Christopher M Haggerty1, Kevin K Whitehead2, James Bethel3, Mark A Fogel2, Ajit P Yoganathan4. 1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia. 2. Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Westat, Inc, Rockville, Maryland. 4. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia. Electronic address: ajit.yoganathan@bme.gatech.edu.
Abstract
BACKGROUND: Single ventricle lesions are associated with gradual attrition after surgical palliation with the total cavopulmonary connection (TCPC). Ventricular dysfunction is frequently noted, particularly impaired diastolic performance. This study seeks to relate TCPC hemodynamic energy losses to single ventricle volumes and filling characteristics. METHODS: Cardiac magnetic resonance (CMR) data were retrospectively analyzed for 30 single ventricle patients at an average age of 12.7 ± 4.8 years. Cine ventricular short-axis scans were semiautomatically segmented for all cardiac phases. Ventricular volumes, ejection fraction, peak filling rate, peak ejection rate, and time to peak filling were calculated. Corresponding patient-specific TCPC geometry was acquired from a stack of transverse CMR images; relevant flow rates were segmented from through-plane phase contrast CMR data at TCPC inlets and outlets. The TCPC indexed power loss was calculated from computational fluid dynamics simulations using a validated custom solver. Time-averaged flow conditions and rigid vessel walls were assumed in all cases. Pearson correlations were used to detect relationships between variables, with p less than 0.05 considered significant. RESULTS: Ventricular end-diastolic (R = -0.48) and stroke volumes (R = -0.37) had significant negative correlations with the natural logarithm of a flow-independent measure of power loss. This power loss measure also had a significant positive relationship to time to peak filling rate (normalized to cycle time; R = 0.67). CONCLUSIONS: Flow-independent TCPC power loss is inversely related with ventricular end-diastolic and stroke volumes. Elevated power losses may contribute to impaired diastolic filling and limited preload reserve in single ventricle patients.
BACKGROUND: Single ventricle lesions are associated with gradual attrition after surgical palliation with the total cavopulmonary connection (TCPC). Ventricular dysfunction is frequently noted, particularly impaired diastolic performance. This study seeks to relate TCPC hemodynamic energy losses to single ventricle volumes and filling characteristics. METHODS: Cardiac magnetic resonance (CMR) data were retrospectively analyzed for 30 single ventricle patients at an average age of 12.7 ± 4.8 years. Cine ventricular short-axis scans were semiautomatically segmented for all cardiac phases. Ventricular volumes, ejection fraction, peak filling rate, peak ejection rate, and time to peak filling were calculated. Corresponding patient-specific TCPC geometry was acquired from a stack of transverse CMR images; relevant flow rates were segmented from through-plane phase contrast CMR data at TCPC inlets and outlets. The TCPC indexed power loss was calculated from computational fluid dynamics simulations using a validated custom solver. Time-averaged flow conditions and rigid vessel walls were assumed in all cases. Pearson correlations were used to detect relationships between variables, with p less than 0.05 considered significant. RESULTS:Ventricular end-diastolic (R = -0.48) and stroke volumes (R = -0.37) had significant negative correlations with the natural logarithm of a flow-independent measure of power loss. This power loss measure also had a significant positive relationship to time to peak filling rate (normalized to cycle time; R = 0.67). CONCLUSIONS: Flow-independent TCPC power loss is inversely related with ventricular end-diastolic and stroke volumes. Elevated power losses may contribute to impaired diastolic filling and limited preload reserve in single ventricle patients.
Authors: David H Frakes; Mark J T Smith; James Parks; Shiva Sharma; S Mark Fogel; Ajit P Yoganathan Journal: J Cardiovasc Magn Reson Date: 2005 Impact factor: 5.364
Authors: Alison L Marsden; Irene E Vignon-Clementel; Frandics P Chan; Jeffrey A Feinstein; Charles A Taylor Journal: Ann Biomed Eng Date: 2006-12-15 Impact factor: 3.934
Authors: Alison L Marsden; Adam J Bernstein; V Mohan Reddy; Shawn C Shadden; Ryan L Spilker; Frandics P Chan; Charles A Taylor; Jeffrey A Feinstein Journal: J Thorac Cardiovasc Surg Date: 2009-02 Impact factor: 5.209
Authors: Kartik S Sundareswaran; David H Frakes; Mark A Fogel; Dennis D Soerensen; John N Oshinski; Ajit P Yoganathan Journal: J Magn Reson Imaging Date: 2009-01 Impact factor: 4.813
Authors: Page A W Anderson; Lynn A Sleeper; Lynn Mahony; Steven D Colan; Andrew M Atz; Roger E Breitbart; Welton M Gersony; Dianne Gallagher; Tal Geva; Renee Margossian; Brian W McCrindle; Stephen Paridon; Marcy Schwartz; Mario Stylianou; Richard V Williams; Bernard J Clark Journal: J Am Coll Cardiol Date: 2008-07-08 Impact factor: 24.094
Authors: Lakshmi P Dasi; Kerem Pekkan; Diane de Zelicourt; Kartik S Sundareswaran; Resmi Krishnankutty; Pedro J Delnido; Ajit P Yoganathan Journal: Ann Biomed Eng Date: 2009-02-18 Impact factor: 3.934
Authors: Kartik S Sundareswaran; Kerem Pekkan; Lakshmi P Dasi; Kevin Whitehead; Shiva Sharma; Kirk R Kanter; Mark A Fogel; Ajit P Yoganathan Journal: Am J Physiol Heart Circ Physiol Date: 2008-10-17 Impact factor: 4.733
Authors: Kartik S Sundareswaran; Diane de Zélicourt; Shiva Sharma; Kirk R Kanter; Thomas L Spray; Jarek Rossignac; Fotis Sotiropoulos; Mark A Fogel; Ajit P Yoganathan Journal: JACC Cardiovasc Imaging Date: 2009-08
Authors: Kevin K Whitehead; Kerem Pekkan; Hiroumi D Kitajima; Stephen M Paridon; Ajit P Yoganathan; Mark A Fogel Journal: Circulation Date: 2007-09-11 Impact factor: 29.690
Authors: Zhenglun Alan Wei; Michael Tree; Phillip M Trusty; Wenjun Wu; Shelly Singh-Gryzbon; Ajit Yoganathan Journal: Ann Biomed Eng Date: 2017-11-01 Impact factor: 3.934
Authors: Friso M Rijnberg; Joe F Juffermans; Mark G Hazekamp; Willem A Helbing; Hildo J Lamb; Arno A W Roest; Jos J M Westenberg; Hans C van Assen Journal: Eur Heart J Open Date: 2021-08-09
Authors: Laura Mercer-Rosa; Mark A Fogel; Zhenglun Alan Wei; Phillip M Trusty; Michael Tree; Elaine Tang; Maria Restrepo; Kevin K Whitehead; Amy Cassedy; Stephen M Paridon; Ajit Yoganathan; Bradley S Marino Journal: Ann Thorac Surg Date: 2022-02-01 Impact factor: 5.102