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Erschienen in: Current Cardiovascular Imaging Reports 12/2023

28.11.2023 | Review

Effect of Virtual Aortic Arch Reconstruction After Norwood Procedure on Cardiac Function, Energy Efficiency, and Wall Shear Stress from Multiscale Simulations

verfasst von: Aloma Blanch-Granada, Margaret M. Samyn, Stephanie S. Handler, Jennifer F Gerardin, Benjamin Goot, Viktor Hraška, Joseph R. Cava, John F. LaDisa Jr

Erschienen in: Current Cardiovascular Imaging Reports | Ausgabe 12/2023

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Abstract

Purpose of Review

The current in silico study features a patient who underwent Norwood arch reconstruction to compare hemodynamic and energy-based indices between the image-based pre-operative reconstructed geometry (i.e., Pre-op) and a virtual post-operative reconstruction (i.e., Post-op). We hypothesized that the Post-op geometry would be associated with decreased afterload and increased stroke volume, consequently leading to a decrease in single ventricle workload as well as more favorable hemodynamic indices (i.e., decreased oscillatory shear index (OSI) and increased time-averaged wall shear stress (TAWSS)), particularly within the reconstructed region.

Recent Findings

Computational modeling can facilitate assessment of energy and hemodynamic alterations for difficult surgical procedures including the Norwood operation where outcomes remain suboptimal with high interstage mortality and frequent reoperations.

