1. Prediction of Ventricular Mechanics After Pulmonary Valve Replacement in Tetralogy of Fallot by Biomechanical Modeling: A Step Towards Precision Healthcare
- Author
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Camille Hancock Friesen, Gerald F. Greil, Radomir Chabiniok, Maria Gusseva, Dominique Chapelle, Tarique Hussain, Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine (M3DISIM), Laboratoire de mécanique des solides (LMS), École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), University of Texas Southwestern Medical Center [Dallas], University of Nebraska Medical Center, University of Nebraska System, Czech Technical University in Prague (CTU), École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris)
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Contractility ,03 medical and health sciences ,0302 clinical medicine ,Afterload ,Valve replacement ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,Pulmonary Valve Replacement ,Medicine ,ComputingMilieux_MISCELLANEOUS ,Ventricular mechanics ,Tetralogy of Fallot ,business.industry ,valvular heart disease ,medicine.disease ,020601 biomedical engineering ,3. Good health ,medicine.anatomical_structure ,Ventricle ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Clinical indicators of heart function are often limited in their ability to accurately evaluate the current mechanical state of the myocardium. Biomechanical modeling has been shown to be a promising tool in addition to clinical indicators. By providing a patient-specific measure of myocardial active stress (contractility), biomechanical modeling can enhance the precision of the description of patient’s pathophysiology at any given point in time. In this work we aim to explore the ability of biomechanical modeling to predict the response of ventricular mechanics to the progressively decreasing afterload in repaired tetralogy of Fallot (rTOF) patients undergoing pulmonary valve replacement (PVR) for significant residual right ventricular outflow tract obstruction (RVOTO). We used 19 patient-specific models of patients with rTOF prior to pulmonary valve replacement (PVR), denoted as PSMpre, and patient-specific models of the same patients created post-PVR (PSMpost)—both created in our previous published work. Using the PSMpre and assuming cessation of the pulmonary regurgitation and a progressive decrease of RVOT resistance, we built relationships between the contractility and RVOT resistance post-PVR. The predictive value of such in silico obtained relationships were tested against the PSMpost, i.e. the models created from the actual post-PVR datasets. Our results show a linear 1-dimensional relationship between the in silico predicted contractility post-PVR and the RVOT resistance. The predicted contractility was close to the contractility in the PSMpost model with a mean (± SD) difference of 6.5 (± 3.0)%. The relationships between the contractility predicted by in silico PVR vs. RVOT resistance have a potential to inform clinicians about hypothetical mechanical response of the ventricle based on the degree of pre-operative RVOTO.
- Published
- 2021
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