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A MULTISCALE MODEL OF THE NEONATAL CIRCULATORY SYSTEM FOLLOWING HYBRID NORWOOD PALLIATION
Title
A MULTISCALE MODEL OF THE NEONATAL CIRCULATORY SYSTEM FOLLOWING HYBRID NORWOOD PALLIATION.
Creator
Ceballos, Andres, Kassab, Alain, University of Central Florida
Abstract / Description
Hypoplastic left heart syndrome (HLHS) is a complex cardiac malformation in neonates suffering from congenital heart disease and occurs in nearly 1 per 5000 births. HLHS is uniformly fatal within the first hours or days after birth as the severely malformed anatomies of the left ventricle, mitral and aortic valves, and ascending aorta are not compatible with life. The regularly implemented treatment, the Norwood operation, is a complex open heart procedure that attempts to establish...
Show moreHypoplastic left heart syndrome (HLHS) is a complex cardiac malformation in neonates suffering from congenital heart disease and occurs in nearly 1 per 5000 births. HLHS is uniformly fatal within the first hours or days after birth as the severely malformed anatomies of the left ventricle, mitral and aortic valves, and ascending aorta are not compatible with life. The regularly implemented treatment, the Norwood operation, is a complex open heart procedure that attempts to establish univentricular circulation by removing the atrial septum (communicating the right and left ventricle), reconstructing the malformed aortic arch, and connecting the main pulmonary artery into the reconstructed arch to allow direct perfusion from the right ventricle into the systemic circulation. A relatively new treatment being utilized, the Hybrid Norwood procedure, involves a less invasive strategy to establish univentricular circulation that avoids a cardiopulmonary bypass (heart-lung machine), deliberate cardiac arrest, and circulatory arrest of the patient during the procedure. The resulting systemic-pulmonary circulation is unconventional; blood is pumped simultaneously and in parallel to the systemic and pulmonary arteries after the procedure. Cardiac surgeons are deeply interested in understanding the global and local hemodynamics of this anatomical configuration. To this end, a multiscale model of the entire circulatory system was developed utilizing an electrical lumped parameter model for the peripheral or distal circulation coupled with a 3D Computational Fluid Dynamics (CFD) model to understand the local hemodynamics. The lumped parameter (LP) model is mainly a closed loop circuit comprised of RLC compartments that model cardiac function as well as the viscous drag, flow inertia, and compliance of the different arterial and venous beds in the body. A system of 32 first-order differential equations is formulated and solved for the LP model using a fourth-order adaptive Runge-Kutta solver. The output pressure and flow waveforms obtained from the LP model are imposed as boundary conditions on the CFD model. Coupling of the two models is done through an iterative process where the parameters in the LP model are adjusted to match the CFD solution. The CFD model domain is a representative HLHS anatomy of an infant after undergoing the Hybrid Norwood procedure and is comprised of the neo-aorta, pulmonary roots, aortic arch with branching arteries, and pulmonary arteries. The flow field is solved over several cardiac cycles using an implicit-unsteady RANS equation solver with the k-epsilon turbulence model.
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Date Issued
2011
Identifier
CFE0004037, ucf:49183
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004037
Computational Fluid Dynamics Study of Thromboembolism as a Function of Shunt Size and Placement in the Hybrid Norwood Palliative Treatment of Hypoplastic Left Heart Syndrome
Title
Computational Fluid Dynamics Study of Thromboembolism as a Function of Shunt Size and Placement in the Hybrid Norwood Palliative Treatment of Hypoplastic Left Heart Syndrome.
Creator
Seligson, John, Kassab, Alain, DeCampli, William, Mansy, Hansen, University of Central Florida
Abstract / Description
The Hybrid Norwood procedure has emerged as a promising alternative palliative first stage treatment for infants with Hypoplastic Left Heart Syndrome (HLHS). The procedure is done to provide necessary blood flow to the pulmonary and systemic regions of the body. The procedure can affect hemodynamic conditions to be pro-thrombotic, and thrombus particles can form and release from the vessel walls and enter the flow. Assuming these particles are formed and released from the shunt surface, a...
