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Itatani K, Sekine T, Yamagishi M, Maeda Y, Higashitani N, Miyazaki S, Matsuda J, Takehara Y. Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications. Magn Reson Med Sci 2022; 21:380-399. [PMID: 35173116 DOI: 10.2463/mrms.rev.2021-0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Blood flow imaging becomes an emerging trend in cardiology with the recent progress in computer technology. It not only visualizes colorful flow velocity streamlines but also quantifies the mechanical stress on cardiovascular structures; thus, it can provide the detailed inspections of the pathophysiology of diseases and predict the prognosis of cardiovascular functions. Clinical applications include the comprehensive assessment of hemodynamics and cardiac functions in echocardiography vector flow mapping (VFM), 4D flow MRI, and surgical planning as a simulation medicine in computational fluid dynamics (CFD).For evaluation of the hemodynamics, novel mathematically derived parameters obtained using measured velocity distributions are essential. Among them, the traditional and typical parameters are wall shear stress (WSS) and its related parameters. These parameters indicate the mechanical damages to endothelial cells, resulting in degenerative intimal change in vascular diseases. Apart from WSS, there are abundant parameters that describe the strength of the vortical and/or helical flow patterns. For instance, vorticity, enstrophy, and circulation indicate the rotating flow strength or power of 2D vortical flows. In addition, helicity, which is defined as the cross-linking number of the vortex filaments, indicates the 3D helical flow strength and adequately describes the turbulent flow in the aortic root in cases with complicated anatomies. For the description of turbulence caused by the diseased flow, there exist two types of parameters based on completely different concepts, namely: energy loss (EL) and turbulent kinetic energy (TKE). EL is the dissipated energy with blood viscosity and evaluates the cardiac workload related to the prognosis of heart failure. TKE describes the fluctuation in kinetic energy during turbulence, which describes the severity of the diseases that cause jet flow. These parameters are based on intuitive and clear physiological concepts, and are suitable for in vivo flow measurements using inner velocity profiles.
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Affiliation(s)
- Keiichi Itatani
- Department of Cardiovascular Surgery, Osaka City University.,Cardio Flow Design Inc
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Norika Higashitani
- Cardio Flow Design Inc.,Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya university Graduate School of Medicine
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Kainuma A, Itatani K, Akiyama K, Naito Y, Ishii M, Shimizu M, Ohara J, Nakamura N, Nakajima Y, Numata S, Yaku H, Sawa T. Preoperative Left Ventricular Energy Loss in the Operating Theater Reflects Subjective Symptoms in Chronic Aortic Regurgitation. Front Surg 2022; 9:739743. [PMID: 35252323 PMCID: PMC8889468 DOI: 10.3389/fsurg.2022.739743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is currently no subjective, definitive evaluation method for therapeutic indication other than symptoms in aortic regurgitation. Energy loss, a novel parameter of cardiac workload, can be visualized and quantified using echocardiography vector flow mapping. The purpose of the present study was to evaluate whether energy loss in patients with chronic aortic regurgitation can quantify their subjective symptoms more clearly than other conventional metrics. Methods We studied 15 patients undergoing elective aortic valve surgery for aortic regurgitation. We divided the patients into symptomatic and asymptomatic groups using their admission records. We analyzed the mean energy loss in one cardiac cycle using transesophageal echocardiography during the preoperative period. The relationships between symptoms, energy loss, and other conventional metrics were statistically analyzed. Results There were seven and eight patients in the symptomatic and asymptomatic groups, respectively. The mean energy loss of one cardiac cycle was higher in the symptomatic group (121 mW/m [96–184]) than in the asymptomatic group (87 mW/m [80–103]) (p = 0.040), whereas the diastolic diameter was higher in the asymptomatic group (65 mm [59–78]) than in the symptomatic group (57 mm [51–57]) (p = 0.040). There was no significant difference between the symptomatic and asymptomatic groups in terms of other conventional metrics. Conclusions An energy loss can quantify patients' subjective symptoms more clearly than other conventional metrics. The small sample size is the primary limitation of our study, further studies assessing larger cohort of patients are warranted to validate our findings.
