Abstract
Investigating the causes of failure of Fontan circulation in individual patients remains challenging despite detailed combined invasive cardiac catheterisation and magnetic resonance (XMR) exams at rest and during stress. In this work, we use a biomechanical model of the heart and Fontan circulation with the components of systemic and pulmonary beds to augment the diagnostic assessment of patients undergoing the XMR stress exam. We apply our model in 3 Fontan patients and one biventricular “control” case. In all subjects, we obtained important biophysical factors of cardiovascular physiology – contractility, contractile reserve and changes in systemic and pulmonary vascular resistance – which contribute to explaining the mechanism of failure in individual patients. Finally, we used the patient-specific model of one Fontan patient to investigate the impact of changes in pulmonary vascular resistance, aiming at in silico testing of pulmonary vasodilation treatments.
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Acknowledgments
The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and the NIHR Cardiovascular MedTech Co-operative (previously existing as the Cardiovascular Healthcare Technology Co-operative 2012–2017), the support of Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z], and from the Inria Associated team ToFMOD. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
In addition, the authors would like to acknowledge Philippe Moireau and Dominique Chapelle, Inria research team M\(\mathsf{{\** }}\)DISIM, for providing the cardiac simulation software CardiacLab under a Royalty-fee software license.
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Ruijsink, B., Zugaj, K., Pushparajah, K., Chabiniok, R. (2019). Model-Based Indices of Early-Stage Cardiovascular Failure and Its Therapeutic Management in Fontan Patients. In: Coudière, Y., Ozenne, V., Vigmond, E., Zemzemi, N. (eds) Functional Imaging and Modeling of the Heart. FIMH 2019. Lecture Notes in Computer Science(), vol 11504. Springer, Cham. https://doi.org/10.1007/978-3-030-21949-9_41
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DOI: https://doi.org/10.1007/978-3-030-21949-9_41
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