Summary

A patient-specific computational fluid dynamics (CFD) model was created from cardiac magnetic resonance imaging, blood flow, and blood pressure data. Virtual reconstruction was implemented based on surgeon and clinician input. Resulting simulations incorporated downstream vascular resistance and compliance to replicate patient physiology using 3-element Windkessel representations to quantify TAWSS and OSI locally. A closed-loop heart model was used to determine global differences in energy efficiency (Eeff), energy loss (EL), and cardiac workload. WSS indices generally improved with virtual arch geometry reconstruction, which resulted in only modest changes in EL, Eeff, and cardiac workload. A framework to implement and compare virtual arch reconstruction is presented. Results show that more drastic changes in geometry may need to be implemented if the virtual reconstruction is to yield a significant impact on indices of cardiac function.
Literatur
1.
Zurück zum Zitat Elzenga NJ, Gittenberger-de Groot AC. Coarctation and related aortic arch anomalies in hypoplastic left heart syndrome. Int J Cardiol. 1985;8(4):379–89. CrossRefPubMed Elzenga NJ, Gittenberger-de Groot AC. Coarctation and related aortic arch anomalies in hypoplastic left heart syndrome. Int J Cardiol. 1985;8(4):379–89. CrossRefPubMed
2.
Zurück zum Zitat • Alsoufi B, Slesnick T, McCracken C, Ehrlich A, Kanter K, Schlosser B, Maher K, Sachdeva R, Kogon B. Current outcomes of the Norwood operation in patients with single-ventricle malformations other than hypoplastic left heart syndrome. World J Pediatr Congenit Heart Surg. 2015;6(1):46–52. https://​doi.​org/​10.​1177/​2150135114558069​. A recent paper reviewing outcomes from Norwood patients serving as motivation for the current work. CrossRefPubMed Alsoufi B, Slesnick T, McCracken C, Ehrlich A, Kanter K, Schlosser B, Maher K, Sachdeva R, Kogon B. Current outcomes of the Norwood operation in patients with single-ventricle malformations other than hypoplastic left heart syndrome. World J Pediatr Congenit Heart Surg. 2015;6(1):46–52. https://​doi.​org/​10.​1177/​2150135114558069​. A recent paper reviewing outcomes from Norwood patients serving as motivation for the current work. CrossRefPubMed
5.
Zurück zum Zitat Ellwein L, Samyn MM, Danduran M, Schindler-Ivens S, Liebham S, LaDisa JF. Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise. Biomech Model Mechanobiol. 2017;16(1):75–96. CrossRefPubMed Ellwein L, Samyn MM, Danduran M, Schindler-Ivens S, Liebham S, LaDisa JF. Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise. Biomech Model Mechanobiol. 2017;16(1):75–96. CrossRefPubMed
6.
Zurück zum Zitat Razavi A, Sachdeva S, Frommelt PC, LaDisa JF Jr. Patient-specific numerical analysis of coronary flow in children with intramural anomalous aortic origin of coronary arteries. Semin Thorac Cardiovasc Surg. 2021;33(1):155–67. CrossRefPubMed Razavi A, Sachdeva S, Frommelt PC, LaDisa JF Jr. Patient-specific numerical analysis of coronary flow in children with intramural anomalous aortic origin of coronary arteries. Semin Thorac Cardiovasc Surg. 2021;33(1):155–67. CrossRefPubMed
7.
Zurück zum Zitat Wendell DC, Samyn MM, Cava JR, Krolikowski MM, LaDisa JF. The impact of cardiac motion on aortic valve flow used in computational simulations of the thoracic aorta. J Biomech Eng. 2016;138(9) Wendell DC, Samyn MM, Cava JR, Krolikowski MM, LaDisa JF. The impact of cardiac motion on aortic valve flow used in computational simulations of the thoracic aorta. J Biomech Eng. 2016;138(9)
8.
Zurück zum Zitat Vignon-Clementel IE, Figueroa CA, Jansen KE, Taylor CA. Outflow boundary conditions for three-dimensional finite element modeling of blood flow and pressure in arteries. Comput Methods Appl Mech Eng. 2006;195(29–32):3776–96. CrossRef Vignon-Clementel IE, Figueroa CA, Jansen KE, Taylor CA. Outflow boundary conditions for three-dimensional finite element modeling of blood flow and pressure in arteries. Comput Methods Appl Mech Eng. 2006;195(29–32):3776–96. CrossRef
9.
Zurück zum Zitat Westerhof N, Elzinga G, Sipkema P. An artificial arterial system for pumping hearts. J Appl Physiol. 1971;31(5):776–81. CrossRefPubMed Westerhof N, Elzinga G, Sipkema P. An artificial arterial system for pumping hearts. J Appl Physiol. 1971;31(5):776–81. CrossRefPubMed
10.
Zurück zum Zitat LaDisa JF, Dholakia RJ, Figueroa CA, Vignon-Clementel IE, Chan FP, Samyn MM, Cava JR, Taylor CA, Feinstein JA. Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis. Congenit Heart Dis. 2011a;6(5):432–43. CrossRefPubMedPubMedCentral LaDisa JF, Dholakia RJ, Figueroa CA, Vignon-Clementel IE, Chan FP, Samyn MM, Cava JR, Taylor CA, Feinstein JA. Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis. Congenit Heart Dis. 2011a;6(5):432–43. CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat LaDisa JF, Figueroa AC, Vignon-Clementel IE, Jin Kim H, Xiao N, Ellwein LM, Chan FP, Feinstein JA, Taylor CA. Computational simulations for aortic coarctation: Representative results from a sampling of patients. J Biomech Eng. 2011b;133(9) https://​doi.​org/​10.​1115/​1.​4004996. LaDisa JF, Figueroa AC, Vignon-Clementel IE, Jin Kim H, Xiao N, Ellwein LM, Chan FP, Feinstein JA, Taylor CA. Computational simulations for aortic coarctation: Representative results from a sampling of patients. J Biomech Eng. 2011b;133(9) https://​doi.​org/​10.​1115/​1.​4004996.
12.
Zurück zum Zitat Laskey WK, Parker HG, Ferrari VA, Kussmaul WG, Noordergraaf A. Estimation of total systemic arterial compliance in humans. J Appl Physiol. 1990;69(1):112–9. CrossRefPubMed Laskey WK, Parker HG, Ferrari VA, Kussmaul WG, Noordergraaf A. Estimation of total systemic arterial compliance in humans. J Appl Physiol. 1990;69(1):112–9. CrossRefPubMed
13.
Zurück zum Zitat Stergiopulos N, Segers P, Westerhof N. Use of pulse pressure method for estimating total arterial compliance in vivo. Am J Physiol Heart Circ Physiol. 1999;276(2):H424–8. CrossRef Stergiopulos N, Segers P, Westerhof N. Use of pulse pressure method for estimating total arterial compliance in vivo. Am J Physiol Heart Circ Physiol. 1999;276(2):H424–8. CrossRef
