1
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McConnell B, Stoll VM, Panayiotou H, Piechnik SK, Neubauer S, van der Geest RJ, Myerson SG, Orchard E, Bissell MM. Acute vasodilator response testing in the adult Fontan circulation using non-invasive 4D Flow MRI: a proof-of-principle study. Cardiol Young 2023; 33:1342-1349. [PMID: 35942899 DOI: 10.1017/s1047951122002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary vasodilator therapy in Fontan patients can improve exercise tolerance. We aimed to assess the potential for non-invasive testing of acute vasodilator response using four-dimensional (D) flow MRI during oxygen inhalation. MATERIALS AND METHODS Six patients with well-functioning Fontan circulations were prospectively recruited and underwent cardiac MRI. Ventricular anatomical imaging and 4D Flow MRI were acquired at baseline and during inhalation of oxygen. Data were compared with six age-matched healthy volunteers with 4D Flow MRI scans acquired at baseline. RESULTS All six patients tolerated the MRI scan well. The dominant ventricle had a left ventricular morphology in all cases. On 4D Flow MRI assessment, two patients (Patients 2 and 6) showed improved cardiac filling with improved preload during oxygen administration, increased mitral inflow, increased maximum E-wave kinetic energy, and decreased systolic peak kinetic energy. Patient 1 showed improved preload only. Patient 5 showed no change, and patient 3 had equivocal results. Patient 4, however, showed a decrease in preload and cardiac filling/function with oxygen. DISCUSSION Using oxygen as a pulmonary vasodilator to assess increased pulmonary venous return as a marker for positive acute vasodilator response would provide pre-treatment assessment in a more physiological state - the awake patient. This proof-of-concept study showed that it is well tolerated and has shown changes in some stable patients with a Fontan circulation.
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Affiliation(s)
- Benjamin McConnell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Victoria M Stoll
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Hannah Panayiotou
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Centrum, the Netherlands
| | - Saul G Myerson
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Elizabeth Orchard
- Department of Congenital Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
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2
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Balmus M, Massing A, Hoffman J, Razavi R, Nordsletten DA. A partition of unity approach to fluid mechanics and fluid-structure interaction. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2020; 362:112842. [PMID: 34093912 PMCID: PMC7610902 DOI: 10.1016/j.cma.2020.112842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
For problems involving large deformations of thin structures, simulating fluid-structure interaction (FSI) remains a computationally expensive endeavour which continues to drive interest in the development of novel approaches. Overlapping domain techniques have been introduced as a way to combine the fluid-solid mesh conformity, seen in moving-mesh methods, without the need for mesh smoothing or re-meshing, which is a core characteristic of fixed mesh approaches. In this work, we introduce a novel overlapping domain method based on a partition of unity approach. Unified function spaces are defined as a weighted sum of fields given on two overlapping meshes. The method is shown to achieve optimal convergence rates and to be stable for steady-state Stokes, Navier-Stokes, and ALE Navier-Stokes problems. Finally, we present results for FSI in the case of 2D flow past an elastic beam simulation. These initial results point to the potential applicability of the method to a wide range of FSI applications, enabling boundary layer refinement and large deformations without the need for re-meshing or user-defined stabilization.