Show moreThe Hybrid Norwood procedure has emerged as a promising alternative palliative first stage treatment for infants with Hypoplastic Left Heart Syndrome (HLHS). The procedure is done to provide necessary blood flow to the pulmonary and systemic regions of the body. The procedure can affect hemodynamic conditions to be pro-thrombotic, and thrombus particles can form and release from the vessel walls and enter the flow. Assuming these particles are formed and released from the shunt surface, a Computational Fluid Dynamics (CFD) model can be used to mimic the patient's vasculature geometry and predict the occurrence of embolization to the carotid or coronary arteries, as well as the other major arteries surrounding the heart. This study used a time dependent, multi-scale CFD analysis on patient-specific geometry to determine the statistical probability of thrombus particles exiting each major artery. The geometries explored were of a nominal and patient specific nature. Cases of 90% and 0% stenosis at the aortic arch were analyzed, including shunt diameters of 3mm, 3.5mm, and 4mm. Three different placements of the shunt were explored as well. The intent of this study was to suggest best methods of surgical planning in the Hybrid Norwood procedure by providing supporting data for optimal stroke and myocardial infarction prevention.
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Date Issued
2017
Identifier
CFE0006655, ucf:51232
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006655
A COUPLED CFD-LUMPED PARAMETER MODEL OF THE HUMAN CIRCULATION: ELUCIDATING THE HEMODYNAMICS OF THE HYBRID NORWOOD PALLIATIVE TREATMENT AND EFFECTS OF THE REVERSE BLALOCK-TAUSSIG SHUNT PLACEMENT AND DIAMETER
Title
A COUPLED CFD-LUMPED PARAMETER MODEL OF THE HUMAN CIRCULATION: ELUCIDATING THE HEMODYNAMICS OF THE HYBRID NORWOOD PALLIATIVE TREATMENT AND EFFECTS OF THE REVERSE BLALOCK-TAUSSIG SHUNT PLACEMENT AND DIAMETER.
Creator
Ceballos, Andres, Kassab, Alain, Bai, Yuanli, Deng, Weiwei, DeCampli, William, Divo, Eduardo, University of Central Florida
Abstract / Description
The Hybrid Norwood (HN) is a relatively new first stage procedure for neonates with Hypoplastic Left Heart Syndrome (HLHS), in which a sustainable univentricular circulation is established in a less invasive manner than with the standard procedure. A computational multiscale model of such HLHS circulation following the HN procedure was used to obtain detailed hemodynamics. Implementation of a reverse-BT shunt (RBTS), a synthetic bypass from the main pulmonary to the innominate artery placed...
Show moreThe Hybrid Norwood (HN) is a relatively new first stage procedure for neonates with Hypoplastic Left Heart Syndrome (HLHS), in which a sustainable univentricular circulation is established in a less invasive manner than with the standard procedure. A computational multiscale model of such HLHS circulation following the HN procedure was used to obtain detailed hemodynamics. Implementation of a reverse-BT shunt (RBTS), a synthetic bypass from the main pulmonary to the innominate artery placed to counteract aortic arch stenosis, and its effects on local and global hemodynamics were studied.A synthetic and a 3D reconstructed, patient derived anatomy after the HN procedure were utilized, with varying degrees of distal arch obstruction, or stenosis, (nominal and 90% reduction in lumen) and varying RBTS diameters (3.0, 3.5, 4.0 mm). A closed lumped parameter model (LPM) for the peripheral or distal circulation coupled to a 3D Computational Fluid Dynamics (CFD) model that allows detailed description of the local hemodynamics was created for each anatomy. The implementation of the RBTS in any of the chosen diameters under severe stenosis resulted in a restoration of arterial perfusion to near-nominal levels. Shunt flow velocity, vorticity, and overall wall shear stress levels are inverse functions of shunt diameter, while shunt perfusion and systemic oxygen delivery correlates positively with diameter. No correlation of shunt diameter with helicity was recorded.In the setting of the hybrid Norwood circulation, our results suggest: (1) the 4.0mm RBTS may be more thrombogenic when implemented in the absence of severe arch stenosis and (2) the 3.0mm and 3.5mm RBTS may be a more suitable alternative, with preference to the latter since it provides similar hemodynamics at lower levels of wall shear stress.
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Date Issued
2015
Identifier
CFE0005772, ucf:50068
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005772