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

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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.

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Acknowledgements

The authors thank Weiguang Yang for sharing his expertise on multiscale modeling.

Funding

This work is supported by the Fulbright Scholars Program (ABG), S. Bert Litwin Family Fund (JFL) and the Dr. Josep G. Llaurado Memorial Fellowship.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA

    Aloma Blanch-Granada, Margaret M. Samyn, Joseph R. Cava & John F. LaDisa Jr

  2. Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    Margaret M. Samyn, Stephanie S. Handler, Jennifer F Gerardin, Benjamin Goot, Joseph R. Cava & John F. LaDisa Jr

  3. Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA

    Margaret M. Samyn, Stephanie S. Handler, Jennifer F Gerardin, Benjamin Goot, Viktor Hraška, Joseph R. Cava & John F. LaDisa Jr

  4. Department of Surgery - Division of Pediatric Cardiothoracic Surgery, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA

    Viktor Hraška

  5. Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA

    John F. LaDisa Jr

Authors
  1. Aloma Blanch-Granada
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  2. Margaret M. Samyn
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  3. Stephanie S. Handler
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  4. Jennifer F Gerardin
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  5. Benjamin Goot
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  6. Viktor Hraška
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  7. Joseph R. Cava
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  8. John F. LaDisa Jr
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Contributions

ABG, VH, SH, and JFL contributed to conception and design of the study and wrote the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding author

Correspondence to John F. LaDisa Jr.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animals. Research involving human subject data was conducted following institutional review board approval.

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Blanch-Granada, A., Samyn, M.M., Handler, S.S. et al. Effect of Virtual Aortic Arch Reconstruction After Norwood Procedure on Cardiac Function, Energy Efficiency, and Wall Shear Stress from Multiscale Simulations. Curr Cardiovasc Imaging Rep 16, 117–127 (2023). https://doi.org/10.1007/s12410-023-09587-z

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