Imaging and patient-specific simulations for the Fontan surgery: Current methodologies and clinical applications

There is an urgent need for early diagnosis in medicine, whereupon effective treatments could prevent irreversible tissue damage. The special structure of the eye provides a unique opportunity for noninvasive light-based imaging of ocular fundus vasculature. To detect endothelial injury at the early and reversible stage of adhesion molecule upregulation, some novel imaging agents that target retinal endothelial molecules were generated.In vivomolecular imaging has a great potential to impact medicine by detecting diseases or screening disease in early stages, identifying extent of disease, selecting disease and patient-specific therapeutic treatment, applying a directed or targeted therapy, and measuring molecular-specific effects of treatment. Current preclinical findings and advances in instrumentation such as endoscopes and microcatheters suggest that these molecular imaging modalities have numerous clinical applications and will be translated into clinical use in the near future.

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CorFix: Virtual Reality Cardiac Surgical Planning Software for Designing Patient-Specific Vascular Grafts: Development and Pilot Usability Study (Preprint)

10.2196/preprints.35488 ◽

2021 ◽

Author(s):

Byeol Kim ◽

Phong Nguyen ◽

Yue-Hin Loke ◽

Vincent Cleveland ◽

Paige Mass ◽

...

Keyword(s):

Shear Stress ◽

Virtual Reality ◽

Wall Shear Stress ◽

User Study ◽

Vena Cava ◽

Patient Specific ◽

Wall Shear ◽

Hemodynamic Performance ◽

Fontan Surgery ◽

The Impact

BACKGROUND Patients with single ventricle heart defects receives three stages of surgeries culminating in the Fontan surgery. During the Fontan surgery, a vascular graft is sutured between the inferior vena cava and pulmonary artery to divert deoxygenated blood flow to the lungs via passive flow. Customizing the graft configuration can maximize the long-term benefits of Fontan surgery. However, planning patient-specific surgery has several challenges including the ability for physicians to customize grafts and evaluate its hemodynamic performance. OBJECTIVE The aim of this study was to develop a virtual reality (VR) Fontan graft modeling and evaluation software for physicians. User study was performed to achieve three additional goals: 1) evaluate the software when used by medical doctors and engineers, 2) identify if doctors have a baseline intuition about hemodynamic performance of Fontan grafts in a VR setting, and 3) explore the impact of viewing hemodynamic simulation results in numerical and graphical formats. METHODS A total of 5 medical professionals including 4 physicians (1 fourth-year resident, 1 third-year cardiac fellow, 1 pediatric intensivist, and 1 pediatric cardiac surgeon) and 1 biomedical engineer voluntarily participated in the study. The study was pre-scripted to minimize the variability of the interactions between the experimenter and the participants. Unless a participant was familiar with the Fontan surgery, a quick information session was provided at the start. Then, all participants were trained to use the VR gear and our software, CorFix. Each participant designed one bifurcated and one tube-shaped Fontan graft for a single patient. Then a hemodynamic performance evaluation was completed, allowing the participants to further modify their tube-shaped design. The design time and hemodynamic performance for each graft design were recorded. At the end of the study, all participants were provided surveys to evaluate the usability and learnability of the software and rate the intensity of VR sickness. RESULTS The average time for creating one bifurcated and one tube-shaped grafts after a single 10-minute training were 13.40 and 5.49 minutes, accordingly. Three out of 5 bifurcated and 1 out of 5 tube-shaped graft designs were in the benchmark range of hepatic flow distribution. Reviewing hemodynamic performance results and modifying the tube-shaped design took an average time of 2.92 minutes. Participants who modified their tube-shaped graft designs were able to improve the non-physiologic wall shear stress percentage by 7.02%. All tube-shaped graft designs improved wall shear stress compared the native surgical case of the patient. None of the designs met the benchmark indexed power loss. CONCLUSIONS VR graft design software can quickly be taught to physicians without any engineering background and VR experience. Improving the system of CorFix could improve performance of the users in customizing and optimizing grafts for patients. With graphical visualization, physicians were able to improve wall shear stress of a tube-shaped graft, lowering the chance of thrombosis. Bifurcated graft designs showed potential strength in better flow split to the lungs, reducing the risk for pulmonary arteriovenous malformations.

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Clinical applications of patient-specific induced pluripotent stem cells in cardiovascular medicine

Heart ◽

10.1136/heartjnl-2011-301317 ◽

2012 ◽

Vol 98 (6) ◽

pp. 443-449 ◽

Cited By ~ 34

Author(s):

Yingzi Oh ◽

Heming Wei ◽

Dongrui Ma ◽

Xiaoming Sun ◽

Reginald Liew

Keyword(s):

Stem Cells ◽

Induced Pluripotent Stem Cells ◽

Pluripotent Stem Cells ◽

Clinical Applications ◽

Patient Specific ◽

Cardiovascular Medicine ◽

Induced Pluripotent

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Magnetic resonance imaging-guided surgical design: can we optimise the Fontan operation?