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Affiliation(s)
- Maximilian Balmus
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King’s College London, King’s Health Partners, London SE1 7EH, United Kingdom
| | - André Massing
- Department of Mathematics and Mathematical Statistics, Umeå University, SE-90187 Umeå, Sweden
- Department of Mathematical Sciences, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Johan Hoffman
- Division of Computational Science and Technology, KTH Royal Institute of Technology, Sweden
| | - Reza Razavi
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King’s College London, King’s Health Partners, London SE1 7EH, United Kingdom
| | - David A. Nordsletten
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King’s College London, King’s Health Partners, London SE1 7EH, United Kingdom
- Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, MI, USA
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3
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Le Rolle V, Galli E, Danan D, El Houari K, Hubert A, Donal E, Hernández AI. Sensitivity Analysis of a Left Ventricle Model in the Context of Intraventricular Dyssynchrony. Acta Biotheor 2020; 68:45-59. [PMID: 31506833 DOI: 10.1007/s10441-019-09362-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
The objective of the current study was to propose a sensitivity analysis of a 3D left ventricle model in order to assess the influence of parameters on myocardial mechanical dispersion. A finite element model of LV electro-mechanical activity was proposed and a screening method was used to evaluate the sensitivity of model parameters on the standard deviation of time to peak strain. Results highlight the importance of propagation parameters associated with septal and lateral segments activation. Simulated curves were compared to myocardial strains, obtained from echocardiography of one healthy subject and one patient diagnosed with intraventricular dyssynchrony and coronary artery disease. Results show a close match between simulation and clinical strains and illustrate the model ability to reproduce myocardial strains in the context of intraventricular dyssynchrony.
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4
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Santiago A, Aguado-Sierra J, Zavala-Aké M, Doste-Beltran R, Gómez S, Arís R, Cajas JC, Casoni E, Vázquez M. Fully coupled fluid-electro-mechanical model of the human heart for supercomputers. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3140. [PMID: 30117302 DOI: 10.1002/cnm.3140] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/28/2018] [Accepted: 07/22/2018] [Indexed: 05/12/2023]
Abstract
In this work, we present a fully coupled fluid-electro-mechanical model of a 50th percentile human heart. The model is implemented on Alya, the BSC multi-physics parallel code, capable of running efficiently in supercomputers. Blood in the cardiac cavities is modeled by the incompressible Navier-Stokes equations and an arbitrary Lagrangian-Eulerian (ALE) scheme. Electrophysiology is modeled with a monodomain scheme and the O'Hara-Rudy cell model. Solid mechanics is modeled with a total Lagrangian formulation for discrete strains using the Holzapfel-Ogden cardiac tissue material model. The three problems are simultaneously and bidirectionally coupled through an electromechanical feedback and a fluid-structure interaction scheme. In this paper, we present the scheme in detail and propose it as a computational cardiac workbench.
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Affiliation(s)
- Alfonso Santiago
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Jazmín Aguado-Sierra
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Miguel Zavala-Aké
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | | | - Samuel Gómez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Ruth Arís
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Juan C Cajas
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Eva Casoni
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Mariano Vázquez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Instituto de Investigación en Inteligencia Artificial (IIIA), Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
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5
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Abstract
Identification of in vivo passive biomechanical properties of healthy human myocardium from regular clinical data is essential for subject-specific modelling of left ventricle (LV). In this work, myocardium was defined by Holzapfel-Ogden constitutive law. Therefore, the objectives of the study were (a) to estimate the ranges of the constitutive parameters for healthy human myocardium using non-invasive routine clinical data, and (b) to investigate the effect of geometry, LV end-diastolic pressure (EDP) and fibre orientations on estimated values. In order to avoid invasive measurements and additional scans, LV cavity volume, measured from routine MRI, and empirical pressure-normalised-volume relation (Klotz-curve) were used as clinical data. Finite element modelling, response surface method and genetic algorithm were used to inversely estimate the constitutive parameters. Due to the ill-posed nature of the inverse optimisation problem, the myocardial properties was extracted by identifying the ranges of the parameters, instead of finding unique values. Additional sensitivity studies were carried out to identify the effect of LV EDP, fibre orientation and geometry on estimated parameters. Although uniqueness of the solution cannot be achieved, the normal ranges of the parameters produced similar mechanical responses within the physiological ranges. These information could be used in future computational studies for designing heart failure treatments. Graphical abstract.
