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A computational study of aortic reconstruction in single ventricle patients

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Abstract

Patients with hypoplastic left heart syndrome (HLHS) are born with an underdeveloped left heart. They typically receive a sequence of surgeries that result in a single ventricle physiology called the Fontan circulation. While these patients usually survive into early adulthood, they are at risk for medical complications, partially due to their lower than normal cardiac output, which leads to insufficient cerebral and gut perfusion. While clinical imaging data can provide detailed insight into cardiovascular function within the imaged region, it is difficult to use these data for assessing deficiencies in the rest of the body and for deriving blood pressure dynamics. Data from patients used in this paper include three-dimensional, magnetic resonance angiograms (MRA), time-resolved phase contrast cardiac magnetic resonance images (4D-MRI) and sphygmomanometer blood pressure measurements. The 4D-MRI images provide detailed insight into velocity and flow in vessels within the imaged region, but they cannot predict flow in the rest of the body, nor do they provide values of blood pressure. To remedy these limitations, this study combines the MRA, 4D-MRI, and pressure data with 1D fluid dynamics models to predict hemodynamics in the major systemic arteries, including the cerebral and gut vasculature. A specific focus is placed on studying the impact of aortic reconstruction occurring during the first surgery that results in abnormal vessel morphology. To study these effects, we compare simulations for an HLHS patient with simulations for a matched control patient that has double outlet right ventricle (DORV) physiology with a native aorta. Our results show that the HLHS patient has hypertensive pressures in the brain as well as reduced flow to the gut. Wave intensity analysis suggests that the HLHS patient has irregular circulatory function during light upright exercise conditions and that predicted wall shear stresses are lower than normal, suggesting the HLHS patient may have hypertension.

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Notes

  1. Image intensities are taken in the range 100–264 Houndsfield Units.

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Acknowledgements

This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. DGE-2137100. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors(s) and do not necessarily reflect the views of the National Science Foundation. The project described was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant TL1 TR001415 (MJC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Mathematics, North Carolina State University, Raleigh, NC, 27695, USA

    Alyssa M. Taylor-LaPole & Mette S. Olufsen

  2. Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center, Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, 92617, USA

    Mitchel J. Colebank

  3. Division of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, 77030, USA

    Justin D. Weigand & Charles Puelz

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  1. Alyssa M. Taylor-LaPole
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Taylor-LaPole, A.M., Colebank, M.J., Weigand, J.D. et al. A computational study of aortic reconstruction in single ventricle patients. Biomech Model Mechanobiol 22, 357–377 (2023). https://doi.org/10.1007/s10237-022-01650-w

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