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In Vitro Model of Physiological and Pathological Blood Flow with Application to Investigations of Vascular Cell Remodeling
Published on: November 3, 2015
Computer and physical modeling of blood circulation pump support for a new field of application in palliative surgery
1Foundation of Cardiac Surgery Development, Zabrze, Poland. zmalota@o2.pl
Insights
Integrating an axial pump into Blalock-Taussig (BT) or Glenn shunts improves pulmonary blood flow control in children with congenital heart defects. While enhancing flow regulation, the pump increases resistance when inactive, potentially reducing blood flow by 70%.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Palliative shunt operations like the Blalock-Taussig (BT) graft or Glenn procedure are vital for increasing pulmonary blood flow in pediatric congenital heart defects.
- Current shunt procedures face challenges with suboptimal effectiveness and lack of flow regulation.
- Graft stenosis and insufficient flow with patient growth are significant limitations.
Purpose of the Study:
- To investigate the efficacy of incorporating a small axial blood pump into BT or Glenn shunts.
- To explore the potential of this hybrid shunt to regulate blood flow and prevent graft stenosis.
- To optimize shunt design using advanced simulation for improved hemodynamic conditions.
Main Methods:
- Utilized physical and 3-D computer simulations employing a finite element mesh (FEM) model.
- Performed optimization studies on both standard shunts and hybrid shunts with integrated pumps.
- Evaluated shunt performance across various stages of congenital heart disease.
Main Results:
- The hybrid shunt with an axial pump demonstrated potential for regulating pulmonary artery blood flow and blood pressure.
- Integration of the pump facilitated a decrease in left heart ventricle afterload.
- An inactive pump significantly increased hemodynamic resistance, reducing graft blood flow by up to 70%.
Conclusions:
- The axial pump-integrated graft offers improved vascular and pulmonary artery conditions and blood pressure regulation.
- This technology allows for optimized flow during palliative care, facilitating a safer wait for definitive cardiac surgery.
- The pump's ability to regulate flow addresses the limitations of fixed-size grafts in growing children.
Objectives:
One of the most popular palliative procedures performed to increase pulmonary blood flow in children with congenital heart defects is a shunt operation (Blalock-Taussig graft or Glenn procedure), which creates the new blood channel to the pulmonary artery. The main problem with this kind of surgery is poor shunt effectiveness and the lack of possibility to regulate the flow. The aim of this work is to use advanced computer simulation methods to study the effectiveness of a new idea to introduce a small axial blood pump into a Blalock-Taussig (B-T) or Glenn shunt in order to control the blood flow and prevent any increase in the graft stenosis.
Methods:
Physical and computer 3-D simulation based on a finite element mesh (FEM) model was applied. Studies for optimization of the shunt and hybrid shunt with pump were performed for different stages of the disease.
Results And Conclusion:
The graft with the axial pump creates good conditions for the vascular system and pulmonary artery blood flow as well as regulating blood pressure under variable conditions caused by palliative procedures. Its use permits the afterload of the left heart ventricle to be decreased. A palliative procedure is only a temporary solution. When a child grows, while the graft size is fixed, the blood flow through this graft may be not sufficient under changing hemodynamic conditions. The use of an axial pump for regulating the blood flow volume, during palliative procedures, allows to obtain the optimal flow conditions in pulmonary artery and safely wait on the final cardiac surgery correction later. However, the use of a pump mounted inside the graft increased hemodynamic resistance, which caused the flow to decrease up to 70% in the graft when the axial pump was not working.
