Thorac Cardiovasc Surg 2022; 70(S 02): S67-S103
DOI: 10.1055/s-0042-1742954
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Intraventricular Flow Dynamics in Single Right Ventricle Patients with Real-Time Echocardiography and Computational Modeling Provide Additional Insight into Cardiac Function

M. Neidlin
1   Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
,
A. Grünwald
1   Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
,
J. Korte
1   Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
,
N. Wilmanns
2   Institute of General Mechanics, RWTH Aachen University, Aachen, Deutschland
,
C. Winkler
3   Department of Pediatric Cardiology, Uniklinik Bonn, Bonn, Deutschland
,
S. Gross-Hardt
1   Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
,
U. Steinseifer
1   Institute of Applied Medical Engineering, Uniklinik RWTH Aachen, Aachen, Deutschland
,
K. Linden
3   Department of Pediatric Cardiology, Uniklinik Bonn, Bonn, Deutschland
,
U. Herberg
3   Department of Pediatric Cardiology, Uniklinik Bonn, Bonn, Deutschland
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Background: Fluid dynamics within the ventricle play an important role in many aspects of physiology. There exists a relationship between fluid dynamical features and cardiac performance in health and disease. The vortex formation time is subject of research to determine the severity and prognosis of left ventricular heart failure. In addition, fluid kinetic energy can be used as a marker of cardiac function. In our study, we investigated the fluid dynamics in single right ventricles (SRVs) in univentricular hearts and compared them to healthy left ventricles (LVs) in a small cohort of pediatric patients through medical imaging and computational models.

Method: We acquired transthoracic real-time three-dimensional echocardiography measurements of five patients with SRV (age = 6–17 years, EDV = 26–100 mL, EF = 39–52%) and two patients with healthy LVs (age = 4 and 8 years, EDV = 40 and 54 mL, EF = 67 and 58%). We extracted the movement of the myocardium and then used patient-specific hemodynamic simulations to determine the three-dimensional blood flow velocities within the moving ventricles. Subsequently, we compared features such as diastolic vortex formation and fluid kinetic energy between the two groups.

Results: Differences in the flow structures particularly during the diastolic phase were evident. Vortex formation and the kinetic energy of the blood, a marker for the efficiency of ventricular function, were deteriorated and significantly lower in SRV compared with the LV group (p < 0.001, one-sample t-test). These observations were consistent for all SRV patients, even the ones with normal EF values.

Marker

SRV

LV no. 1

p-Value

LV no. 2

p-Value

TKE (J/kg)

0.881 ± 0.71

23.71

<0.0001

5.44

0.0001

VFT (−)

1.16 ± 0.53

4.26

0.0002

3.96

0.0003

Fluid dynamic markers of SRV versus LV group. TKE, turbulent kinetic energy; VFT, vortex formation time. Mean ± SD.


Conclusion: Using computational modeling based on three-dimensional echocardiography, detailed information on patient-specific ventricular flow dynamics was obtained. Additional parameters for the evaluation of systemic ventricular function were determined. Our data show that there are intriguing flow differences in SRV patients caused by the highly complex three-dimensional movement of the ventricular wall and that these differences cannot be captured by conventional parameters such as the ejection fraction.



Publication History

Article published online:
12 February 2022

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