Patient-specific design of the right ventricle to pulmonary artery conduit via computational analysis

Cardiovascular prostheses are routinely used in surgical procedures to address congenital malformations, for example establishing a pathway from the right ventricle to the pulmonary arteries (RV-PA) in pulmonary atresia and truncus arteriosus. Currently available options are fixed size and have limited durability. Hence, multiple re-operations are required to match the patients’ growth and address structural deterioration of the conduit. Moreover, the pre-set shape of these implants increases the complexity of operation to accommodate patient specific anatomy. The goal of the research group is to address these limitations by 3D printing geometrically customised implants with growth capacity. In this study, patient-specific geometrical models of the heart were constructed by segmenting MRI data of patients using Mimics inPrint 2.0. Computational Fluid Dynamics (CFD) analysis was performed, using ANSYS CFX, to design customised geometries with better haemodynamic performance. CFD simulations showed that customisation of a replacement RV-PA conduit can improve its performance. For instance, mechanical energy dissipation and wall shear stress can be significantly reduced. Finite Element modelling also allowed prediction of the suitable thickness of a synthetic material to replicate the behaviour of pulmonary artery wall under arterial pressures. Hence, eliminating costly and time-consuming experiments based on trial-and-error. In conclusion, it is shown that patient-specific design is feasible, and these designs are likely to improve the flow dynamics of the RV-PA connection. Modelling also provides information for optimisation of biomaterial. In time, 3D printing a customised implant may simplify replacement procedures and potentially reduce the number of operations required over a life time, bringing substantial improvements in quality of life to the patient

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): Guidelines for medical 3D printing and appropriateness for clinical scenarios

Este número da revista Cadernos de Estudos Sociais estava em organização quando fomos colhidos pela morte do sociólogo Ernesto Laclau. Seu falecimento em 13 de abril de 2014 surpreendeu a todos, e particularmente ao editor Joanildo Burity, que foi seu orientando de doutorado na University of Essex, Inglaterra, e que recentemente o trouxe à Fundação Joaquim Nabuco para uma palestra, permitindo que muitos pudessem dialogar com um dos grandes intelectuais latinoamericanos contemporâneos. Assim, buscamos fazer uma homenagem ao sociólogo argentino publicando uma entrevista inédita concedida durante a sua passagem pelo Recife, em 2013, encerrando essa revista com uma sessão especial sobre a sua trajetória

Computer Vision Techniques for Transcatheter Intervention

Minimally invasive transcatheter technologies have demonstrated substantial promise for the diagnosis and treatment of cardiovascular diseases. For example, TAVI is an alternative to AVR for the treatment of severe aortic stenosis and TAFA is widely used for the treatment and cure of atrial fibrillation. In addition, catheter-based IVUS and OCT imaging of coronary arteries provides important information about the coronary lumen, wall and plaque characteristics. Qualitative and quantitative analysis of these cross-sectional image data will be beneficial for the evaluation and treatment of coronary artery diseases such as atherosclerosis. In all the phases (preoperative, intraoperative, and postoperative) during the transcatheter intervention procedure, computer vision techniques (e.g., image segmentation, motion tracking) have been largely applied in the field to accomplish tasks like annulus measurement, valve selection, catheter placement control, and vessel centerline extraction. This provides beneficial guidance for the clinicians in surgical planning, disease diagnosis, and treatment assessment. In this paper, we present a systematical review on these state-of-the-art methods.We aim to give a comprehensive overview for researchers in the area of computer vision on the subject of transcatheter intervention. Research in medical computing is multi-disciplinary due to its nature, and hence it is important to understand the application domain, clinical background, and imaging modality so that methods and quantitative measurements derived from analyzing the imaging data are appropriate and meaningful. We thus provide an overview on background information of transcatheter intervention procedures, as well as a review of the computer vision techniques and methodologies applied in this area

Right ventricular biomechanics in pulmonary hypertension

As outcome in pulmonary hypertension is strongly associated with progressive right ventricular dysfunction, the work in this thesis seeks to determine the regional distribution of forces on the right ventricle, its geometry, and deformations subsequent to load. This thesis contributes to the understanding of how circulating biomarkers of energy metabolism and stress-response pathways are related to adverse cardiac remodelling and functional decompensation. A numerical model of the heart was used to derive a three-dimensional representation of right ventricular morphology, function and wall stress in pulmonary hypertension patients. This approach was tested by modelling the effect of pulmonary endarterectomy in patients with chronic thromboembolic disease. The relationship between the cardiac phenotype and 10 circulating metabolites, known to be associated with all-cause mortality, was assessed using mass univariate regression. Increasing afterload (mean pulmonary artery pressure) was significantly associated with hypertrophy of the right ventricular inlet and dilatation, indicative of global eccentric remodelling, and decreased systolic excursion. Right ventricular ejection fraction was found to be negatively associated with 3-hydroxy-3-methylglutarate, N-formylmethionine, and fumarate. Wall stress was related to all-cause mortality and its decrease after pulmonary endarterectomy was associated with a fall in brain natriuretic peptide. Six metabolites were associated with elevated end-systolic wall stress: dehydroepiandrosterone sulfate, N2,N2-dimethylguanosine, N1-methylinosine, 3-hydroxy-3-methylglutarate, N-acetylmethionine, and N-formylmethionine. Metabolic profiles related to energy metabolism and stress-response are associated with elevations in right ventricular end-systolic wall stress that have prognostic significance in pulmonary hypertension patients. These results show that statistical parametric mapping can give regional information on the right ventricle and that metabolic phenotyping, as well as predicting outcomes, provides markers informative of the biomechanical status of the right ventricle in pulmonary hypertension.Open Acces

Multiscale Modeling of Cardiovascular Flows

Simulations of blood flow in the cardiovascular system offer investigative and predictive capabilities to augment current clinical tools. Using image-based modeling, the Navier-Stokes equations can be solved to obtain detailed 3-dimensional hemodynamics in patient-specific anatomical models. Relevant parameters such as wall shear stress and particle residence times can then be calculated from the 3D results and correlated with clinical data for treatment planning and device evaluation. Reduced-order models such as open or closed loop 0D lumped-parameter models can simulate the dynamic behavior of the circulatory system using an analogy to electrical circuits. When coupled to 3D simulations as boundary conditions, they produce physiologically realistic pressure and flow conditions in the 3D domain. We describe fundamentals and current state of the art of patient-specific, multi-scale computational modeling approaches applied to cardiovascular disease. These tools enable investigations of hemodynamics reflecting individual patients physiology, and we provide several illustrative case studies. These methods can supplement current clinical measurement and imaging capabilities and provide predictions of patient outcomes for surgical planning and risk stratification