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Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes
- Source :
- Clinical Physiology and Functional Imaging. 38:622-629
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- SummaryPurpose Patients with complex congenital heart disease may need to be converted to a Fontan circulation with systemic venous return surgically connected to the pulmonary circulation. These patients frequently form aortopulmonary collaterals (APC), that is arterial inflows to the pulmonary artery vascular tree. The aim of this study was to develop a method to calculate the effect of APC on the pulmonary flow distribution based on magnetic resonance imaging (MRI) measurements and computational fluid dynamics simulations in order to enable prediction of interventional outcomes in Fontan patients. Methods Patient-specific models of 11 patients were constructed in a 3D-design software based on MRI segmentations. APC flow was quantified as the difference between pulmonary venous flow and pulmonary artery flow, measured by MRI. A method was developed to include the modulating effect of the APC flow by calculating the patient-specific relative pulmonary vascular resistance. Simulations, including interventions with a Y-graft replacement and a stent dilatation, were validated against MRI results. Results The bias between simulated and MRI-measured fraction of blood to the left lung was 2·9 ± 5·3%. Including the effects of the APC flow in the simulation (n = 6) reduced simulation error from 9·8 ± 7·0% to 5·2 ± 6·3%. Preliminary findings in two patients show that the effect of surgical and catheter interventions could be predicted using the demonstrated methods. Conclusions The work demonstrates a novel method to include APC flow in predictive simulations of Fontan hemodynamics. APC flow was found to have a significant contribution to the pulmonary flow distribution in Fontan patients.
- Subjects :
- Male
Patient-Specific Modeling
Pulmonary Circulation
Physiology
medicine.medical_treatment
Hemodynamics
02 engineering and technology
030204 cardiovascular system & hematology
Fontan Procedure
0302 clinical medicine
Prospective Studies
Child
Aorta
medicine.diagnostic_test
Endovascular Procedures
Models, Cardiovascular
General Medicine
Magnetic Resonance Imaging
Catheter
Treatment Outcome
medicine.anatomical_structure
Collateral flow
Child, Preschool
Cardiology
Female
Stents
Blood Flow Velocity
Adult
Heart Defects, Congenital
medicine.medical_specialty
Adolescent
0206 medical engineering
Collateral Circulation
Young Adult
03 medical and health sciences
Predictive Value of Tests
Physiology (medical)
Internal medicine
medicine.artery
Image Interpretation, Computer-Assisted
medicine
Humans
business.industry
Stent
Magnetic resonance imaging
020601 biomedical engineering
Blood Vessel Prosthesis
Pulmonary artery
Hydrodynamics
Vascular resistance
Vascular Resistance
business
Software
Venous return curve
Subjects
Details
- ISSN :
- 14750961
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- Clinical Physiology and Functional Imaging
- Accession number :
- edsair.doi.dedup.....3539635b030955a1613fca87474246f8