Simulating Cardiac Surgery for Children with Severe Congenital Heart Disease

摘要 先天性心脏病（CHD）影响约1.2%的儿童，是出生缺陷的主要原因- 相关死亡。单心室心脏病（SVHD）是CHD的一种严重形式，具有高发病率， mortality.这些患者需要多次姑息手术，最终导致完全空洞化 吻合术尽管SVHD患者的生存率有了相当大的提高， 发病率和死亡率。目前尚不清楚为什么一些SVHD患者的手术修复失败， 其他人则相对较好。临床医生通常依赖于从显微镜获得的2维（2D）图像。 超声心动图、导管插入术或心血管磁共振（CMR）检查，以评估SVHD 患者，并定性地选择最佳的手术修复。然而，2D图像导致次优的 复杂的3D空间关系和血液动力学的理解，并限制了有效的决策制定。 为了解决这一缺陷，开发了自由呼吸序列以获取3D电影CMR图像。 心脏和大血管3D数据块将用于生成患者特定的脉动信号 心脏模型该心脏模型将用于模拟患者心血管系统， 参数模型集总参数模型将用于模拟不同的手术修复， 定量地为每个患者选择最佳修复。我们希望这一平台能合理化 外科医生决定最佳手术方法，提高SVHD患者的生存率。

Abstract Congenital heart disease (CHD) affects approximately 1.2% of children and is the leading cause of birth defect- related deaths. Single ventricle heart disease (SVHD) is a severe form of CHD, with high morbidity and mortality. These patients require multiple palliative surgeries, culminating with a total cavopulmonary anastomosis. Despite considerable improvement in the survival of patients with SVHD, there is increasing morbidity and mortality over time. It remains unclear why some SVHD patients fail their surgical repairs while others remain relatively well. Clinicians often rely on 2-dimensional (2D) images acquired from echocardiograms, catheterizations, or cardiovascular magnetic resonance (CMR) exams to assess SVHD patients and qualitatively choose the optimal surgical repair. The 2D images, however, lead to a suboptimal understanding of the complex 3D spatial relationships and hemodynamics, and limit efficient decision making. To address this deficiency, a free-breathing sequence is developed to acquire 3D cine CMR images of the heart and great vessels in 10 minutes. The 3D block of data will be used to generate a patient-specific pulsatile heart model. This heart model will be used to simulate the patient cardiovascular system with a lumped- parameter model. The lumped-parameter model will be used to simulate different surgical repairs and quantitatively choose the most optimal repair for each patient. We expect that this platform rationalizes surgeons' decisions for the best surgical approach and improves the survival rate of patients with SVHD.