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Deng S, Wheeler G, Toussaint N, Munroe L, Bhattacharya S, Sajith G, Lin E, Singh E, Chu KYK, Kabir S, Pushparajah K, Simpson JM, Schnabel JA, Gomez A. A Virtual Reality System for Improved Image-Based Planning of Complex Cardiac Procedures. J Imaging 2021; 7:151. [PMID: 34460787 PMCID: PMC8404926 DOI: 10.3390/jimaging7080151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
The intricate nature of congenital heart disease requires understanding of the complex, patient-specific three-dimensional dynamic anatomy of the heart, from imaging data such as three-dimensional echocardiography for successful outcomes from surgical and interventional procedures. Conventional clinical systems use flat screens, and therefore, display remains two-dimensional, which undermines the full understanding of the three-dimensional dynamic data. Additionally, the control of three-dimensional visualisation with two-dimensional tools is often difficult, so used only by imaging specialists. In this paper, we describe a virtual reality system for immersive surgery planning using dynamic three-dimensional echocardiography, which enables fast prototyping for visualisation such as volume rendering, multiplanar reformatting, flow visualisation and advanced interaction such as three-dimensional cropping, windowing, measurement, haptic feedback, automatic image orientation and multiuser interactions. The available features were evaluated by imaging and nonimaging clinicians, showing that the virtual reality system can help improve the understanding and communication of three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.
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Affiliation(s)
- Shujie Deng
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Gavin Wheeler
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Nicolas Toussaint
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Lindsay Munroe
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Suryava Bhattacharya
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Gina Sajith
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Ei Lin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Eeshar Singh
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Ka Yee Kelly Chu
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ National Health Service Foundation Trust, London SE1 7EH, UK;
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ National Health Service Foundation Trust, London SE1 7EH, UK;
| | - John M. Simpson
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ National Health Service Foundation Trust, London SE1 7EH, UK;
| | - Julia A. Schnabel
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
- Department of Informatics, Technische Universität München, 85748 Garching, Germany
- Helmholtz Zentrum München—German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Alberto Gomez
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
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De Vecchi A, Marlevi D, Nordsletten DA, Ntalas I, Leipsic J, Bapat V, Rajani R, Niederer SA. Left ventricular outflow obstruction predicts increase in systolic pressure gradients and blood residence time after transcatheter mitral valve replacement. Sci Rep 2018; 8:15540. [PMID: 30341365 PMCID: PMC6195528 DOI: 10.1038/s41598-018-33836-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/01/2018] [Indexed: 11/14/2022] Open
Abstract
Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodelling, its effects upon left ventricular hemodynamics remain poorly characterised. This study uses validated computational models to identify the LVOT obstruction degree that causes significant changes in ventricular hemodynamics after TMVR. Seven TMVR patients underwent personalised flow simulations based on pre-procedural imaging data. Different virtual valve configurations were simulated in each case, for a total of 32 simulations, and the resulting obstruction degree was correlated with pressure gradients and flow residence times. These simulations identified a threshold LVOT obstruction degree of 35%, beyond which significant deterioration of systolic function was observed. The mean increase from baseline (pre-TMVR) in the peak systolic pressure gradient rose from 5.7% to 30.1% above this threshold value. The average blood volume staying inside the ventricle for more than two cycles also increased from 4.4% to 57.5% for obstruction degrees above 35%, while the flow entering and leaving the ventricle within one cycle decreased by 13.9%. These results demonstrate the unique ability of modelling to predict the hemodynamic consequences of TMVR and to assist in the clinical decision-making process.