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6
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In vivo estimation of passive biomechanical properties of human myocardium. Med Biol Eng Comput 2018; 56:1615-1631. [PMID: 29479659 PMCID: PMC6096751 DOI: 10.1007/s11517-017-1768-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 12/13/2017] [Indexed: 11/24/2022]
Abstract
Identification of in vivo passive biomechanical properties of healthy human myocardium from regular clinical data is essential for subject-specific modelling of left ventricle (LV). In this work, myocardium was defined by Holzapfel-Ogden constitutive law. Therefore, the objectives of the study were (a) to estimate the ranges of the constitutive parameters for healthy human myocardium using non-invasive routine clinical data, and (b) to investigate the effect of geometry, LV end-diastolic pressure (EDP) and fibre orientations on estimated values. In order to avoid invasive measurements and additional scans, LV cavity volume, measured from routine MRI, and empirical pressure-normalised-volume relation (Klotz-curve) were used as clinical data. Finite element modelling, response surface method and genetic algorithm were used to inversely estimate the constitutive parameters. Due to the ill-posed nature of the inverse optimisation problem, the myocardial properties was extracted by identifying the ranges of the parameters, instead of finding unique values. Additional sensitivity studies were carried out to identify the effect of LV EDP, fibre orientation and geometry on estimated parameters. Although uniqueness of the solution cannot be achieved, the normal ranges of the parameters produced similar mechanical responses within the physiological ranges. These information could be used in future computational studies for designing heart failure treatments. Graphical abstract ![]()
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7
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Cutrì E, Meoli A, Dubini G, Migliavacca F, Hsia TY, Pennati G. Patient-specific biomechanical model of hypoplastic left heart to predict post-operative cardio-circulatory behaviour. Med Eng Phys 2017; 47:85-92. [DOI: 10.1016/j.medengphy.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/02/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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8
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Augustin CM, Crozier A, Neic A, Prassl AJ, Karabelas E, Ferreira da Silva T, Fernandes JF, Campos F, Kuehne T, Plank G. Patient-specific modeling of left ventricular electromechanics as a driver for haemodynamic analysis. Europace 2017; 18:iv121-iv129. [PMID: 28011839 PMCID: PMC5386137 DOI: 10.1093/europace/euw369] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/26/2016] [Indexed: 01/30/2023] Open
Abstract
Aims Models of blood flow in the left ventricle (LV) and aorta are an important tool for analysing the interplay between LV deformation and flow patterns. Typically, image-based kinematic models describing endocardial motion are used as an input to blood flow simulations. While such models are suitable for analysing the hemodynamic status quo, they are limited in predicting the response to interventions that alter afterload conditions. Mechano-fluidic models using biophysically detailed electromechanical (EM) models have the potential to overcome this limitation, but are more costly to build and compute. We report our recent advancements in developing an automated workflow for the creation of such CFD ready kinematic models to serve as drivers of blood flow simulations. Methods and results EM models of the LV and aortic root were created for four pediatric patients treated for either aortic coarctation or aortic valve disease. Using MRI, ECG and invasive pressure recordings, anatomy as well as electrophysiological, mechanical and circulatory model components were personalized. Results The implemented modeling pipeline was highly automated and allowed model construction and execution of simulations of a patient’s heartbeat within 1 day. All models reproduced clinical data with acceptable accuracy. Conclusion Using the developed modeling workflow, the use of EM LV models as driver of fluid flow simulations is becoming feasible. While EM models are costly to construct, they constitute an important and nontrivial step towards fully coupled electro-mechano-fluidic (EMF) models and show promise as a tool for predicting the response to interventions which affect afterload conditions.