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Affiliation(s)
- Atsushi Kainuma
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- *Correspondence: Keiichi Itatani
| | - Koichi Akiyama
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshifumi Naito
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maki Ishii
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaru Shimizu
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Ohara
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naotoshi Nakamura
- Center for Mathematical Modeling and Data Science, Osaka University, Osaka, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology and Critical Care, Kansai Medical University, Osaka, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Fumagalli I, Vitullo P, Vergara C, Fedele M, Corno AF, Ippolito S, Scrofani R, Quarteroni A. Image-Based Computational Hemodynamics Analysis of Systolic Obstruction in Hypertrophic Cardiomyopathy. Front Physiol 2022; 12:787082. [PMID: 35069249 PMCID: PMC8773089 DOI: 10.3389/fphys.2021.787082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is a pathological condition characterized by an abnormal thickening of the myocardium. When affecting the medio-basal portion of the septum, it is named Hypertrophic Obstructive Cardiomyopathy (HOCM) because it induces a flow obstruction in the left ventricular outflow tract. In any type of HCM, the myocardial function can become compromised, possibly resulting in cardiac death. In this study, we investigated with computational analysis the hemodynamics of patients with different types of HCM. The aim was quantifying the effects of this pathology on the intraventricular blood flow and pressure gradients, and providing information potentially useful to guide the indication and the modality of the surgical treatment (septal myectomy). We employed an image-based computational approach, integrating fluid dynamics simulations with geometric and functional data, reconstructed from standard cardiac cine-MRI acquisitions. We showed that with our approach we can better understand the patho-physiological behavior of intraventricular blood flow dynamics due to the abnormal morphological and functional aspect of the left ventricle. The main results of our investigation are: (a) a detailed patient-specific analysis of the blood velocity, pressure and stress distribution associated to HCM; (b) a computation-based classification of patients affected by HCM that can complement the current clinical guidelines for the diagnosis and treatment of HOCM.
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Affiliation(s)
- Ivan Fumagalli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Piermario Vitullo
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Marco Fedele
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Antonio F. Corno
- Children’s Heart Institute, Hermann Children’s Hospital, McGovern Medical School, University of Texas Health, Houston, TX, United States
| | | | | | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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An image-based computational hemodynamics study of the Systolic Anterior Motion of the mitral valve. Comput Biol Med 2020; 123:103922. [PMID: 32741752 DOI: 10.1016/j.compbiomed.2020.103922] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/23/2023]
Abstract
Systolic Anterior Motion (SAM) of the mitral valve - often associated with Hypertrophic Obstructive Cardiomyopathy (HOCM) - is a cardiac pathology in which a functional subaortic stenosis is induced during systole by the mitral leaflets partially obstructing the outflow tract of the left ventricle. Its assessment by diagnostic tests is often difficult, possibly underestimating its severity and thus increasing the risk of heart failure. In this paper, we propose a new computational pipeline, based on cardiac cine Magnetic Resonance Imaging (cine-MRI) data, for the assessment of SAM. The pipeline encompasses image processing of the left ventricle and the mitral valve, and numerical investigation of cardiac hemodynamics by means of Computational Fluid Dynamics (CFD) in a moving domain with image-based prescribed displacement. Patient-specific geometry and motion of the left ventricle are considered in view of an Arbitrary Lagrangian-Eulerian approach for CFD, while the reconstructed mitral valve is immersed in the computational domain by means of a resistive method. We assess clinically relevant flow and pressure indicators in a parametric study for different degrees of SAM severity, in order to provide a better quantitative evaluation of the pathological condition. Moreover, we provide specific indications for its possible surgical treatment, i.e. septal myectomy.
