Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 12/2023

28-11-2023 | Review

Effect of Virtual Aortic Arch Reconstruction After Norwood Procedure on Cardiac Function, Energy Efficiency, and Wall Shear Stress from Multiscale Simulations

Authors: Aloma Blanch-Granada, Margaret M. Samyn, Stephanie S. Handler, Jennifer F Gerardin, Benjamin Goot, Viktor Hraška, Joseph R. Cava, John F. LaDisa Jr

Published in: Current Cardiovascular Imaging Reports | Issue 12/2023

Login to get access

Abstract

Purpose of Review

The current in silico study features a patient who underwent Norwood arch reconstruction to compare hemodynamic and energy-based indices between the image-based pre-operative reconstructed geometry (i.e., Pre-op) and a virtual post-operative reconstruction (i.e., Post-op). We hypothesized that the Post-op geometry would be associated with decreased afterload and increased stroke volume, consequently leading to a decrease in single ventricle workload as well as more favorable hemodynamic indices (i.e., decreased oscillatory shear index (OSI) and increased time-averaged wall shear stress (TAWSS)), particularly within the reconstructed region.

Recent Findings

Computational modeling can facilitate assessment of energy and hemodynamic alterations for difficult surgical procedures including the Norwood operation where outcomes remain suboptimal with high interstage mortality and frequent reoperations.