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Affiliation(s)
- Christoph M Augustin
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.,Department of Mechanical Engineering, University of California, 5126 Etcheverry Hall, Berkeley, CA 94720, USA
| | - Andrew Crozier
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria
| | - Aurel Neic
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria
| | - Anton J Prassl
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria
| | - Elias Karabelas
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria
| | - Tiago Ferreira da Silva
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Joao F Fernandes
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Fernando Campos
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria
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9
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Aorta Ascending Aneurysm Analysis Using CFD Models towards Possible Anomalies. FLUIDS 2017. [DOI: 10.3390/fluids2020031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Doost SN, Zhong L, Su B, Morsi YS. Two-dimensional intraventricular flow pattern visualization using the image-based computational fluid dynamics. Comput Methods Biomech Biomed Engin 2016; 20:492-507. [PMID: 27796137 DOI: 10.1080/10255842.2016.1250891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The image-based computational fluid dynamics (IB-CFD) technique, as the combination of medical images and the CFD method, is utilized in this research to analyze the left ventricle (LV) hemodynamics. The research primarily aims to propose a semi-automated technique utilizing some freely available and commercial software packages in order to simulate the LV hemodynamics using the IB-CFD technique. In this research, moreover, two different physiological time-resolved 2D models of a patient-specific LV with two different types of aortic and mitral valves, including the orifice-type valves and integrated with rigid leaflets, are adopted to visualize the process of developing intraventricular vortex formation and propagation. The blood flow pattern over the whole cardiac cycle of two models is also compared to investigate the effect of utilizing different valve types in the process of the intraventricular vortex formation. Numerical findings indicate that the model with integrated valves can predict more complex intraventricular flow that can match better the physiological flow pattern in comparison to the orifice-type model.
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Affiliation(s)
- Siamak N Doost
- a Biomechanical and Tissue Engineering Lab, Faculty of Science, Engineering and Technology , Swinburne University of Technology , Melbourne , Australia
| | - Liang Zhong
- b National Heart Research Institute of Singapore , National Heart Centre , Singapore , Singapore.,c Duke-NUS Medical School , Singapore , Singapore
| | - Boyang Su
- b National Heart Research Institute of Singapore , National Heart Centre , Singapore , Singapore
| | - Yosry S Morsi
- a Biomechanical and Tissue Engineering Lab, Faculty of Science, Engineering and Technology , Swinburne University of Technology , Melbourne , Australia
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11
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Doost SN, Ghista D, Su B, Zhong L, Morsi YS. Heart blood flow simulation: a perspective review. Biomed Eng Online 2016; 15:101. [PMID: 27562639 PMCID: PMC5000510 DOI: 10.1186/s12938-016-0224-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/15/2016] [Indexed: 02/03/2023] Open
Abstract
Cardiovascular disease (CVD), the leading cause of death today, incorporates a wide range of cardiovascular system malfunctions that affect heart functionality. It is believed that the hemodynamic loads exerted on the cardiovascular system, the left ventricle (LV) in particular, are the leading cause of CVD initiation and propagation. Moreover, it is believed that the diagnosis and prognosis of CVD at an early stage could reduce its high mortality and morbidity rate. Therefore, a set of robust clinical cardiovascular assessment tools has been introduced to compute the cardiovascular hemodynamics in order to provide useful insights to physicians to recognize indicators leading to CVD and also to aid the diagnosis of CVD. Recently, a combination of computational fluid dynamics (CFD) and different medical imaging tools, image-based CFD (IB-CFD), has been widely employed for cardiovascular functional assessment by providing reliable hemodynamic parameters. Even though the capability of CFD to provide reliable flow dynamics in general fluid mechanics problems has been widely demonstrated for many years, up to now, the clinical implications of the IB-CFD patient-specific LVs have not been applicable due to its limitations and complications. In this paper, we review investigations conducted to numerically simulate patient-specific human LV over the past 15 years using IB-CFD methods. Firstly, we divide different studies according to the different LV types (physiological and different pathological conditions) that have been chosen to reconstruct the geometry, and then discuss their contributions, methodologies, limitations, and findings. In this regard, we have studied CFD simulations of intraventricular flows and related cardiology insights, for (i) Physiological patient-specific LV models, (ii) Pathological heart patient-specific models, including myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy and hypoplastic left heart syndrome. Finally, we discuss the current stage of the IB-CFD LV simulations in order to mimic realistic hemodynamics of patient-specific LVs. We can conclude that heart flow simulation is on the right track for developing into a useful clinical tool for heart function assessment, by (i) incorporating most of heart structures' (such as heart valves) operations, and (ii) providing useful diagnostic indices based hemodynamic parameters, for routine adoption in clinical usage.
