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Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes

Frieberg, Petter LU ; Sjöberg, Pia LU ; Revstedt, Johan LU ; Heiberg, Einar LU ; Liuba, Petru LU and Carlsson, Marcus LU (2017) In Clinical Physiology and Functional Imaging2002-01-01+01:00
Abstract
Purpose: 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... (More)
Purpose: 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 29 53%. Including the effects of the APC flow in the simulation (n = 6) reduced simulation error from 98 70% to 52 63%. 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
4D-flow, cardiac magnetic resonance, patient-specific simulation, prediction of invasive interventions, total cavopulmonary connection
in
Clinical Physiology and Functional Imaging2002-01-01+01:00
pages
8 pages
publisher
Wiley Online Library
ISSN
1475-097X
DOI
10.1111/cpf.12457
language
English
LU publication?
yes
id
f3879370-c28d-4683-ae54-73208469d478
alternative location
http://rdcu.be/uQMh
date added to LUP
2017-08-25 11:29:49
date last changed
2017-11-25 03:00:12
@article{f3879370-c28d-4683-ae54-73208469d478,
  abstract     = {Purpose: 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.<br/><br/>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.<br/><br/>Results: The bias between simulated and MRI-measured fraction of blood to the left lung was 29  53%. Including the effects of the APC flow in the simulation (n = 6) reduced simulation error from 98  70% to 52  63%. Preliminary findings in two patients show that the effect of surgical and catheter interventions could be predicted using the demonstrated methods.<br/><br/>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.},
  author       = {Frieberg, Petter and Sjöberg, Pia and Revstedt, Johan and Heiberg, Einar and Liuba, Petru and Carlsson, Marcus},
  issn         = {1475-097X},
  keyword      = {4D-flow,cardiac magnetic resonance,patient-specific simulation,prediction of invasive interventions,total cavopulmonary connection},
  language     = {eng},
  month        = {08},
  pages        = {8},
  publisher    = {Wiley Online Library},
  series       = {Clinical Physiology and Functional Imaging2002-01-01+01:00},
  title        = {Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes},
  url          = {http://dx.doi.org/10.1111/cpf.12457},
  year         = {2017},
}