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Item does not contain fulltext, BACKGROUND: Optimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Ventricular wall stress is considered to be an early marker of right ventricular (RV) dysfunction. OBJECTIVES: To investigate the association of RV wall stresses and their change over time with functional parameters in TOF patients. METHODS: Ten TOF patients after surgical repair with moderate/severe pulmonary regurgitation were included. At two timepoints (median follow-up time 7.2 years), patient-specific computational biventricular models for wall stress assessment were created using CMR short-axis cine images and echocardiography-based RV pressures. RV ejection fraction (RVEF), NT-proBNP and cardiopulmonary exercise tests were used as outcome measures reflecting RV function. Associations between regional RV diastolic wall stress and RV function were investigated using linear mixed models. RESULTS: Increased wall stress correlated with lower RV mass (r(rm )= -0.70, p = 0.017) and lower RV mass-to-volume (r(rm )= -0.80, p = 0.003) using repeated measures. Wall stress decreased significantly over time, especially in patients with a stable RVEF (p < 0.001). Higher wall stress was independently associated with lower RVEF, adjusted for left ventricular ejection fraction, RV end-diastolic volume and time since initial surgery (decrease of 1.27% RVEF per kPa increase in wall stress, p = 0.029) using repeated measurements. No association was found between wall stress, NT-proBNP, and exercise capacity. CONCLUSIONS: Using a computational method to calculate wall stress locally in geometrically complex ventricles, we demonstrated that lower wall stress might be important to maintain ventricular function. RV wall stress assessment can be used in serial follow-up, and is potentially an early marker of impending RV dysfunction.

© 2023 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0, Background Intra-arterial thrombectomy is the main treatment for acute ischemic stroke due to large vessel occlusions and can consist in mechanically removing the thrombus with a stent-retriever. A cause of failure of the procedure is the fragmentation of the thrombus and formation of micro-emboli, difficult to remove. This work proposes a methodology for the creation of a low-dimensional surrogate model of the mechanical thrombectomy procedure, trained on realizations from high-fidelity simulations, able to estimate the evolution of the maximum first principal strain in the thrombus. Method A parametric finite-element model was created, composed of a tapered vessel, a thrombus, a stent-retriever and a catheter. A design of experiments was conducted to sample 100 combinations of the model parameters and the corresponding thrombectomy simulations were run and post-processed to extract the maximum first principal strain in the thrombus during the procedure. Then, a surrogate model was built with a combination of principal component analysis and Kriging. Results The surrogate model was chosen after a sensitivity analysis on the number of principal components and was tested with 10 additional cases. The model provided predictions of the strain curves with correlation above 0.9 and a maximum error of 28%, with an error below 20% in 60% of the test cases. Conclusions The surrogate model provides nearly instantaneous estimates and constitutes a valuable tool for evaluating the risk of thrombus rupture during pre-operative planning for the treatment of acute ischemic stroke., Peer Reviewed, Postprint (author's final draft)

This manuscript presents a novel formulation for a linear elastic model of a heterogeneous arterial section undergoing uniform pressure in a quasi-static regime. The novelties are twofold. First, an elastic bed support on the external boundary (elastic bed boundary condition) replaces the classical Dirichlet boundary condition (i.e., blocking displacements at arbitrarily selected nodes) for elastic solids to ensure a solvable problem. In addition, this modeling approach can be used to effectively account for the effect of the surrounding material on the vessel. Secondly, to study many geometrical configurations corresponding to different patients, we devise an unfitted strategy based on the Immersed Boundary (IB) framework. It allows using the same (background) mesh for all possible configurations both to describe the geometrical features of the cross-section (using level sets) and to compute the solution of the mechanical problem. Results on coronary arterial sections from realistic segmented images demonstrate that the proposed unfitted IB-based approach provides results equivalent to the standard finite elements (FE) for the same number of active degrees of freedom with an average difference in the displacement field of less than 0.5%. However, the proposed methodology does not require the use of a different mesh for every configuration. Thus, it is paving the way for dimensionality reduction., The authors acknowledge the financial support from the Ministerio de Ciencia e Innovación (MCIN/AEI/10.13039/501100011033) through the grants PID2020-113463RB-C33 and CEX2018-000797-S and the Italian Ministry of Education, University and Research (Grant number 1613 FISR2019_03221, CECOMES), Peer Reviewed, Postprint (published version)