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Affiliation(s)
- Siamak N Doost
- Biomechanics and Tissue Engineering Lab, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
| | | | - Boyang Su
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Yosry S Morsi
- Biomechanics and Tissue Engineering Lab, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
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12
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Chabiniok R, Wang VY, Hadjicharalambous M, Asner L, Lee J, Sermesant M, Kuhl E, Young AA, Moireau P, Nash MP, Chapelle D, Nordsletten DA. Multiphysics and multiscale modelling, data-model fusion and integration of organ physiology in the clinic: ventricular cardiac mechanics. Interface Focus 2016; 6:20150083. [PMID: 27051509 PMCID: PMC4759748 DOI: 10.1098/rsfs.2015.0083] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With heart and cardiovascular diseases continually challenging healthcare systems worldwide, translating basic research on cardiac (patho)physiology into clinical care is essential. Exacerbating this already extensive challenge is the complexity of the heart, relying on its hierarchical structure and function to maintain cardiovascular flow. Computational modelling has been proposed and actively pursued as a tool for accelerating research and translation. Allowing exploration of the relationships between physics, multiscale mechanisms and function, computational modelling provides a platform for improving our understanding of the heart. Further integration of experimental and clinical data through data assimilation and parameter estimation techniques is bringing computational models closer to use in routine clinical practice. This article reviews developments in computational cardiac modelling and how their integration with medical imaging data is providing new pathways for translational cardiac modelling.
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Affiliation(s)
- Radomir Chabiniok
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
- Inria and Paris-Saclay University, Bâtiment Alan Turing, 1 rue Honoré d'Estienne d'Orves, Campus de l'Ecole Polytechnique, Palaiseau 91120, France
| | - Vicky Y. Wang
- Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, New Zealand
| | - Myrianthi Hadjicharalambous
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| | - Liya Asner
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| | - Jack Lee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| | - Maxime Sermesant
- Inria, Asclepios team, 2004 route des Lucioles BP 93, Sophia Antipolis Cedex 06902, France
| | - Ellen Kuhl
- Departments of Mechanical Engineering, Bioengineering, and Cardiothoracic Surgery, Stanford University, 496 Lomita Mall, Durand 217, Stanford, CA 94306, USA
| | - Alistair A. Young
- Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, New Zealand
| | - Philippe Moireau
- Inria and Paris-Saclay University, Bâtiment Alan Turing, 1 rue Honoré d'Estienne d'Orves, Campus de l'Ecole Polytechnique, Palaiseau 91120, France
| | - Martyn P. Nash
- Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, 70 Symonds Street, Auckland, New Zealand
| | - Dominique Chapelle
- Inria and Paris-Saclay University, Bâtiment Alan Turing, 1 rue Honoré d'Estienne d'Orves, Campus de l'Ecole Polytechnique, Palaiseau 91120, France
| | - David A. Nordsletten
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
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13
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Meoli A, Cutrì E, Krishnamurthy A, Dubini G, Migliavacca F, Hsia TY, Pennati G, Taylor A, Giardini A, Khambadkone S, Schievano S, de Leval M, Hsia TY, Bove E, Dorfman A, Baker GH, Hlavacek A, Migliavacca F, Pennati G, Dubini G, Marsden A, Feinstein J, Vignon-Clementel I, Figliola R, McGregor J. A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case. Interface Focus 2015; 5:20140079. [PMID: 25844151 DOI: 10.1098/rsfs.2014.0079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.
