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An integrated approach to patient-specific predictive modeling for single ventricle heart palliation

Identifieur interne : 001B34 ( Pmc/Curation ); précédent : 001B33; suivant : 001B35

An integrated approach to patient-specific predictive modeling for single ventricle heart palliation

Auteurs : Chiara Corsini [Italie] ; Catriona Baker [Royaume-Uni] ; Ethan Kung [États-Unis] ; Silvia Schievano [Royaume-Uni] ; Gregory Arbia [France] ; Alessia Baretta [Italie] ; Giovanni Biglino [Royaume-Uni] ; Francesco Migliavacca [Italie] ; Gabriele Dubini [Italie] ; Giancarlo Pennati [Italie] ; Alison Marsden [États-Unis] ; Irene Vignon-Clementel [France] ; Andrew Taylor [Royaume-Uni] ; Tain-Yen Hsia [Royaume-Uni] ; Adam Dorfman [États-Unis]

Source :

RBID : PMC:4242799

Abstract

In patients with congenital heart disease and a single ventricle (SV), ventricular support of the circulation is inadequate, and staged palliative surgery (usually 3 stages) is needed for treatment. In the various palliative surgical stages individual differences in the circulation are important and patient-specific surgical planning is ideal. In this study, an integrated approach between clinicians and engineers has been developed, based on patient-specific multi-scale models, and is here applied to predict stage 2 surgical outcomes. This approach involves four distinct steps: (1) collection of pre-operative clinical data from a patient presenting for SV palliation, (2) construction of the pre-operative model, (3) creation of feasible virtual surgical options which couple a three-dimensional model of the surgical anatomy with a lumped parameter model (LPM) of the remainder of the circulation and (4) performance of post-operative simulations to aid clinical decision making. The pre-operative model is described, agreeing well with clinical flow tracings and mean pressures. Two surgical options (bi-directional Glenn and hemi-Fontan operations) are virtually performed and coupled to the pre-operative LPM, with the hemodynamics of both options reported. Results are validated against postoperative clinical data. Ultimately, this work represents the first patient-specific predictive modeling of stage 2 palliation using virtual surgery and closed-loop multi-scale modeling.


