Elaine Tang1, Zhenglun Alan Wei2, Phillip M Trusty2, Kevin K Whitehead3, Lucia Mirabella2, Alessandro Veneziani4, Mark A Fogel3, Ajit P Yoganathan5. 1. School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, USA. 2. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA. 3. Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4. Department of Mathematics and Computer Science, Emory University, Atlanta, GA, USA. 5. School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA. Electronic address: ajit.yoganathan@bme.gatech.edu.
Abstract
OBJECTIVE: Poor total cavopulmonary connection (TCPC) hemodynamics have been hypothesized to be associated with long-term complications in Fontan patients. Image-based Fontan surgical planning has shown great potential as a clinical tool because it can pre-operatively evaluate patient-specific hemodynamics. Current surgical planning paradigms commonly utilize cardiac-gated phase contrast magnetic resonance (MR) imaging to acquire vessel flows. These acquisitions are often taken under breath-held (BH) conditions and ignore the effect of respiration on blood flow waveforms. This study investigates the effect of respiration-driven flow waveforms on patient-specific hemodynamics using real-time MR acquisitions. METHODS: Patient-specific TCPCs were reconstructed from cardiovascular MR images. Real-time phase contrast MR images were acquired under both free-breathing (FB) and breath-held conditions for 9 patients. Numerical simulations were employed to assess flow structures and hemodynamics used in Fontan surgical planning including hepatic flow distribution (HFD) and indexed power loss (iPL), which were then compared between FB and BH conditions. RESULTS: Differences in TCPC flow structures between FB and BH conditions were observed throughout the respiratory cycle. However, the average differences (BH - FB values for each patient, which are then averaged) in iPL and HFD between these conditions were 0.002 ± 0.011 (p = 0.40) and 1 ± 3% (p = 0.28), respectively, indicating no significant difference in clinically important hemodynamic metrics. CONCLUSIONS: Respiration affects blood flow waveforms and flow structures, but might not significantly influence the values of iPL or HFD. Therefore, breath-held MR acquisition can be adequate for Fontan surgical planning when focusing on iPL and HFD.
OBJECTIVE: Poor total cavopulmonary connection (TCPC) hemodynamics have been hypothesized to be associated with long-term complications in Fontan patients. Image-based Fontan surgical planning has shown great potential as a clinical tool because it can pre-operatively evaluate patient-specific hemodynamics. Current surgical planning paradigms commonly utilize cardiac-gated phase contrast magnetic resonance (MR) imaging to acquire vessel flows. These acquisitions are often taken under breath-held (BH) conditions and ignore the effect of respiration on blood flow waveforms. This study investigates the effect of respiration-driven flow waveforms on patient-specific hemodynamics using real-time MR acquisitions. METHODS:Patient-specific TCPCs were reconstructed from cardiovascular MR images. Real-time phase contrast MR images were acquired under both free-breathing (FB) and breath-held conditions for 9 patients. Numerical simulations were employed to assess flow structures and hemodynamics used in Fontan surgical planning including hepatic flow distribution (HFD) and indexed power loss (iPL), which were then compared between FB and BH conditions. RESULTS: Differences in TCPC flow structures between FB and BH conditions were observed throughout the respiratory cycle. However, the average differences (BH - FB values for each patient, which are then averaged) in iPL and HFD between these conditions were 0.002 ± 0.011 (p = 0.40) and 1 ± 3% (p = 0.28), respectively, indicating no significant difference in clinically important hemodynamic metrics. CONCLUSIONS: Respiration affects blood flow waveforms and flow structures, but might not significantly influence the values of iPL or HFD. Therefore, breath-held MR acquisition can be adequate for Fontan surgical planning when focusing on iPL and HFD.
Authors: T Y Hsia; S Khambadkone; A N Redington; F Migliavacca; J E Deanfield; M R de Leval Journal: Circulation Date: 2000-11-07 Impact factor: 29.690
Authors: David H Frakes; Christopher P Conrad; Timothy M Healy; Joseph W Monaco; Mark Fogel; Shiva Sharma; Mark J T Smith; Ajit P Yoganathan Journal: IEEE Trans Biomed Eng Date: 2003-02 Impact factor: 4.538
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: T Y Hsia; S Khambadkone; J E Deanfield; J F Taylor; F Migliavacca; M R De Leval Journal: J Thorac Cardiovasc Surg Date: 2001-03 Impact factor: 5.209
Authors: Michael Tree; Zhenglun Alan Wei; Phillip M Trusty; Vrishank Raghav; Mark Fogel; Kevin Maher; Ajit Yoganathan Journal: Ann Biomed Eng Date: 2017-10-24 Impact factor: 3.934
Authors: Phillip M Trusty; Timothy C Slesnick; Zhenglun Alan Wei; Jarek Rossignac; Kirk R Kanter; Mark A Fogel; Ajit P Yoganathan Journal: J Cardiovasc Transl Res Date: 2018-01-16 Impact factor: 4.132
Authors: Einar Heiberg; Jane Sjögren; Martin Ugander; Marcus Carlsson; Henrik Engblom; Håkan Arheden Journal: BMC Med Imaging Date: 2010-01-11 Impact factor: 1.930
Authors: Zhenglun Alan Wei; Connor Huddleston; Phillip M Trusty; Shelly Singh-Gryzbon; Mark A Fogel; Alessandro Veneziani; Ajit P Yoganathan Journal: Ann Biomed Eng Date: 2019-06-24 Impact factor: 3.934
Authors: Nicolas Tobin; Bryan C Good; Jonathan D Plasencia; Mark A Fogel; William J Weiss; Keefe B Manning Journal: Ann Biomed Eng Date: 2022-04-22 Impact factor: 3.934
Authors: Zhenglun Wei; Shelly Singh-Gryzbon; Phillip M Trusty; Connor Huddleston; Yingnan Zhang; Mark A Fogel; Alessandro Veneziani; Ajit P Yoganathan Journal: Ann Biomed Eng Date: 2020-05-05 Impact factor: 3.934
Authors: Zhenglun Alan Wei; Camille Johnson; Phillip Trusty; Morgan Stephens; Wenjun Wu; Ritchie Sharon; Balaji Srimurugan; Brijesh P Kottayil; G S Sunil; Mark A Fogel; Ajit P Yoganathan; Mahesh Kappanayil Journal: Pediatr Cardiol Date: 2020-05-06 Impact factor: 1.655
Authors: Arno A W Roest; Hildo J Lamb; Friso M Rijnberg; Jos J M Westenberg; Hans C van Assen; Joe F Juffermans; Lucia J M Kroft; Pieter J van den Boogaard; Covadonga Terol Espinosa de Los Monteros; Evangeline G Warmerdam; Tim Leiner; Heynric B Grotenhuis; Monique R M Jongbloed; Mark G Hazekamp Journal: J Cardiovasc Magn Reson Date: 2022-03-28 Impact factor: 6.903