Cardiology in the Young ◽

10.1017/s1047951113001637 ◽

2013 ◽

Vol 23 (6) ◽

pp. 818-823 ◽

Cited By ~ 1

Author(s):

Christopher M. Haggerty ◽

Ajit P. Yoganathan ◽

Mark A. Fogel

Keyword(s):

Planning Process ◽

Fontan Procedure ◽

Fontan Operation ◽

Patient Specific ◽

Modern Approach ◽

Technological Advances ◽

Operative Planning ◽

Fontan Surgery ◽

Improve Patient

AbstractThe Fontan procedure, although an imperfect solution for children born with a single functional ventricle, is the only reconstruction at present short of transplantation. The haemodynamics associated with the total cavopulmonary connection, the modern approach to Fontan, are severely altered from the normal biventricular circulation and may contribute to the long-term complications that are frequently noted. Through recent technological advances, spear-headed by advances in medical imaging, it is now possible to virtually model these surgical procedures and evaluate the patient-specific haemodynamics as part of the pre-operative planning process. This is a novel paradigm with the potential to revolutionise the approach to Fontan surgery, help to optimise the haemodynamic results, and improve patient outcomes. This review provides a brief overview of these methods, presents preliminary results of their clinical usage, and offers insights into its potential future directions.

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Journal of Clinical and Translational Science ◽

10.1017/cts.2017.166 ◽

2017 ◽

Vol 1 (S1) ◽

pp. 46-46

Author(s):

Meghan J. Arwood ◽

Caitrin Rowe McDonough ◽

Larisa H. Cavallari ◽

Amanda R. Elsey ◽

Reginald F. Frye ◽

...

Keyword(s):

Personalized Medicine ◽

Teaching Strategies ◽

Clinical Decision Making ◽

Genomic Medicine ◽

Genomic Data ◽

Clinical Applications ◽

Patient Specific ◽

Patient Case ◽

Didactic Teaching ◽

Case Based

OBJECTIVES/SPECIFIC AIMS: Compare effectiveness of a patient case-based, interactive teaching approach that included optional student genotyping with traditional didactic teaching strategies for increasing students’ knowledge and ability to effectively use pharmacogenomic data in clinical decision making. METHODS/STUDY POPULATION: The UF College of Pharmacy offers a required Personalized Medicine (PM) course for pharmacy students as well as an elective course, Clinical Applications of Personalized Medicine (CAPM). Students dual enrolled in the PM and elective CAPM courses comprised the intervention (INT) group, with interactive patient case-based teaching and the option to undergo personal genotyping, whereas students enrolled in PM alone comprised the control (CTR) group, which primarily used a traditional didactic teaching format and did not include personal genotyping. Both groups completed a pre- and post-course patient case-based test (15 questions/1 point each) to evaluate their knowledge and abilities to apply genotype and other patient-specific data to drug therapy recommendations. Pre- and post-course test scores for knowledge were compared between the INT and CTR groups using the Student t-test. RESULTS/ANTICIPATED RESULTS: In total, 52 students completed surveys (INT group, n=21; CTR group, n=31). Race was similar between groups, but there were fewer females in the INT compared with CTR group (8 vs. 22, p=0.02). Pre-course knowledge scores did not differ between INT and CTR groups (6.8±2.2 vs. 6.3±1.6 respectively, p=0.34), however, post-course scores were significantly higher in the INT Versus CTR group (10.0±2.3 vs. 7.5±1.7, p<0.0001). DISCUSSION/SIGNIFICANCE OF IMPACT: There have been significant advancements in the clinical applications of pharmacogenomic and genomic data, however, barriers to routine clinical adoption of genomic medicine persist. Developing education and training methods that equip practitioners to effectively translate genomic data into evidence-based clinical recommendations has been identified as a key strategy to overcome such barriers. Our data suggest that a personalized medicine course that employs patient-centered, case-based teaching strategies and includes optional personal genotyping for students compared with traditional didactic instruction improves students’ knowledge and abilities to apply pharmacogenomic data in practice-based scenarios. These results can inform future strategies for educating healthcare professionals on the clinical use of pharmacogenomic and genomic data.

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3D Printing—A Cutting Edge Technology for Treating Post-Infarction Patients

Life ◽

10.3390/life11090910 ◽

2021 ◽

Vol 11 (9) ◽

pp. 910

Author(s):

Daniel Cernica ◽

Imre Benedek ◽

Stefania Polexa ◽

Cosmin Tolescu ◽

Theodora Benedek

Keyword(s):

3D Printing ◽

Heart Diseases ◽

Scientific Evidence ◽

Interventional Cardiology ◽

3D Models ◽

Clinical Applications ◽

Patient Specific ◽

Interventional Treatment ◽

Printing Technology ◽

Surgery Patient

The increasing complexity of cardiovascular interventions requires advanced peri-procedural imaging and tailored treatment. Three-dimensional printing technology represents one of the most significant advances in the field of cardiac imaging, interventional cardiology or cardiovascular surgery. Patient-specific models may provide substantial information on intervention planning in complex cardiovascular diseases, and volumetric medical imaging from CT or MRI can be translated into patient-specific 3D models using advanced post-processing applications. 3D printing and additive manufacturing have a great variety of clinical applications targeting anatomy, implants and devices, assisting optimal interventional treatment and post-interventional evaluation. Although the 3D printing technology still lacks scientific evidence, its benefits have been shown in structural heart diseases as well as for treatment of complex arrhythmias and corrective surgery interventions. Recent development has enabled transformation of conventional 3D printing into complex 3D functional living tissues contributing to regenerative medicine through engineered bionic materials such hydrogels, cell suspensions or matrix components. This review aims to present the most recent clinical applications of 3D printing in cardiovascular medicine, highlighting also the potential for future development of this revolutionary technology in the medical field.

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