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Kainuma A, Akiyama K, Naito Y, Hayase K, Hongu H, Itatani K, Yamagishi M, Sawa T. Energetic performance index improvement after Glenn and Damus-Kaye-Stansel procedure using vector flow mapping analysis: a case report. JA Clin Rep 2020; 6:5. [PMID: 32026035 PMCID: PMC6973790 DOI: 10.1186/s40981-020-0312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Echocardiography vector flow mapping can assess dynamic flow to treat congenital heart diseases. We evaluated intracardiac flow, energy loss, left ventricular output kinetic energy, and energetic performance index using vector flow mapping during Glenn and Damus-Kaye-Stansel procedures in order to assess the efficacy of the surgery. Case presentation A 9-month-old boy underwent Glenn and Damus-Kaye-Stansel procedures. The energy loss depends on the left ventricular preload; therefore, energy loss decreased after the Glenn procedure. After the Damus-Kaye-Stansel procedure, the kinetic energy would increase owing to the integrated systemic outflow; however, in our case, kinetic energy decreased, which was potentially explained by the fact that kinetic energy also depends on the left ventricular preload. After the Glenn and Damus-Kaye-Stansel procedures, we detected an improvement in energetic performance index, indicating that the cardiac workload improved as well. Conclusion We revealed the efficiency of the Glenn and Damus-Kaye-Stansel procedures using vector flow mapping.
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Affiliation(s)
- Atsushi Kainuma
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyoku, Kyoto, 602-8566, Japan.
| | - Koichi Akiyama
- Department of Anesthesiology, Yodogawa Christian Hospital, 1 Chome-7-50, Kunijima, Higashiyodogawa Ward, Osaka, 533-0024, Japan
| | - Yoshifumi Naito
- Department of Anesthesia and Perioperative care, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Kazuma Hayase
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyoku, Kyoto, 602-8566, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyoku, Kyoto, 602-8566, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyoku, Kyoto, 602-8566, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyoku, Kyoto, 602-8566, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyoku, Kyoto, 602-8566, Japan
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Kinoshita M, Akiyama K, Itatani K, Yamashita A, Ishii M, Kainuma A, Maeda Y, Miyazaki T, Yamagishi M, Sawa T. Energetic performance analysis of staged palliative surgery in tricuspid atresia using vector flow mapping. Cardiovasc Ultrasound 2017; 15:27. [PMID: 29241451 PMCID: PMC5731082 DOI: 10.1186/s12947-017-0118-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Staged palliative surgery markedly shifts the balance of volume load on a single ventricle and pulmonary vascular bed. Blalock-Taussig shunt necessitates a single ventricle eject blood to both the systemic and pulmonary circulation. On the contrary, bidirectional cavopulmonary shunt release the single ventricle from pulmonary circulation. Case presentation We report a case of tricuspid atresia patient who underwent first palliative surgery and second palliative surgery. Volume loading condition was assessed by energetic parameters (energy loss, kinetic energy) intraoperatively using vector flow mapping. These energetic parameters can simply indicate the volume loading condition. Conclusion Vector flow mapping was useful tool for monitoring volume loading condition in congenital heart disease surgery. Electronic supplementary material The online version of this article (10.1186/s12947-017-0118-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mao Kinoshita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii Cho, Hirokoji Agaru, Kawaramachi Street, Kamigyo Ward, Kyoto City, Kyoto Prefecture, 602-8566, Japan
| | - Koichi Akiyama
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii Cho, Hirokoji Agaru, Kawaramachi Street, Kamigyo Ward, Kyoto City, Kyoto Prefecture, 602-8566, Japan.
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ayahiro Yamashita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii Cho, Hirokoji Agaru, Kawaramachi Street, Kamigyo Ward, Kyoto City, Kyoto Prefecture, 602-8566, Japan
| | - Maki Ishii
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii Cho, Hirokoji Agaru, Kawaramachi Street, Kamigyo Ward, Kyoto City, Kyoto Prefecture, 602-8566, Japan
| | - Atsushi Kainuma
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii Cho, Hirokoji Agaru, Kawaramachi Street, Kamigyo Ward, Kyoto City, Kyoto Prefecture, 602-8566, Japan
| | - Yoshinobu Maeda
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takako Miyazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii Cho, Hirokoji Agaru, Kawaramachi Street, Kamigyo Ward, Kyoto City, Kyoto Prefecture, 602-8566, Japan
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Visualization of suppressed intraventricular flow by constrictive pericarditis. J Clin Anesth 2017; 42:40-41. [PMID: 28800477 DOI: 10.1016/j.jclinane.2017.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/22/2022]
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