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Affiliation(s)
- Alessio Meoli
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Elena Cutrì
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | | | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Tain-Yen Hsia
- Department of Cardiothoracic Surgery , Great Ormond Street Hospital for Children, NHS Foundation Trust , London WC1N 3JH , UK
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | | | - Andrew Taylor
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Alessandro Giardini
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Sachin Khambadkone
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Silvia Schievano
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Marc de Leval
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - T-Y Hsia
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Edward Bove
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Adam Dorfman
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - G Hamilton Baker
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Anthony Hlavacek
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Alison Marsden
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Jeffrey Feinstein
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Irene Vignon-Clementel
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - Richard Figliola
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
| | - John McGregor
- Laboratory of Biological Structure Mechanics, Chemistry, Materials and Chemical Engineering Department 'Giulio Natta', Politecnico di Milano, Milan , Italy
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Biglino G, Cosentino D, Steeden JA, De Nova L, Castelli M, Ntsinjana H, Pennati G, Taylor AM, Schievano S. Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study. Front Pediatr 2015; 3:107. [PMID: 26697416 PMCID: PMC4677094 DOI: 10.3389/fped.2015.00107] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022] Open
Abstract
Computational fluid dynamics (CFD) can have a complementary predictive role alongside the exquisite visualization capabilities of 4D cardiovascular magnetic resonance (CMR) imaging. In order to exploit these capabilities (e.g., for decision-making), it is necessary to validate computational models against real world data. In this study, we sought to acquire 4D CMR flow data in a controllable, experimental setup and use these data to validate a corresponding computational model. We applied this paradigm to a case of congenital heart disease, namely, transposition of the great arteries (TGA) repaired with arterial switch operation. For this purpose, a mock circulatory loop compatible with the CMR environment was constructed and two detailed aortic 3D models (i.e., one TGA case and one normal aortic anatomy) were tested under realistic hemodynamic conditions, acquiring 4D CMR flow. The same 3D domains were used for multi-scale CFD simulations, whereby the remainder of the mock circulatory system was appropriately summarized with a lumped parameter network. Boundary conditions of the simulations mirrored those measured in vitro. Results showed a very good quantitative agreement between experimental and computational models in terms of pressure (overall maximum % error = 4.4% aortic pressure in the control anatomy) and flow distribution data (overall maximum % error = 3.6% at the subclavian artery outlet of the TGA model). Very good qualitative agreement could also be appreciated in terms of streamlines, throughout the cardiac cycle. Additionally, velocity vectors in the ascending aorta revealed less symmetrical flow in the TGA model, which also exhibited higher wall shear stress in the anterior ascending aorta.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Daria Cosentino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Lorenzo De Nova
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Matteo Castelli
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Hopewell Ntsinjana
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Giancarlo Pennati
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
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15
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Implicit Partitioned Cardiovascular Fluid-Structure Interaction of the Heart Cycle Using Non-newtonian Fluid Properties and Orthotropic Material Behavior. Cardiovasc Eng Technol 2014; 6:8-18. [PMID: 26577098 DOI: 10.1007/s13239-014-0205-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
Although image-based methods like MRI are well-developed, numerical simulation can help to understand human heart function. This function results from a complex interplay of biochemistry, structural mechanics, and blood flow. The complexity of the entire system often causes one of the three parts to be neglected, which limits the truth to reality of the reduced model. This paper focuses on the interaction of myocardial stress distribution and ventricular blood flow during diastole and systole in comparison to a simulation of the same patient-specific geometry with a given wall movement (Spiegel, Strömungsmechanischer Beitrag zur Planung von Herzoperationen, 2009). The orthotropic constitutive law proposed by Holzapfel et al. (Philos. Trans. R. Soc. Lond. Ser. A, 367:3445-3475, 2009) was implemented in a finite element package to model the passive behavior of the myocardium. Then, this law was modified for contraction. Via the ALE method, the structural model was coupled to a flow model which incorporates blood rheology and the circulatory system (Oertel, Prandtl-Essentials of Fluid Mechanics, 3rd edn, Springer Science + Business Media, 2010; Oertel et al., Modelling the Human Cardiac Fluid Mechanics, 3rd edn, Universitätsverlag Karlsruhe, 2009). Comparison reveals a good quantitative and qualitative agreement with respect to fluid flow. The motion of the myocardium is consistent with physiological observations. The calculated stresses and the distribution are within the physiological range and appear to be reasonable. The coupled model presented contains many features essential to cardiac function. It is possible to calculate wall stresses as well as the characteristic ventricular fluid flow. Based on the simulations we derive two characteristics to assess the health state quantitatively including solid and fluid mechanical aspects.
