA in a paediatric CHD cohort following the injection of gadobenate dimeglumine (Study 3). This is a high-relaxivity contrast agent, with a long half-life thus providing higher and longer intravascular signal ideal for CMRA. We showed that our methodology improved significantly image quality in small children with high heart rates. Finally, this sequence design was incorporated in Study 6 to provide the high resolution radiation-free anatomic data of the coronaries and proximal systemic and pulmonary arteries of a six year-old ALGS child with associated pulmonary vascular disease (i.e. increased pulmonary arterial pressure despite treated PPS) undergoing pre-liver transplantation risk assessment. This data was segmented using a custom-made software developed by our team (CRIMSON) to produce the 3D domains of the closed-loop 0D-3D multi-domain PSCM. Two separate studies were carried out in parallel, one in a sample of hypertrophic cardiomyopathy (HCM) patients (Study 4), and another in a mixed cohort of middle-aged twins and aortic coarctation patients (Study 5), both involving the evaluation of CMRderived methodologies to provide parameters such as left atrial volumes/elastance and vascular stiffness, respectively, that were used in the parametrisation of the PSCM. In Study 4, we studied the different components of left atrial (LA) function (the reservoir, conduit and booster pump function) using phasic volume changes and tissue-tracking, and showed that this robust methodology could improve disease staging. In Study 5, we developed and evaluated a novel tool for automated extraction of the thoracic aorta length from different CMR sequences to streamline pulse wave velocity calculation. The aforementioned measures together with other imaging and invasive data obtained during the clinical XMR study (e.g. intraventricular volumes and pressure, aortic and pulmonary flow, pressure and resistance) were used to calibrate the different components of the PSCM (e.g the LPNs resistance and capacitance) and replicated the rest and dobutamine stress haemodynamics (Study 6). We demonstrated that at rest, due to abnormally high RV afterload, CBF in the right coronary artery (RCA) territory occurred mainly in diastole, akin to the left coronary artery. This abnormal profile was even more pronounced during dobutamine stress. We then modelled a generalised vasodilation, similar to that occurring immediately post-transplant (post-reperfusion syndrome, PRS) by imposing a 31% drop in the mean arterial pressure through manual adjustment of the resistor components in the systemic arterial bed LPNs. Our computational model predicted that the heart would be unable to maintain adequate RCA perfusion in the face of such reduced aortic perfusion pressure, despite a major reduction in coronary resistance. This study provided a mechanistic 6 insight into how abnormal ventricular-vascular coupling (high RV afterload resulting in extravascular compressive resistance) could translate into RV ischaemia during the critical stage of liver reperfusion, eventually leading to pump failure, a resulted not expected given the adequate cardiac output increase (> 40%) during the clinical XMR dobutamine stress study. We hypothesise that this impaired coronary autoregulation and RV myocardial oxygen demand-supply imbalance could be related to the unfavourable ALGS post-transplant outcomes described in the literature when compared to other paediatric liver transplantation indications. This research shows great promise not only for the application of the novel 2D iNAV IR-CMRA sequence in paediatric CHD imaging but also for the use of the different imaging and computational methods to study CBF autoregulation in ALGS patients with pulmonary vascular disease. The PSCM presented could be an appealing option to refine pre-transplant risk assessment of these patients. On the one hand, there is a scarcity of strong medical evidence due to the low prevalence of the disease and the constrains of studying the coronary circulation in children. On the other hand, there is a great need to personalise medical management given the limitations of current pre-operative diagnostic workup. As the ethical and methodological constrains preclude direct invasive validation of these results, obtaining PSCM in other ALGS patients and correlating them to transplantation outcomes could enable clinical translation.