Computational Modeling of Right Ventricular Intracardiac Flow in Tetralogy of Fallot

1法洛四联症是最常见的青紫型心脏病，通常在早期手术矫正。 2婴儿期。然而，大多数法乐四联症修复术(RTOF)的幸存者将长期遭受 3肺功能不全，右室扩大，需行肺瓣膜置换术 4青少年或青年时期。手术的时机历来是由心脏决定的 5磁共振成像(CMRI)。然而，PVR的时机是有争议的，因为存在可变的CMR 6关于PVR的标准，瓣膜更换的耐久性有限，并且没有方法确定 7PVR的血流动力学益处。计算流体动力学(CFD)模拟是解决这一困境的关键，正如CFD 8被用来模拟和指导其他形式的先天性心脏手术。 9拟议研究的总体目标是创建对rTOF患者异常血流的模拟 10脑磁共振图数据。我们假设我们可以在rTOF患者中检测到重要的血流异常，在PVR之前， 11通过我们独特的使用CMRI数据的CFD解算器。与其他形式的CFD相比，我们的方法是 12是独一无二的，因为它模拟了运动的房车内的流动，并且只依赖于CMRI数据。我们计划解决我们的 13个假设，使用CMRI数据创建对50名rTOF患者的全面模拟。 14本应用程序的具体目标包括：1)使用CMRI数据重建RV室壁运动，2) 15)模拟rTOF患者队列中的右室心内血流，3)用体内CMRI验证CFD解算器的结果 以三维速度编码的相位对比度(4D流)的形式的16个测量。 这项工作的结果将验证我们完全开发的、全面的rTOF中RV流动的CFD解算器 18例患者。未来的工作将利用这个求解器来开发PVR的预测模型。随着越来越多的人使用 19 PVR和不断增长的RTTOF成年人口，这项工作将对他们的整体护理产生重大影响，提供 20名临床医生具有流动生物标志物，可以预测PVR的益处并指导治疗。

1 Tetralogy of Fallot is the most common form of cyanotic heart disease, typically surgically corrected in early 2 infancy. However, a majority of survivors with repaired Tetralogy of Fallot (rTOF) will suffer from long-standing 3 pulmonary insufficiency, right ventricular (RV) enlargement, and require pulmonary valve replacement (PVR) 4 as a teenager or young adult. The timing of the procedure has been historically determined by cardiac 5 magnetic resonance imaging (cMRI). However, the timing of PVR is controversial, as there are variable CMR 6 criteria for PVR, valve replacements have limited durability, and there is no method to determine the 7 hemodynamic benefit of PVR. Computational fluid dynamics (CFD) simulation is key to this dilemma, as CFD 8 been used to simulate and guide other forms of congenital heart surgery. 9 The overall objective of the proposed research is to create a simulation of abnormal flow in rTOF patients using 10 cMRI data. We hypothesize that we can detect important flow abnormalities in rTOF patients, prior to PVR, 11 through our unique CFD solver using cMRI data. When compared to other forms of CFD, our method is 12 unique as it simulates flow inside a moving RV and relies only on cMRI data. We plan on addressing our 13 hypothesis by using cMRI data to create comprehensive simulations of 50 rTOF patients. 14 The specific objectives of this application include: 1) To reconstruct RV wall motion with cMRI data, 2) To 15 simulate RV intracardiac flow in a cohort of rTOF patients, 3) To validate CFD solver results with in-vivo cMRI 16 measurements in the form of three-dimensional velocity-encoded phase contrast (4D flow). 17 The results from this work will validate our fully developed, comprehensive CFD solver of RV flow in rTOF 18 patients. Future work would utilize this solver to develop a prediction model for PVR. With the increasing use of 19 PVR and growing adult population of rTOF, this work will have significant impact on their overall care, providing 20 clinicians with flow biomarkers that may predict the benefit of PVR and guide therapy.