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Affiliation(s)
- Adelaide De Vecchi
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK.
| | - David Marlevi
- School of Technology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 52, Huddinge, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 17177, Stockholm, Sweden
| | - David A Nordsletten
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinayak Bapat
- Department of Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven A Niederer
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK
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Spazzapan M, Sastry P, Dunning J, Nordsletten D, de Vecchi A. The Use of Biophysical Flow Models in the Surgical Management of Patients Affected by Chronic Thromboembolic Pulmonary Hypertension. Front Physiol 2018; 9:223. [PMID: 29593574 PMCID: PMC5859070 DOI: 10.3389/fphys.2018.00223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/28/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from progressive thrombotic occlusion of the pulmonary arteries. It is treated by surgical removal of the occlusion, with success rates depending on the degree of microvascular remodeling. Surgical eligibility is influenced by the contributions of both the thrombus occlusion and microvasculature remodeling to the overall vascular resistance. Assessing this is challenging due to the high inter-individual variability in arterial morphology and physiology. We investigated the potential of patient-specific computational flow modeling to quantify pressure gradients in the pulmonary arteries of CTEPH patients to assist the decision-making process for surgical eligibility. Methods: Detailed segmentations of the pulmonary arteries were created from postoperative chest Computed Tomography scans of three CTEPH patients. A focal stenosis was included in the original geometry to compare the pre- and post-surgical hemodynamics. Three-dimensional flow simulations were performed on each morphology to quantify velocity-dependent pressure changes using a finite element solver coupled to terminal 2-element Windkessel models. In addition to transient flow simulations, a parametric modeling approach based on constant flow simulations is also proposed as faster technique to estimate relative pressure drops through the proximal pulmonary vasculature. Results: An asymmetrical flow split between left and right pulmonary arteries was observed in the stenosed models. Removing the proximal obstruction resulted in a reduction of the right-left pressure imbalance of up to 18%. Changes were also observed in the wall shear stresses and flow topology, where vortices developed in the stenosed model while the non-stenosed retained a helical flow. The predicted pressure gradients from constant flow simulations were consistent with the ones measured in the transient flow simulations. Conclusion: This study provides a proof of concept that patient-specific computational modeling can be used as a noninvasive tool for assisting surgical decisions in CTEPH based on hemodynamics metrics. Our technique enables determination of the proximal relative pressure, which could subsequently be compared to the total pressure drop to determine the degree of distal and proximal vascular resistance. In the longer term this approach has the potential to form the basis for a more quantitative classification system of CTEPH types.
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Affiliation(s)
- Martina Spazzapan
- King's College London, GKT School of Medical Education, London, United Kingdom
| | - Priya Sastry
- Cardiothoracic Surgery Unit, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - John Dunning
- Cardiothoracic Surgery Unit, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - David Nordsletten
- King's College London, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, United Kingdom
| | - Adelaide de Vecchi
- King's College London, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, United Kingdom
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4
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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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Nasopoulou A, Shetty A, Lee J, Nordsletten D, Rinaldi CA, Lamata P, Niederer S. Improved identifiability of myocardial material parameters by an energy-based cost function. Biomech Model Mechanobiol 2017. [PMID: 28188386 DOI: 10.1007/s10237‐016‐0865‐3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Myocardial stiffness is a valuable clinical biomarker for the monitoring and stratification of heart failure (HF). Cardiac finite element models provide a biomechanical framework for the assessment of stiffness through the determination of the myocardial constitutive model parameters. The reported parameter intercorrelations in popular constitutive relations, however, obstruct the unique estimation of material parameters and limit the reliable translation of this stiffness metric to clinical practice. Focusing on the role of the cost function (CF) in parameter identifiability, we investigate the performance of a set of geometric indices (based on displacements, strains, cavity volume, wall thickness and apicobasal dimension of the ventricle) and a novel CF derived from energy conservation. Our results, with a commonly used transversely isotropic material model (proposed by Guccione et al.), demonstrate that a single geometry-based CF is unable to uniquely constrain the parameter space. The energy-based CF, conversely, isolates one of the parameters and in conjunction with one of the geometric metrics provides a unique estimation of the parameter set. This gives rise to a new methodology for estimating myocardial material parameters based on the combination of deformation and energetics analysis. The accuracy of the pipeline is demonstrated in silico, and its robustness in vivo, in a total of 8 clinical data sets (7 HF and one control). The mean identified parameters of the Guccione material law were [Formula: see text] and [Formula: see text] ([Formula: see text], [Formula: see text], [Formula: see text]) for the HF cases and [Formula: see text] and [Formula: see text] ([Formula: see text], [Formula: see text], [Formula: see text]) for the healthy case.