Summary

A patient-specific computational fluid dynamics (CFD) model was created from cardiac magnetic resonance imaging, blood flow, and blood pressure data. Virtual reconstruction was implemented based on surgeon and clinician input. Resulting simulations incorporated downstream vascular resistance and compliance to replicate patient physiology using 3-element Windkessel representations to quantify TAWSS and OSI locally. A closed-loop heart model was used to determine global differences in energy efficiency (Eeff), energy loss (EL), and cardiac workload. WSS indices generally improved with virtual arch geometry reconstruction, which resulted in only modest changes in EL, Eeff, and cardiac workload. A framework to implement and compare virtual arch reconstruction is presented. Results show that more drastic changes in geometry may need to be implemented if the virtual reconstruction is to yield a significant impact on indices of cardiac function.
Literature
1.
Elzenga NJ, Gittenberger-de Groot AC. Coarctation and related aortic arch anomalies in hypoplastic left heart syndrome. Int J Cardiol. 1985;8(4):379–89.CrossRefPubMed
2.
• Alsoufi B, Slesnick T, McCracken C, Ehrlich A, Kanter K, Schlosser B, Maher K, Sachdeva R, Kogon B. Current outcomes of the Norwood operation in patients with single-ventricle malformations other than hypoplastic left heart syndrome. World J Pediatr Congenit Heart Surg. 2015;6(1):46–52. https://​doi.​org/​10.​1177/​2150135114558069​. A recent paper reviewing outcomes from Norwood patients serving as motivation for the current work.CrossRefPubMed
3.
4.
Blanch-Granada, A., Ladisa, Jr. J. F., Samyn, M. M., Cava, J. R., Handler, S. S., Gerardin, J. F., Goot, B., Maadooliat, M., Hraška, V. (2023), Hemodynamic evaluation of Norwood arch geometry compared to native arch controls. PREPRINT (Version 1) available at Research Square. https://​doi.​org/​10.​21203/​rs.​3.​rs-2672891/​v1.
5.
Ellwein L, Samyn MM, Danduran M, Schindler-Ivens S, Liebham S, LaDisa JF. Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise. Biomech Model Mechanobiol. 2017;16(1):75–96.CrossRefPubMed
6.
Razavi A, Sachdeva S, Frommelt PC, LaDisa JF Jr. Patient-specific numerical analysis of coronary flow in children with intramural anomalous aortic origin of coronary arteries. Semin Thorac Cardiovasc Surg. 2021;33(1):155–67.CrossRefPubMed
7.
Wendell DC, Samyn MM, Cava JR, Krolikowski MM, LaDisa JF. The impact of cardiac motion on aortic valve flow used in computational simulations of the thoracic aorta. J Biomech Eng. 2016;138(9)
8.
Vignon-Clementel IE, Figueroa CA, Jansen KE, Taylor CA. Outflow boundary conditions for three-dimensional finite element modeling of blood flow and pressure in arteries. Comput Methods Appl Mech Eng. 2006;195(29–32):3776–96.CrossRef
9.
Westerhof N, Elzinga G, Sipkema P. An artificial arterial system for pumping hearts. J Appl Physiol. 1971;31(5):776–81.CrossRefPubMed
10.
LaDisa JF, Dholakia RJ, Figueroa CA, Vignon-Clementel IE, Chan FP, Samyn MM, Cava JR, Taylor CA, Feinstein JA. Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis. Congenit Heart Dis. 2011a;6(5):432–43.CrossRefPubMedPubMedCentral
11.
LaDisa JF, Figueroa AC, Vignon-Clementel IE, Jin Kim H, Xiao N, Ellwein LM, Chan FP, Feinstein JA, Taylor CA. Computational simulations for aortic coarctation: Representative results from a sampling of patients. J Biomech Eng. 2011b;133(9) https://​doi.​org/​10.​1115/​1.​4004996.
12.
Laskey WK, Parker HG, Ferrari VA, Kussmaul WG, Noordergraaf A. Estimation of total systemic arterial compliance in humans. J Appl Physiol. 1990;69(1):112–9.CrossRefPubMed
13.
Stergiopulos N, Segers P, Westerhof N. Use of pulse pressure method for estimating total arterial compliance in vivo. Am J Physiol Heart Circ Physiol. 1999;276(2):H424–8.CrossRef
14.
Migliavacca F, Pennati G, Dubini G, Fumero R, Pietrabissa R, Urcelay G, Bove EL, Hsia T-Y, de Leval MR, Dubini G-E, De MR, Modeling L. Modeling of the Norwood circulation: effects of shunt size, vascular resistances, and heart rate. Am J Physiol Heart Circ Physiol. 2001;280(5):H2076–86. http://​www.​ajpheart.​orgCrossRefPubMed
15.
Pennati G, Bellottit M, Fumero R. Mathematical modelling of the human foetal cardiovascular system based on Doppler ultrasound data. Med Eng Phys. 1997a;19(4):327–35.CrossRefPubMed
16.
Pennati G, Migliavacca F, Dubinit G, Pietrabissa R, de Levalf MR. A mathematical model of circulation in the presence of the bidirectional cavopulmonary anastomosis in children with a univentricular heart. Med Eng Phys. 1997b;19(3):223–34.CrossRefPubMed
17.
18.
19.
Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Glagov S. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res. 1983;53(4):502–14.CrossRefPubMed
20.
Taylor CA, Hughes TJR, Zarins CK. Effect of exercise on hemodynamic conditions in the abdominal aorta. J Vasc Surg. 1999;29(6):1077–89.CrossRefPubMed
21.
Vlachopoulos C, O’Rourke M, Nichols WW. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. CRC press; 2011.CrossRef
22.
• Itatani K, Miyaji K, Qian Y, Liu JL, Miyakoshi T, Murakami A, Ono M, Umezu M. Influence of surgical arch reconstruction methods on single ventricle workload in the Norwood procedure. J Thorac Cardiovasc Surg. 2012;144(1):130–8. https://​doi.​org/​10.​1016/​j.​jtcvs.​2011.​08.​013. A previous study reporting EL results for a related group of patients for comparison and building from using results from the current work.CrossRefPubMed
23.
24.
Ward MR, Pasterkamp G, Yeung AC, Borst C. Arterial remodeling: mechanisms and clinical implications. Circulation. 2000;102(10):1186–91.CrossRefPubMed
25.
Wentzel JJ, Corti R, Fayad ZA, Wisdom P, Macaluso F, Winkelman MO, Fuster V, Badimon JJ. Does shear stress modulate both plaque progression and regression in the thoracic aorta? Human study using serial magnetic resonance imaging. J Am Coll Cardiol. 2005;45(6):846–54.CrossRefPubMed
26.
Coogan JS, Chan FP, LaDisa JF Jr, Taylor CA, Hanley FL, Feinstein JA. Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions. J Thorac Cardiovasc Surg. 2013;145(2):489–95.CrossRefPubMed
27.
• Primeaux J, Salavitabar A, Lu JC, Grifka RG, Figueroa CA. Characterization of Post-Operative Hemodynamics Following the Norwood Procedure Using Population Data and Multi-Scale Modeling. Front Physiol. 2021;12:603040. A recent study using similar computational methods pre and post aortic reconstruction and including a BT shuntCrossRefPubMedPubMedCentral
Metadata
Title
Effect of Virtual Aortic Arch Reconstruction After Norwood Procedure on Cardiac Function, Energy Efficiency, and Wall Shear Stress from Multiscale Simulations
Authors
Aloma Blanch-Granada
Margaret M. Samyn
Stephanie S. Handler
Jennifer F Gerardin
Benjamin Goot
Viktor Hraška
Joseph R. Cava
John F. LaDisa Jr
Publication date
28-11-2023
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 12/2023
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-023-09587-z