14.
Zurück zum Zitat Migliavacca F, Pennati G, Dubini G, Fumero R, Pietrabissa R, Urcelay G, Bove EL, Hsia T-Y, de Leval MR, Dubini G-E, De MR, Modeling L. Modeling of the Norwood circulation: effects of shunt size, vascular resistances, and heart rate. Am J Physiol Heart Circ Physiol. 2001;280(5):H2076–86. http://​www.​ajpheart.​org CrossRefPubMed Migliavacca F, Pennati G, Dubini G, Fumero R, Pietrabissa R, Urcelay G, Bove EL, Hsia T-Y, de Leval MR, Dubini G-E, De MR, Modeling L. Modeling of the Norwood circulation: effects of shunt size, vascular resistances, and heart rate. Am J Physiol Heart Circ Physiol. 2001;280(5):H2076–86. http://​www.​ajpheart.​org CrossRefPubMed
15.
Zurück zum Zitat Pennati G, Bellottit M, Fumero R. Mathematical modelling of the human foetal cardiovascular system based on Doppler ultrasound data. Med Eng Phys. 1997a;19(4):327–35. CrossRefPubMed Pennati G, Bellottit M, Fumero R. Mathematical modelling of the human foetal cardiovascular system based on Doppler ultrasound data. Med Eng Phys. 1997a;19(4):327–35. CrossRefPubMed
16.
Zurück zum Zitat Pennati G, Migliavacca F, Dubinit G, Pietrabissa R, de Levalf MR. A mathematical model of circulation in the presence of the bidirectional cavopulmonary anastomosis in children with a univentricular heart. Med Eng Phys. 1997b;19(3):223–34. CrossRefPubMed Pennati G, Migliavacca F, Dubinit G, Pietrabissa R, de Levalf MR. A mathematical model of circulation in the presence of the bidirectional cavopulmonary anastomosis in children with a univentricular heart. Med Eng Phys. 1997b;19(3):223–34. CrossRefPubMed
19.
Zurück zum Zitat Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Glagov S. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res. 1983;53(4):502–14. CrossRefPubMed Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Glagov S. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res. 1983;53(4):502–14. CrossRefPubMed
20.
Zurück zum Zitat Taylor CA, Hughes TJR, Zarins CK. Effect of exercise on hemodynamic conditions in the abdominal aorta. J Vasc Surg. 1999;29(6):1077–89. CrossRefPubMed Taylor CA, Hughes TJR, Zarins CK. Effect of exercise on hemodynamic conditions in the abdominal aorta. J Vasc Surg. 1999;29(6):1077–89. CrossRefPubMed
21.
Zurück zum Zitat Vlachopoulos C, O’Rourke M, Nichols WW. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. CRC press; 2011. CrossRef Vlachopoulos C, O’Rourke M, Nichols WW. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. CRC press; 2011. CrossRef
22.
Zurück zum Zitat • Itatani K, Miyaji K, Qian Y, Liu JL, Miyakoshi T, Murakami A, Ono M, Umezu M. Influence of surgical arch reconstruction methods on single ventricle workload in the Norwood procedure. J Thorac Cardiovasc Surg. 2012;144(1):130–8. https://​doi.​org/​10.​1016/​j.​jtcvs.​2011.​08.​013. A previous study reporting EL results for a related group of patients for comparison and building from using results from the current work. CrossRefPubMed Itatani K, Miyaji K, Qian Y, Liu JL, Miyakoshi T, Murakami A, Ono M, Umezu M. Influence of surgical arch reconstruction methods on single ventricle workload in the Norwood procedure. J Thorac Cardiovasc Surg. 2012;144(1):130–8. https://​doi.​org/​10.​1016/​j.​jtcvs.​2011.​08.​013. A previous study reporting EL results for a related group of patients for comparison and building from using results from the current work. CrossRefPubMed
24.
Zurück zum Zitat Ward MR, Pasterkamp G, Yeung AC, Borst C. Arterial remodeling: mechanisms and clinical implications. Circulation. 2000;102(10):1186–91. CrossRefPubMed Ward MR, Pasterkamp G, Yeung AC, Borst C. Arterial remodeling: mechanisms and clinical implications. Circulation. 2000;102(10):1186–91. CrossRefPubMed
25.
Zurück zum Zitat Wentzel JJ, Corti R, Fayad ZA, Wisdom P, Macaluso F, Winkelman MO, Fuster V, Badimon JJ. Does shear stress modulate both plaque progression and regression in the thoracic aorta? Human study using serial magnetic resonance imaging. J Am Coll Cardiol. 2005;45(6):846–54. CrossRefPubMed Wentzel JJ, Corti R, Fayad ZA, Wisdom P, Macaluso F, Winkelman MO, Fuster V, Badimon JJ. Does shear stress modulate both plaque progression and regression in the thoracic aorta? Human study using serial magnetic resonance imaging. J Am Coll Cardiol. 2005;45(6):846–54. CrossRefPubMed
26.
Zurück zum Zitat Coogan JS, Chan FP, LaDisa JF Jr, Taylor CA, Hanley FL, Feinstein JA. Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions. J Thorac Cardiovasc Surg. 2013;145(2):489–95. CrossRefPubMed Coogan JS, Chan FP, LaDisa JF Jr, Taylor CA, Hanley FL, Feinstein JA. Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions. J Thorac Cardiovasc Surg. 2013;145(2):489–95. CrossRefPubMed
27.
Zurück zum Zitat • Primeaux J, Salavitabar A, Lu JC, Grifka RG, Figueroa CA. Characterization of Post-Operative Hemodynamics Following the Norwood Procedure Using Population Data and Multi-Scale Modeling. Front Physiol. 2021;12:603040. A recent study using similar computational methods pre and post aortic reconstruction and including a BT shunt CrossRefPubMedPubMedCentral Primeaux J, Salavitabar A, Lu JC, Grifka RG, Figueroa CA. Characterization of Post-Operative Hemodynamics Following the Norwood Procedure Using Population Data and Multi-Scale Modeling. Front Physiol. 2021;12:603040. A recent study using similar computational methods pre and post aortic reconstruction and including a BT shunt CrossRefPubMedPubMedCentral
Metadaten
Titel
Effect of Virtual Aortic Arch Reconstruction After Norwood Procedure on Cardiac Function, Energy Efficiency, and Wall Shear Stress from Multiscale Simulations
verfasst von
Aloma Blanch-Granada
Margaret M. Samyn
Stephanie S. Handler
Jennifer F Gerardin
Benjamin Goot
Viktor Hraška
Joseph R. Cava
John F. LaDisa Jr
Publikationsdatum
28.11.2023
Verlag
Springer US
Erschienen in
Current Cardiovascular Imaging Reports / Ausgabe 12/2023
Print ISSN: 1941-9066
Elektronische ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-023-09587-z

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