KEYWORDS: Process modeling, 3D modeling, Heart, Silicon, Pathology, Image segmentation, Data modeling, Ultrasonography, Surgery, Visual process modeling
Physical replicas of patient specific heart valve pathologies may improve clinicians’ ability to plan the optimal treatment for patients with complex valvular heart disease. Our previous work has demonstrated the ability to replicate patient pathology of the adult mitral valve (MV) in a dynamic environment [13]. Infant congenital heart defects present possibly the most challenging form of valvular disease, given the range of pathologies, the relative size of these valves compared to adult anatomy, and the rarity of congenital heart disease. Patient specific valve models could be particularly valuable for pediatric cardiologists and surgeons, as a means to both plan for and practice interventions. Our current goal is to assess our ability to apply our workflow to the more challenging case of the tricuspid valve (TV) presented in cases of hypoplastic left heart syndrome (HLHS). We explore the feasibility of adapting our previous workflow for creating dynamic silicone MV models for pre-surgical planning and simulation training, to developing 3D echocardiogram derived, patient specific TV models for use in a physical heart simulator. These models are intended for characterization of the TV, and exploration of the relationship between specific anatomical features and tricuspid regurgitation (TR) severity. The simulations may be relevant to pre-surgical planning of repair of the particularly complex and unique anatomical pathologies presented in children with HLHS.
New high-frame-rate ultrasound imaging techniques are being developed to image tissue motion and blood flow with high sensitivity and at high temporal resolution. An emerging application for these new techniques is diagnosing inutero and neonatal cardiac disease. We have developed a morphologically and hemodynamically accurate neonatal heart phantom to provide a high-fidelity physical model for laboratory testing of ultrafast color Doppler echocardiography methods. This paper summarizes the design and functionality of the simulator by measuring pressure gradients across the mitral valve at a physiologic heart-rate range and stroke volume and by evaluating valve function using 2D transesophageal echocardiography (TEE) and Doppler images. The phantom achieved normal physiological pressures across the mitral valve ranging from 42 to 87 mmHg in systole and 2.4 to 4.2 mmHg in diastole at heartrates of 100, 125 and 150 beats per minute (bpm), with a realistic neonatal stroke volume of 7 ml. 2D ultrasound images were obtained at 60 bpm.
KEYWORDS: Modeling and simulation, Cardiac imaging, Heart, 3D modeling, Silicon, Data modeling, Surgery, Pathology, Modeling, 3D image processing, Hemodynamics
Mitral valve disease affects 2% of the Canadian population and 10% of those over the age of 75. Mitral valve regurgitation is a common valve disease often requiring surgical intervention for repair or replacement. Repair is often preferred over replacement, as it is associated with improved outcomes. Current mitral valve repair training is typically limited primarily to intraoperative experience. Additionally, the outcome of complex repair procedures is often unknown preoperatively, and is particularly true of new, off-pump repair techniques. Further challenges include identifying the most effective repair technique based on patient pathology, as multiple approaches exist. We present a hemodynamically accurate mitral valve phantom for testing previously validated patient specific pathological mitral valves. The device can be used for surgical resident training as well as complex procedure planning. The simulator is validated using pressure measurements across the mitral valve demonstrating realistic hemodynamics across a range of heart rates , and by evaluating valve function using 2D and 3D transesophageal echocardiography (TEE).
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