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Affiliation(s)
- Anastasia Nasopoulou
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Anoop Shetty
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Jack Lee
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - David Nordsletten
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - C Aldo Rinaldi
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Pablo Lamata
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - Steven Niederer
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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6
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Nasopoulou A, Shetty A, Lee J, Nordsletten D, Rinaldi CA, Lamata P, Niederer S. Improved identifiability of myocardial material parameters by an energy-based cost function. Biomech Model Mechanobiol 2017; 16:971-988. [PMID: 28188386 PMCID: PMC5480093 DOI: 10.1007/s10237-016-0865-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022]
Abstract
Myocardial stiffness is a valuable clinical biomarker for the monitoring and stratification of heart failure (HF). Cardiac finite element models provide a biomechanical framework for the assessment of stiffness through the determination of the myocardial constitutive model parameters. The reported parameter intercorrelations in popular constitutive relations, however, obstruct the unique estimation of material parameters and limit the reliable translation of this stiffness metric to clinical practice. Focusing on the role of the cost function (CF) in parameter identifiability, we investigate the performance of a set of geometric indices (based on displacements, strains, cavity volume, wall thickness and apicobasal dimension of the ventricle) and a novel CF derived from energy conservation. Our results, with a commonly used transversely isotropic material model (proposed by Guccione et al.), demonstrate that a single geometry-based CF is unable to uniquely constrain the parameter space. The energy-based CF, conversely, isolates one of the parameters and in conjunction with one of the geometric metrics provides a unique estimation of the parameter set. This gives rise to a new methodology for estimating myocardial material parameters based on the combination of deformation and energetics analysis. The accuracy of the pipeline is demonstrated in silico, and its robustness in vivo, in a total of 8 clinical data sets (7 HF and one control). The mean identified parameters of the Guccione material law were [Formula: see text] and [Formula: see text] ([Formula: see text], [Formula: see text], [Formula: see text]) for the HF cases and [Formula: see text] and [Formula: see text] ([Formula: see text], [Formula: see text], [Formula: see text]) for the healthy case.
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Affiliation(s)
- Anastasia Nasopoulou
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Anoop Shetty
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Jack Lee
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - David Nordsletten
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - C Aldo Rinaldi
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Pablo Lamata
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - Steven Niederer
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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Simpson J, Lopez L, Acar P, Friedberg MK, Khoo NS, Ko HH, Marek J, Marx G, McGhie JS, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 30:1-27. [PMID: 27838227 DOI: 10.1016/j.echo.2016.08.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment.
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Affiliation(s)
- John Simpson
- Evelina London Children's Hospital, London, United Kingdom.
