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This article is part of the Research Topic Ventricular Mechanics in Congenital Heart Disease

Original Research ARTICLE

Front. Pediatr. | doi: 10.3389/fped.2017.00078

Reproducing patient-specific hemodynamics in the Blalock-Taussig circulation using a flexible multi-domain simulation framework: applications for optimal shunt design

  • 1King's College London, United Kingdom
  • 2Department of Biomedical Engineering, University of Michigan, USA
  • 3Department of Pediatric Cardiology, University of Michigan Health System, USA
  • 4Department of Surgery, University of Michigan, USA

For babies born with hypoplastic left heart syndrome, several open-heart surgeries are required. During Stage I, a Norwood procedure is performed to construct an appropriate circulation to both the systemic and the pulmonary arteries. The pulmonary arteries receive flow from the systemic circulation, often by using a Blalock-Taussig (BT) shunt between the innominate artery and the right pulmonary artery. This procedure causes significantly disturbed flow in the pulmonary arteries. In this study, we use computational hemodynamic simulations to demonstrate its capacity for examining the properties of the flow through and near the BT shunt. Initially, we construct a computational model which produces blood flow and pressure measurements matching the clinical magnetic resonance imaging (MRI) and catheterization data. Achieving this required us to determine the level of BT shunt occlusion; because the occlusion is below the MRI resolution, this information is difficult to recover without the aid of computational simulations. We determined that the shunt had undergone an effective diameter reduction of 22% since the time of surgery. Using the resulting geometric model, we show that we can computationally reproduce the clinical data. We then replace the BT shunt by with a hypothetical alternative shunt design with a flare at the distal end. Investigation of the impact of the shunt design reveals that the flare can increase pulmonary pressure by as much as 7%, and flow by as much as 9% in the main pulmonary branches, which may be beneficial to the pulmonary circulation.

Keywords: Hypoplastic Left Heart Syndrome, Blalock-Taussig shunt, Computational haemodynamics, simulation, Multidomain, Crimson

Citation: Arthurs CJ, Agarwal P, John A, Dorfman A, Grifka R and Figueroa CA (2017). Reproducing patient-specific hemodynamics in the Blalock-Taussig circulation using a flexible multi-domain simulation framework: applications for optimal shunt design. Front. Pediatr. 5:78. doi: 10.3389/fped.2017.00078

Received: 11 Jan 2017; Accepted: 31 Mar 2017.

Edited by:

Giovanni Biglino, University of Bristol, United Kingdom

Reviewed by:

Yasuhiro Fujii, Okayama University, Japan
Neil W. Bressloff, University of Southampton, United Kingdom  

Copyright: © 2017 Arthurs, Agarwal, John, Dorfman, Grifka and Figueroa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Christopher J. Arthurs, King's College London, London, United Kingdom, carthurs@gmail.com