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Gao H, Wang H, Berry C, Luo X, Griffith BE. Quasi-static image-based immersed boundary-finite element model of left ventricle under diastolic loading. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1199-222. [PMID: 24799090 PMCID: PMC4233956 DOI: 10.1002/cnm.2652] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 05/07/2023]
Abstract
Finite stress and strain analyses of the heart provide insight into the biomechanics of myocardial function and dysfunction. Herein, we describe progress toward dynamic patient-specific models of the left ventricle using an immersed boundary (IB) method with a finite element (FE) structural mechanics model. We use a structure-based hyperelastic strain-energy function to describe the passive mechanics of the ventricular myocardium, a realistic anatomical geometry reconstructed from clinical magnetic resonance images of a healthy human heart, and a rule-based fiber architecture. Numerical predictions of this IB/FE model are compared with results obtained by a commercial FE solver. We demonstrate that the IB/FE model yields results that are in good agreement with those of the conventional FE model under diastolic loading conditions, and the predictions of the LV model using either numerical method are shown to be consistent with previous computational and experimental data. These results are among the first to analyze the stress and strain predictions of IB models of ventricular mechanics, and they serve both to verify the IB/FE simulation framework and to validate the IB/FE model. Moreover, this work represents an important step toward using such models for fully dynamic fluid-structure interaction simulations of the heart. © 2014 The Authors. International Journal for Numerical Methods in Engineering published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
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17
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Pedrizzetti G, Domenichini F. Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications. Ann Biomed Eng 2014; 43:26-40. [PMID: 25186434 DOI: 10.1007/s10439-014-1101-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/25/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Gianni Pedrizzetti
- Dipartimento di Ingegneria e Architettura, University of Trieste, P.le Europa 1, 34127, Trieste, Italy,
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18
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Malakan Rad E, Awad S, Hijazi ZM. Congenital left ventricular outpouchings: a systematic review of 839 cases and introduction of a novel classification after two centuries. CONGENIT HEART DIS 2014; 9:498-511. [PMID: 25159202 DOI: 10.1111/chd.12214] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis. OBJECTIVES The aim of this systematic review is to provide a clear and inclusive classification, with therapeutic and prognostic implications, for congenital LVOs. DATA SOURCES We performed three separate sets of search on three subjects including "congenital left ventricular outpouchings," "important and simply measurable markers of left ventricular function," and "relationship of mechanics of intraventricular blood flow and optimal vortex formation in left ventricle and elliptical geometry of LV." STUDY ELIGIBILITY CRITERIA We enrolled case series, review articles, and case reports with literature review. All types of acquired LVO's were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS We studied the abstracts of all searched articles. We focused on diagnostic criteria and patients' outcome. To examine the validity and reliability of the novel classification, fifteen previous studies were revisited using the novel classification. RESULTS A total of 20 papers from 11 countries fulfilled our inclusion criteria. The age of patients ranged from prenatal age to geriatric age range. Diagnostic criteria were clearly stated only for two of the above five terms (i.e., congenital LVA and congenital LVD). Cases with mixed diagnostic criteria were frequent.Elliptical geometry of left ventricle was found to have significant impact on effective blood flow mechanics in LV. A simple inclusive classification for congenital LVOs, with therapeutic and prognostic implications, was introduced. CONCLUSION The cornerstone of this classification is elliptical LV geometry. Large-type IIc LVO have dismal prognosis, if left untreated. LVO type I and small LVO type IIa have the best prognosis.
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Affiliation(s)
- Elaheh Malakan Rad
- Section of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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