Hemodynamic study of TCPC using in vivo and in vitro 4D Flow MRI and numerical simulation

Roldán‐Alzate, Alejandro; García-Rodríguez, Sylvana; Anagnostopoulos, Petros V.; Srinivasan, Shardha; Wieben, Oliver; François, Christopher J.

doi:10.1016/j.jbiomech.2015.03.009

Cited by 40 publications

(35 citation statements)

References 29 publications

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“…Our study, in agreement with Stalder et al ( 17 ), shows that combining 4D CMR and CFD methodologies in a synergistic way can improve the understanding of in vivo hemodynamics. A very recent study ( 18 ) has applied the paradigm of modeling congenital heart disease in vitro and in silico , including 4D CMR, for an interesting case of Fontan circulation (total cavopulmonary connection). This study supports our observations that patient-specific models of congenital defects including 4D CMR allow fine tuning of CFD models, ultimately narrowing the gap for clinical implementation of the numerical models themselves.…”

Section: Discussionmentioning

confidence: 99%

Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study

et al. 2015

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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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Section: Discussionmentioning

confidence: 99%

Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study

et al. 2015

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“…This has been done mainly via in vitro models, 9,14,[21][22][23][24][25][26][27][28][29][30][31][32][33][34] CFD models, 3,9,16,17,26,27, and in vivo studies. 10,15,34,[68][69][70] In the past 10 years, growing evidence suggests a relationship between energy loss in the TCPC and Fontan hemodynamics 47,[59][60][61][62]69 and exercise tolerance. 63,66 To date, the influence of energy loss on other well-known complications such as protein-losing enteropathy, plastic bronchitis, or liver fibrosis/cirrhosis has not been studied.…”

Section: The Fontan Proceduresmentioning

confidence: 99%

“…38,44,55,67,90 models still use rigid material and steady inflow conditions. 9,30,34 Recently, a promising in vitro model has been introduced that uses a patient-specific, MRI-derived compliant TCPC model based on the patient-specific compliance value and uses condition-specific (breathheld, free breathing and exercise), real-time, phasecontrast MRI-derived flow waveforms as inflow conditions. 92 First results have shown and quantified the effect of respiration and exercise on energy loss and demonstrated that the effect of these parameters was highly patient-specific.…”

Section: In Vitro Studiesmentioning

confidence: 99%

“…Furthermore, large 4D flow MRI series should be obtained and used to validate CFD models in capturing the sometimes highly 3D chaotic flows, which to date have only been performed in a limited number of patients with a Fontan circulation. 34,60 Furthermore, confirmation of the impact of energy loss on clinical outcome based on in vivo data with 4D flow MRI will likely increase confidence in computed results from CFD studies and may accelerate the clinical implementation of patient-specific CFD models in the future.…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

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Energetics of Blood Flow in Cardiovascular Disease

Rijnberg¹,

Hazekamp²,

Wentzel

et al. 2018

Circulation

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Visualization and quantification of the adverse effects of distorted blood flow are important emerging fields in cardiology. Abnormal blood flow patterns can be seen in various cardiovascular diseases and are associated with increased energy loss. These adverse energetics can be measured and quantified using 3-dimensional blood flow data, derived from computational fluid dynamics and 4-dimensional flow magnetic resonance imaging, and provide new, promising hemodynamic markers. In patients with palliated single-ventricular heart defects, the Fontan circulation passively directs systemic venous return to the pulmonary circulation in the absence of a functional subpulmonary ventricle. Therefore, the Fontan circulation is highly dependent on favorable flow and energetics, and minimal energy loss is of great importance. A focus on reducing energy loss led to the introduction of the total cavopulmonary connection (TCPC) as an alternative to the classical Fontan connection. Subsequently, many studies have investigated energy loss in the TCPC, and energy-saving geometric factors have been implemented in clinical care. Great advances have been made in computational fluid dynamics modeling and can now be done in 3-dimensional patient-specific models with increasingly accurate boundary conditions. Furthermore, the implementation of 4-dimensional flow magnetic resonance imaging is promising and can be of complementary value to these models. Recently, correlations between energy loss in the TCPC and cardiac parameters and exercise intolerance have been reported. Furthermore, efficiency of blood flow through the TCPC is highly variable, and inefficient blood flow is of clinical importance by reducing cardiac output and increasing central venous pressure, thereby increasing the risk of experiencing the well-known Fontan complications. Energy loss in the TCPC will be an important new hemodynamic parameter in addition to other well-known risk factors such as pulmonary vascular resistance and can possibly be improved by patient-specific surgical design. This article describes the theoretical background of mechanical energy of blood flow in the cardiovascular system and the methods of calculating energy loss, and it gives an overview of geometric factors associated with energy efficiency in the TCPC and its implications on clinical outcome. Furthermore, the role of 4-dimensional flow magnetic resonance imaging and areas of future research are discussed.

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“…4D Flow MRI can capture time-resolved, three-dimensional velocity vector fields within an area of interest. 20,25,39 Previous application of 4D Flow MRI into the realm of cardiovascular diseases such as, congenital heart disease, 19,27 cerebral aneurysm, 10,22,28 and portal hypertension, 26,32 has shown the potential of this technique to directly impact treatment planning. Limitations of 4D Flow MRI are still present: insufficient spatial resolution for accurate assessment of small vessels and slow velocities near the vessel wall, long scan times and high sensitivity to velocity encoding (VENC) settings.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 4D Flow MRI and Particle Image Velocimetry Using an In Vitro Carotid Bifurcation Model

2018

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Four-dimensional (4D) Flow magnetic resonance imaging (MRI) enables the acquisition and assessment of complex hemodynamics in vivo from different vascular territories. This study investigated the viability of stereoscopic and tomographic particle image velocimetry (stereo- and tomo-PIV, respectively) as experimental validation techniques for 4D Flow MRI. The experiments were performed using continuous and pulsatile flows through an idealized carotid artery bifurcation model. Transverse and longitudinal planes were extracted from the acquired velocity data sets at different regions of interest and were analyzed with a point-by-point comparison. An overall root-mean-square error (RMSE) was calculated resulting in errors as low as 0.06 and 0.03 m/s when comparing 4D Flow MRI with stereo- and tomo-PIV, respectively. Quantitative agreement between techniques was determined by evaluating the relationship for individual velocity components and their magnitudes. These resulted in correlation coefficients (R) of 4D Flow MRI with stereo- and tomo-PIV, as low as 0.76 and 0.73, respectively. The 3D velocity measurements from PIV showed qualitative agreement when compared to 4D Flow MRI, especially with tomo-PIV due to the addition of volumetric velocity measurements. These results suggest that tomo-PIV can be used as a validation technique for 4D Flow MRI, serving as the basis for future validation protocols.

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Hemodynamic study of TCPC using in vivo and in vitro 4D Flow MRI and numerical simulation

Cited by 40 publications

References 29 publications

Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study

Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study

Energetics of Blood Flow in Cardiovascular Disease

Comparison of 4D Flow MRI and Particle Image Velocimetry Using an In Vitro Carotid Bifurcation Model

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