| | - Leo Lopez
- Nicklaus Children's Hospital, Miami, Florida
| | | | | | - Nee S Khoo
- Stollery Children's Hospital & University of Alberta, Edmonton, Alberta, Canada
| | - H Helen Ko
- Mt. Sinai Medical Center, New York, New York
| | - Jan Marek
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gerald Marx
- Boston Children's Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - Jackie S McGhie
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - David Roberson
- Advocate Children's Hospital, Chicago Medical School, Chicago, Illinois
| | | | - Owen Miller
- Evelina London Children's Hospital, London, United Kingdom
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8
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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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9
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Simpson J, Lopez L, Acar P, Friedberg M, Khoo N, Ko H, Marek J, Marx G, McGhie J, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1071-97. [DOI: 10.1093/ehjci/jew172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/02/2023] Open
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10
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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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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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12
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Doost SN, Zhong L, Su B, Morsi YS. The numerical analysis of non-Newtonian blood flow in human patient-specific left ventricle. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 127:232-247. [PMID: 26849955 DOI: 10.1016/j.cmpb.2015.12.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Recently, various non-invasive tools such as the magnetic resonance image (MRI), ultrasound imaging (USI), computed tomography (CT), and the computational fluid dynamics (CFD) have been widely utilized to enhance our current understanding of the physiological parameters that affect the initiation and the progression of the cardiovascular diseases (CVDs) associated with heart failure (HF). In particular, the hemodynamics of left ventricle (LV) has attracted the attention of the researchers due to its significant role in the heart functionality. In this study, CFD owing its capability of predicting detailed flow field was adopted to model the blood flow in images-based patient-specific LV over cardiac cycle. In most published studies, the blood is modeled as Newtonian that is not entirely accurate as the blood viscosity varies with the shear rate in non-linear manner. In this paper, we studied the effect of Newtonian assumption on the degree of accuracy of intraventricular hemodynamics. In doing so, various non-Newtonian models and Newtonian model are used in the analysis of the intraventricular flow and the viscosity of the blood. Initially, we used the cardiac MRI images to reconstruct the time-resolved geometry of the patient-specific LV. After the unstructured mesh generation, the simulations were conducted in the CFD commercial solver FLUENT to analyze the intraventricular hemodynamic parameters. The findings indicate that the Newtonian assumption cannot adequately simulate the flow dynamic within the LV over the cardiac cycle, which can be attributed to the pulsatile and recirculation nature of the flow and the low blood shear rate.
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Affiliation(s)
- Siamak N Doost
- Biomechanical and Tissue Engineering Lab, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Australia.
| | - Liang Zhong
- Duke-NUS Graduate Medical School, Singapore; National Heart Research Institute of Singapore, National Heart Centre, Singapore.
| | - Boyang Su
- National Heart Research Institute of Singapore, National Heart Centre, Singapore
| | - Yosry S Morsi
- Biomechanical and Tissue Engineering Lab, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Australia
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13
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Elbaz MSM, van der Geest RJ, Calkoen EE, de Roos A, Lelieveldt BPF, Roest AAW, Westenberg JJM. Assessment of viscous energy loss and the association with three-dimensional vortex ring formation in left ventricular inflow: In vivo evaluation using four-dimensional flow MRI. Magn Reson Med 2016; 77:794-805. [PMID: 26924448 PMCID: PMC5297883 DOI: 10.1002/mrm.26129] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/20/2015] [Accepted: 12/24/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate viscous energy loss and the association with three-dimensional (3D) vortex ring formation in left ventricular (LV) blood flow during diastolic filling. THEORY AND METHODS Thirty healthy volunteers were compared with 32 patients with corrected atrioventricular septal defect as unnatural mitral valve morphology and inflow are common in these patients. 4DFlow MRI was acquired from which 3D vortex ring formation was identified in LV blood flow at peak early (E)-filling and late (A)-filling and characterized by its presence/absence, orientation, and position from the lateral wall. Viscous energy loss was computed over E-filling, A-filling, and complete diastole using the Navier-Stokes energy equations. RESULTS Compared with healthy volunteers, viscous energy loss was significantly elevated in patients with disturbed vortex ring formation as characterized by a significantly inclined orientation and/or position closer to the lateral wall. Highest viscous energy loss was found in patients without a ring-shaped vortex during E-filling (on average more than double compared with patients with ring-shape vortex, P < 0.003). Altered A-filling vortex ring formation was associated with significant increase in total viscous energy loss over diastole even in the presence of normal E-filling vortex ring. CONCLUSION Altered vortex ring formation during LV filling is associated with increased viscous energy loss. Magn Reson Med 77:794-805, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
| | | | - Emmeline E Calkoen
- Division of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn P F Lelieveldt
- Division of Image Processing, Department of Radiology.,Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Arno A W Roest
- Division of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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14
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Myocardial Stiffness Estimation: A Novel Cost Function for Unique Parameter Identification. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/978-3-319-20309-6_41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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15
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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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Special issue on "Toward physiome based therapeutics". PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 116:1-2. [PMID: 25454286 DOI: 10.1016/j.pbiomolbio.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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