An integrated approach to patient-specific predictive modeling for single ventricle heart palliation

Corsini, Chiara; Baker, Catriona; Kung, Ethan; Schievano, Silvia; Arbia, Gregory; Baretta, Alessia; Biglino, Giovanni; Migliavacca, Francesco; Dubini, Gabriele; Pennati, Giancarlo; Marsden, Alison L.; Vignon-Clementel, Irene E.; Taylor, Andrew M.; Hsia, Tain Yen; Dorfman, Adam L.

doi:10.1080/10255842.2012.758254

Cited by 61 publications

(64 citation statements)

References 32 publications

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“…It should be noted that single-ventricle physiology presents a challenging treatment as only one heart pump functions well at birth; treatment is usually performed in three stages of open-heart surgery where important decisions must be made at each stage [35,36]. In recent years, computational fluid dynamics (CFD) models, large parts of which comprise lumped parameter models, has been employed to aid clinical decision-making and development of novel surgical strategies [36,37].…”

Section: Introductionmentioning

confidence: 99%

Inverse problems in reduced order models of cardiovascular haemodynamics: aspects of data assimilation and heart rate variability

Pant

Corsini

Baker

et al. 2017

J. R. Soc. Interface.

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Inverse problems in cardiovascular modelling have become increasingly important to assess each patient individually. These problems entail estimation of patient-specific model parameters from uncertain measurements acquired in the clinic. In recent years, the method of data assimilation, especially the unscented Kalman filter, has gained popularity to address computational efficiency and uncertainty consideration in such problems. This work highlights and presents solutions to several challenges of this method pertinent to models of cardiovascular haemodynamics. These include methods to (i) avoid ill-conditioning of the covariance matrix, (ii) handle a variety of measurement types, (iii) include a variety of prior knowledge in the method, and (iv) incorporate measurements acquired at different heart rates, a common situation in the clinic where the patient state differs according to the clinical situation. Results are presented for two patient-specific cases of congenital heart disease. To illustrate and validate data assimilation with measurements at different heart rates, the results are presented on a synthetic dataset and on a patient-specific case with heart valve regurgitation. It is shown that the new method significantly improves the agreement between model predictions and measurements. The developed methods can be readily applied to other pathophysiologies and extended to dynamical systems which exhibit different responses under different sets of known parameters or different sets of inputs (such as forcing/excitation frequencies).

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Section: Introductionmentioning

confidence: 99%

Inverse problems in reduced order models of cardiovascular haemodynamics: aspects of data assimilation and heart rate variability

Pant

Corsini

Baker

et al. 2017

J. R. Soc. Interface.

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“…1). Similar LPN models were used in previous multiscale simulations which investigated surgical variations of stages 1 and 2 Fontan procedures [10,16,18]. The LPN features modular blocks to mimic major parts of the circulation, with each block responding to pressure and flow according to its physiological counter-part.…”

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confidence: 99%

“…In vasodilation or vasoconstriction, vascular resistance and capacitance scale to reflect changes in vessel diameters via an exponential coefficient of À4 and 3, respectively. Thus according to the resulting scaling of resistances due to exercise, we further scale capacitances in the corresponding blocks using the equation [16,18,48] where C/C i and R/R i are the capacitance and resistance scaling ratios, respectively. The capacitances in the leg circuit are not scaled since the exercise "effective resistances" largely represent the consequences of the muscle pump, rather than vasodilation alone.…”

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confidence: 99%

“…This section describes the work-flow for deriving a full set of LPN parameters to model a specific patient at a particular exercise level. Tuned based on previous LPN modeling work [16,18], Table 2 lists a set of generic reference values serving as the starting point for the LPN parameters. This generic reference provides the distributed resistance and capacitance values, and initial pressures in the capacitors, to be scaled.…”

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confidence: 99%

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A Simulation Protocol for Exercise Physiology in Fontan Patients Using a Closed Loop Lumped-Parameter Model

Kung

Pennati

Migliavacca

et al. 2014

Journal of Biomechanical Engineering

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Background: Reduced exercise capacity is nearly universal among Fontan patients, though its etiology is not yet fully understood. While previous computational studies have attempted to model Fontan exercise, they did not fully account for global physiologic mechanisms nor directly compare results against clinical and physiologic data. Methods: In this study, we developed a protocol to simulate Fontan lower-body exercise using a closed-loop lumped-parameter model describing the entire circulation. We analyzed clinical exercise data from a cohort of Fontan patients, incorporated previous clinical findings from literature, quantified a comprehensive list of physiological changes during exercise, translated them into a computational model of the Fontan circulation, and designed a general protocol to model Fontan exercise behavior. Using inputs of patient weight, height, and if available, patient-specific reference heart rate (HR) and oxygen consumption, this protocol enables the derivation of a full set of parameters necessary to model a typical Fontan patient of a given body-size over a range of physiologic exercise levels. Results: In light of previous literature data and clinical knowledge, the model successfully produced realistic trends in physiological parameters with exercise level. Applying this method retrospectively to a set of clinical Fontan exercise data, direct comparison between simulation results and clinical data demonstrated that the model successfully reproduced the average exercise response of a cohort of typical Fontan patients. Conclusion: This work is intended to offer a foundation for future advances in modeling Fontan exercise, highlight the needs in clinical data collection, and provide clinicians with quantitative reference exercise physiologies for Fontan patients. [DOI: 10.1115/1.4027271] IntroductionSingle ventricle physiology is one of the most severe forms of congenital heart disease, in which an infant has only one functional pumping chamber. The condition is not compatible with life without treatment and these infants require immediate surgical intervention after birth, typically followed by two additional palliative procedures within the first few years of life. The Fontan procedure, in its various technical modifications, represents the final stage of the multistaged surgery that achieves complete separation of the deoxygenated and oxygenated blood in the circulation. The procedure involves directly connecting the superior venae cavae and inferior venae cavae (SVC and IVC) to the pulmonary arteries, thus bypassing the heart and resulting in the total venous return flowing passively into the pulmonary circulation.Exercise intolerance is among the myriad complications that contribute to the gradual attrition of post-Fontan patients in the years following surgery. Other causes of decreased survival include ventricular dysfunction, atrial arrhythmias, protein-losing enteropathy, arteriovenous malformations, thrombotic complications, and poor neurodevelopmental outcomes [1]. While ...

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“…This simplified LP model of the SV consisted of a time-varying nonlinear elastance (accounting for the active and passive properties of the ventricle) in series with a resistance mimicking the viscous behaviour of the myocardium [13,16]. The myocardium contraction was ruled by a sinusoidal activation function.…”

Section: Circulatory Modelmentioning

confidence: 99%

A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case

et al. 2015

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One contribution of 11 to a theme issue 'Multiscale modelling in biomechanics: theoretical, computational and translational challenges'. 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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An integrated approach to patient-specific predictive modeling for single ventricle heart palliation

Cited by 61 publications

References 32 publications

Inverse problems in reduced order models of cardiovascular haemodynamics: aspects of data assimilation and heart rate variability

Inverse problems in reduced order models of cardiovascular haemodynamics: aspects of data assimilation and heart rate variability

A Simulation Protocol for Exercise Physiology in Fontan Patients Using a Closed Loop Lumped-Parameter Model

A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case

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