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Author Notes:

Corresponding Author and Reprint Info: Ajit P. Yoganathan, PhD, The Wallace H. Coulter Distinguished Faculty Chair in Biomedical Engineering & Regent’s Professor, Associate Chair for Research, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, ajit.yoganathan@bme.gatech.edu, Phone: 404-894-2849, Fax: 404-894-4243

The authors acknowledge Wenjun Wu and Abisshek Lakshman, who are undergraduate students at the Georgia Institute of Technology, for their assistance in data analysis and Luyu Zhang, who is a graduate student at Emory University for her assistance in statistical anlaysis.

In addition, the authors acknowledge the use of ANSYS software which was provided through an Academic Partnership between ANSYS, Inc. and the Cardiovascular Fluid Mechanics Lab at Georgia Institute of Technology.

Subject:

Research Funding:

This study was supported by the National Heart, Lung, and Blood Institute Grants HL67622 and HL098252.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Technology
  • Biophysics
  • Engineering, Biomedical
  • Engineering
  • Computational fluid dynamics
  • Univentricular
  • Patient-specific
  • Surgical planning
  • Boundary conditions
  • TOTAL CAVOPULMONARY CONNECTION
  • PULMONARY ARTERIOVENOUS-MALFORMATIONS
  • MAGNETIC-RESONANCE
  • HEMODYNAMICS
  • SIMULATIONS
  • RECONSTRUCTION
  • INTERPOLATION
  • PALLIATION
  • OPERATION
  • EXERCISE

Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning?

Tools:

Journal Title:

Journal of Biomechanics

Volume:

Volume 50

Publisher:

, Pages 172-179

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Cardiovascular simulations have great potential as a clinical tool for planning and evaluating patient-specific treatment strategies for those suffering from congenital heart diseases, specifically Fontan patients. However, several bottlenecks have delayed wider deployment of the simulations for clinical use; the main obstacle is simulation cost. Currently, time-averaged clinical flow measurements are utilized as numerical boundary conditions (BCs) in order to reduce the computational power and time needed to offer surgical planning within a clinical time frame. Nevertheless, pulsatile blood flow is observed in vivo, and its significant impact on numerical simulations has been demonstrated. Therefore, it is imperative to carry out a comprehensive study analyzing the sensitivity of using time-averaged BCs. In this study, sensitivity is evaluated based on the discrepancies between hemodynamic metrics calculated using time-averaged and pulsatile BCs; smaller discrepancies indicate less sensitivity. The current study incorporates a comparison between 3D patient-specific CFD simulations using both the time-averaged and pulsatile BCs for 101 Fontan patients. The sensitivity analysis involves two clinically important hemodynamic metrics: hepatic flow distribution (HFD) and indexed power loss (iPL). Paired demographic group comparisons revealed that HFD sensitivity is significantly different between single and bilateral superior vena cava cohorts but no other demographic discrepancies were observed for HFD or iPL. Multivariate regression analyses show that the best predictors for sensitivity involve flow pulsatilities, time-averaged flow rates, and geometric characteristics of the Fontan connection. These predictors provide patient-specific guidelines to determine the effectiveness of analyzing patient-specific surgical options with time-averaged BCs within a clinical time frame.

Copyright information:

© 2016 Elsevier Ltd

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