A Patient-Specific Hollow Three-Dimensional Model for Simulating Percutaneous Occlusion of Patent Ductus Arteriosus

Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.

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Effects of Patent Ductus Arteriosus on the Hemodynamics of Modified Blalock–Taussig Shunt Based on Patient-Specific Simulation

Frontiers in Physiology ◽

10.3389/fphys.2021.707128 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jiwen Xiong ◽

Qi Sun ◽

Yi Qian ◽

Liwei Hu ◽

Zhirong Tong ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Computer Aided Design ◽

Ductus Arteriosus ◽

Pulmonary Atresia ◽

Patient Specific ◽

Physiological Data ◽

Shunt Flow ◽

Relative Residence Time ◽

Blalock Taussig Shunt ◽

Patent Ductus

The question of preserving the patent ductus arteriosus (PDA) during the modified Blalock–Taussig shunt (MBTS) procedure remains controversial. The goal of this study was to investigate the effects of the PDA on the flow features of the MBTS to help with preoperative surgery design and postoperative prediction. In this study, a patient with pulmonary atresia and PDA was included. A patient-specific three-dimensional model was reconstructed, and virtual surgeries of shunt insertion and ductus ligation were performed using computer-aided design. Computational fluid dynamics was utilized to analyze the hemodynamic parameters of varied models based on the patient-specific anatomy and physiological data. The preservation of the PDA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided, causing significant and complicated turbulence in the pulmonary artery where low wall shear stress, high oscillatory shear index, and high relative residence time were distributed. The highest energy loss was found when the PDA was preserved. The preservation of PDA is not recommended during MBTS procedures because it negatively influences hemodynamics. This may lead to pulmonary overperfusion, inadequate systemic perfusion, and a heavier cardiac burden, thus increasing the risk of heart failure. Also, it seems to bring no benefit in terms of reducing the risk for thrombosis.

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