Url:
DOI: 10.1080/10255842.2012.758254
PubMed: 23343002
PubMed Central: 4242799

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PMC:4242799

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<p id="P3">In patients with congenital heart disease and a single ventricle (SV), ventricular support of the circulation is inadequate, and staged palliative surgery (usually 3 stages) is needed for treatment. In the various palliative surgical stages individual differences in the circulation are important and patient-specific surgical planning is ideal. In this study, an integrated approach between clinicians and engineers has been developed, based on patient-specific multi-scale models, and is here applied to predict stage 2 surgical outcomes. This approach involves four distinct steps: (1) collection of pre-operative clinical data from a patient presenting for SV palliation, (2) construction of the pre-operative model, (3) creation of feasible virtual surgical options which couple a three-dimensional model of the surgical anatomy with a lumped parameter model (LPM) of the remainder of the circulation and (4) performance of post-operative simulations to aid clinical decision making. The pre-operative model is described, agreeing well with clinical flow tracings and mean pressures. Two surgical options (bi-directional Glenn and hemi-Fontan operations) are virtually performed and coupled to the pre-operative LPM, with the hemodynamics of both options reported. Results are validated against postoperative clinical data. Ultimately, this work represents the first patient-specific predictive modeling of stage 2 palliation using virtual surgery and closed-loop multi-scale modeling.</p>
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<name>
<surname>Corsini</surname>
<given-names>Chiara</given-names>
</name>
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<given-names>Catriona</given-names>
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<name>
<surname>Kung</surname>
<given-names>Ethan</given-names>
</name>
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<name>
<surname>Schievano</surname>
<given-names>Silvia</given-names>
</name>
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<surname>Arbia</surname>
<given-names>Gregory</given-names>
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<given-names>Alessia</given-names>
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<name>
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<given-names>Francesco</given-names>
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<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="corresp" rid="CR1">*</xref>
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<name>
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<given-names>Gabriele</given-names>
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</contrib>
<contrib contrib-type="author">
<name>
<surname>Pennati</surname>
<given-names>Giancarlo</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Marsden</surname>
<given-names>Alison</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Vignon-Clementel</surname>
<given-names>Irene</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Taylor</surname>
<given-names>Andrew</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hsia</surname>
<given-names>Tain-Yen</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dorfman</surname>
<given-names>Adam</given-names>
</name>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<on-behalf-of>for the Modeling of Congenital Hearts Alliance (MOCHA) Investigators</on-behalf-of>
<xref ref-type="author-notes" rid="FN2">2</xref>
</contrib-group>
<aff id="A1">
<label>a</label>
Laboratory of Biological Structure Mechanics, Department of Structural Engineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, Italy</aff>
<aff id="A2">
<label>b</label>
Cardiorespiratory Unit, UCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London, UK</aff>
<aff id="A3">
<label>c</label>
Department of Mechanical and Aerospace Engineering, University of California San Diego, San Diego, CA, USA</aff>
<aff id="A4">
<label>d</label>
INRIA Paris-Rocquencourt, Le Chesnay, France</aff>
<aff id="A5">
<label>e</label>
Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI, USA</aff>
<author-notes>
<title>Notes</title>
<fn id="FN1">
<label>1</label>
<p id="P1">Joint first authors.</p>
</fn>
<fn id="FN2">
<label>2</label>
<p id="P2">MOCHA investigators: Andrew Taylor, MD, Alessandro Giardini, MD, Sachin Khambadkone, MD, Silvia Schievano, PhD, Marc de Leval, MD, and T.-Y. Hsia, MD (Institute of Cardiovascular Sciences, UCL, London, UK); Edward Bove, MD and Adam Dorfman, MD (University of Michigan, Ann Arbor, MI, USA); G. Hamilton Baker, MD and Anthony Hlavacek (Medical University of South Carolina, Charleston, SC, USA); Francesco Migliavacca, PhD, Giancarlo Pennati, PhD, and Gabriele Dubini, PhD (Politecnico di Milano, Milan, Italy); Alison Marsden, PhD (University of California, San Diego, CA, USA); Jeffrey Feinstein, MD (Stanford University, Stanford, CA, USA); Irene Vignon-Clementel (INRIA, Paris, France); Richard Figliola, PhD and John McGregor, PhD (Clemson University, Clemson, SC, USA)</p>
</fn>
<corresp id="CR1">
<label>*</label>
Corresponding author.
<email>francesco.migliavacca@polimi.it</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>16</day>
<month>11</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub">
<day>23</day>
<month>1</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub">
<year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>24</day>
<month>11</month>
<year>2014</year>
</pub-date>
<volume>17</volume>
<issue>14</issue>
<fpage>1572</fpage>
<lpage>1589</lpage>
<pmc-comment>elocation-id from pubmed: 10.1080/10255842.2012.758254</pmc-comment>
<permissions>
<copyright-statement>© 2013 Taylor & Francis</copyright-statement>
<copyright-year>2013</copyright-year>
</permissions>
<abstract>
<p id="P3">In patients with congenital heart disease and a single ventricle (SV), ventricular support of the circulation is inadequate, and staged palliative surgery (usually 3 stages) is needed for treatment. In the various palliative surgical stages individual differences in the circulation are important and patient-specific surgical planning is ideal. In this study, an integrated approach between clinicians and engineers has been developed, based on patient-specific multi-scale models, and is here applied to predict stage 2 surgical outcomes. This approach involves four distinct steps: (1) collection of pre-operative clinical data from a patient presenting for SV palliation, (2) construction of the pre-operative model, (3) creation of feasible virtual surgical options which couple a three-dimensional model of the surgical anatomy with a lumped parameter model (LPM) of the remainder of the circulation and (4) performance of post-operative simulations to aid clinical decision making. The pre-operative model is described, agreeing well with clinical flow tracings and mean pressures. Two surgical options (bi-directional Glenn and hemi-Fontan operations) are virtually performed and coupled to the pre-operative LPM, with the hemodynamics of both options reported. Results are validated against postoperative clinical data. Ultimately, this work represents the first patient-specific predictive modeling of stage 2 palliation using virtual surgery and closed-loop multi-scale modeling.</p>
</abstract>
<kwd-group>
<kwd>computational fluid dynamics</kwd>
<kwd>lumped parameter network</kwd>
<kwd>multi-scale model</kwd>
<kwd>congenital heart disease</kwd>
<kwd>virtual surgery</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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