Tailoring the hybrid palliation for hypoplastic left heart syndrome: A simulation study using a lumped parameter model. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Di Molfetta, A.; Pilati, M.; Gagliardi, M.G.; Fresiello, L.; Amodeo, A.; Cristofaletti, A.; Pongiglione, G.; Ferrari, G.
• Is Part Of: Medical engineering & physics. Volume 37:Issue 9(2015:Sep.)
• Page Start: 898
• Page End: 904
• Publication Date: 2015-09
• Subjects: Congenital heart defects -- Hypoplastic left heart syndrome -- Lumped parameter models; Cao1 aorta1 compliance -- Cao2 aorta 2 compliance -- Rao2 aorta 2 resistance -- CoAo aortic coarctaction -- Pao1 aortic 1 pressure -- Pao2 aortic 2 pressure -- Cap arterial pulmonary compliance -- Cas arterial systemic compliance -- Rap arterial pulmonary resistance -- Ras arterial systemic resistance -- ASD atrial septal defect size -- CO cardiac output -- CVP central venous pressure -- CFD computational fluid dynamics -- EF ejection fraction -- HR heart rate -- HP hybrid procedure -- HLHS hypoplastic left heart syndrome -- Civc inferior vena cava compliance -- Pivc inferior vena cava pressure -- Rvcs inferior vena cava resistance -- Pt intrathoracic Pressure -- Pla left atrial pressure -- Clpa left pulmonary arterial compliance -- Plpa left pulmonary arterial pressure -- Rlpa left pulmonary artery resistance -- Rlpv left pulmonary vein resistance -- Clb lower body compliance -- Pas_lb lower body pressure -- Rlb lower body resistance -- LPM lumped parameter model -- PDA patent ductus arteriosus -- PAB pulmonary artery banding -- Pap pulmonary arterial pressure -- Qpulm pulmonary flow -- Q p/Q s pulmonary to systemic flow ratio -- Rap pulmonary trunk resistance -- Cap pulmonary trunk compliance -- Rri pulmonary valve resistance -- RevBT reverse Blalock–Taussig shunt -- Pra right atrial pressure -- Crpa right pulmonary arterial compliance -- Prpa right pulmonary arterial pressure -- Rrpa right pulmonary artery resistance -- Rrpv right pulmonary vein resistance -- CORV right ventricular cardiac output -- Ervs right ventricular end diastolic elastance -- Ervd right ventricular end sistolic elastance -- RVEDV right ventricular end diastolic volume -- RVESV right ventricular end sistolic volume -- Prv(D) right ventricular diastolic pressure -- Prv(S) right ventricular systolic pressure -- Qlb_S systolic peak flow in the lower body -- Qub_S systolic peak flow in the upper body -- Csvc superior vena cava compliance -- Psvc superior vena cava pressure -- Rsvc superior vena cava resistance -- AoP/Pas systemic arterial pressure -- Rri tricuspid valve resistance -- Cub upper body compliance -- Pas_ub upper body pressure -- Rub upper body resistance -- SW ventricular stroke work; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2015.04.012
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: Lumped parameter models could be useful to support clinical decision in complex heart diseases such as hypoplastic left heart syndrome. Lumped parameter models could be useful in calibrating and tailoring the hybrid palliation procedure. Lumped parameter models could support the setting the parameters that play a role on flow distribution in hybrid palliation such as patent ductus arteriosus stent size, atrial septal defect size, pulmonary artery banding tightness, the necessity of a reverse Blalock–Taussig shunt. Abstract: The results of Hybrid procedure (HP) for the hypoplastic left heart syndrome (HLHS) depend on several variables: pulmonary artery banding tightness (PAB), atrial septal defect size (ASD) and patent ductus arteriosus stent size (PDA). A HP complication could be the aortic coarctaction (CoAo). The reverse Blalock–Taussig shunt (RevBT) placement was proposed to avoid CoAo effects. This work aims at developing a lumped parameter model (LPM) to investigate the effects of the different variables on HP haemodynamics. A preliminary verification was performed collecting measurements on a newborn HLHS patient to calculate LPM input parameters to reproduce patient's baseline. Results suggest that haemodynamics is affected by ASD (ASD: 0.15–0.55 cm, pulmonary to systemic flow ratio Q p / Q s : 0.73–1, cardiac output (CO): 1–1.5 l/min and ventricular stroke work SW: 336–577 ml mmHg) and by the PAB diameter (PAB: 0.07–0.2 cm, Q p / Q s : 0.46–2.1, CO: 1.3–1.6 l/min and SW: 591–535 ml mmHg). Haemodynamics was neither affected by RevBT diameter nor by PDA diameter higher than 0.2 cm. RevBT implantation does not change the HP haemodynamics, but it can make the CoAo effect negligible. LPM could be useful to support clinical decision in complex physiopathology and to calibrate and personalise the parameters that play a role on flow distribution.