Treatment planning for a TCPC test case: A numerical investigation under rigid and moving wall assumptions

• Published in: International journal for numerical methods in biomedical engineering Vol. 29; no. 2; pp. 197 - 216
• Main Authors: Mirabella, Lucia, Haggerty, Christopher M., Passerini, Tiziano, Piccinelli, Marina, Powell, Andrew J., Del Nido, Pedro J., Veneziani, Alessandro, Yoganathan, Ajit P.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.02.2013; Wiley Subscription Services, Inc
• Subjects: Algorithms; Blood Flow Velocity; Child; computational fluid dynamics CFD; Computer Simulation; fenestration; Fontan Procedure; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Heart Defects, Congenital - therapy; Hemodynamics; Humans; Magnetic Resonance Imaging; Models, Cardiovascular; moving wall; MRI-based displacement; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - surgery; Radiography; surgical planning; total cavopulmonary connection TCPC
• ISSN: 2040-7939; 2040-7947; 2040-7947
• DOI: 10.1002/cnm.2517

SUMMARY The hemodynamics in patients with total cavopulmonary connections (TCPC) is generally very complex and characterized by patient‐to‐patient variability. To better understand its effect on patients’ outcome, CFD models are widely used, also to test and optimize surgical options before their implementation. These models often assume rigid geometries, despite the motion experienced by thoracic vessels that could influence the hemodynamics predictions. By improving their accuracy and expanding the range of simulated interventions, the benefit of treatment planning for patients is expected to increase. We simulate three types of intervention on a patient‐specific 3D model, and compare their predicted outcome with baseline condition: a decrease in pulmonary vascular resistance obtainable with medications; a surgical revision of the connection design; the introduction of a fenestration in the TCPC wall. The simulations are performed both with rigid wall assumption and including patient‐specific TCPC wall motion, reconstructed from a 4DMRI dataset. The results show the effect of each option on clinically important metrics and highlight the impact of patient‐specific wall motion. The largest differences between rigid and moving wall models are observed in measures of energetic efficiency of TCPC as well as in hepatic flow distribution and transit time of seeded particles through the connection.Copyright © 2012 John Wiley & Sons, Ltd. In this work, we simulate three types of intervention on a Fontan patient case study, and compare their predicted outcome with baseline conditions: decrease in pulmonary vascular resistance; surgical revision of the connection design; and introduction of a fenestration in the vessel wall. The simulations are performed both with rigid wall assumption and including patient‐specific wall motion, reconstructed from a 4DMRI data set. The results show the effect of each option on clinically important metrics and highlight the impact of patient‐specific wall motion.