LOng-Term anatomical fluid dynamics for new Univentricular heartS palliation (LOTUS)

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Children with functionally univentricular hearts (UVH) have poor life prognosis, despite surgical treatment. This project aims to build an open-source combined Artificial Intelligence and Computational Fluid Dynamics (CFD) tool to determine 'optimal' designs for the Fontan procedure to be used by surgeons, to enhance patient life expectancy (currently 20-30 years).Detailed imaging from UVH patients will be provided by USM to produce 3D geometries on which UK numerical models can be applied. USM currently treats 40-50 new UVH patients/year and 150 in follow-up, therefore they have a large databank covering a wide range of anatomical morphologies changing with patient growth and various palliative stages. This databank enables the construction of a novel mathematical model of how morphology/flow in later life depends on surgical procedure, with the prediction of the 'optimal' surgical design minimizing the negative impact of the Fontan circulation. Combining high-fidelity curvilinear discretization, multiscale modelling, and machine learning, the CFD tool will reliably inform on long-term impact of surgical procedures, including a novel physiological Fontan procedure by the UK team.Expected outcomes. 1. Study of the long-term prognosis of subjects with complex congenital heart defects, specifically following all patients with UVH. 2. Consolidate partnership between Malaysia and UK teams, provide training to USM personnel introducing CFD tools for surgery optimisation. 3. Develop a patient-specific open-source computational tool to optimize surgical procedures in children with functionally UVH, for better long-term quality of life. 4. Combine artificial intelligence techniques with efficient and reliable multiscale CFD modelling based on recent polyhedral discretisations to predict long-term outcome of surgery. 5. We envisage that the project's tool will provide a new insight on the reason for the failure of UVH palliation. 6. The tool will also permit the validation of new Fontan procedures based on more physiological types of surgical connections, such as the one recently proposed and evaluated with CFD studies by the UK team.