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Inflow typology and ventricular geometry determine efficiency of filling in the hypoplastic left heart
Adelaide de Vecchi1, David A Nordsletten, Espen W Remme
1Department of Biomedical Engineering, Division of Imaging Science and Biomedical Engineering, King's College London, London, United Kingdom.
Insights
Ventricular shape and inflow patterns significantly impact diastolic function in hypoplastic left heart syndrome patients. Optimizing these factors can improve right ventricular filling and potentially serve as a new metric for assessing diastolic efficiency.
Area of Science:
- Cardiovascular Physiology
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Hypoplastic left heart syndrome (HLHS) necessitates reliance on the right ventricle, leading to maladaptations that impair diastolic function and cause heart failure.
- Current diastolic function assessments are primarily based on adult left ventricle physiology, limiting their applicability to HLHS patients.
- Investigating ventricular shape and tricuspid inflow is crucial for developing relevant diastolic assessment methods in HLHS.
Purpose of the Study:
- To explore the influence of ventricular cavity shape and tricuspid inflow patterns on diastolic filling dynamics in pediatric HLHS patients.
- To identify novel parameters for assessing diastolic function in the unique context of single-right-ventricle physiology.
- To provide new research directions for evaluating diastolic efficiency in HLHS.
Main Methods:
- Personalized mathematical models were created using magnetic resonance imaging data from four HLHS patients with varying prognoses post-Norwood procedures.
- Numerical simulations were conducted to analyze the intricate interactions between blood flow and myocardial tissue during diastole.
- Models for two patients were further refined after undergoing Stage II surgical procedures.
Main Results:
- Diastolic filling dynamics were characterized by the formation of a distinct vortex ring structure.
- Ventricular shape and the timing of E and A waves critically influenced vortex ring formation and filling efficiency.
- Biphasic inflows and more elliptical ventricular cavities enhanced intraventricular pressure gradients, optimized energy transfer, and improved flow propagation, tissue velocities, and displacements.
Conclusions:
- Variations in blood motion kinetic energy correlate with base-to-apex pressure differences, offering a quantifiable measure of filling efficiency.
- This kinetic energy variation presents a potential novel metric for assessing diastolic function in pediatric patients with hypoplastic left heart syndrome.
- The findings suggest a new avenue for evaluating and understanding diastolic performance in single-right-ventricle physiology.
Background:
Pediatric patients with hypoplastic left heart syndrome rely solely on the right ventricle, resulting in anatomic maladaptations that can significantly compromise diastolic efficiency and lead to heart failure. Clinical indices to evaluate diastole are generally derived from the adult left ventricle, limiting their relevance to patients with hypoplastic left heart syndrome. We investigated the effect of the ventricular cavity shape and tricuspid inflow typology on the filling dynamics to provide new directions of investigation for assessing diastolic function in these patients.
Methods:
Magnetic resonance imaging data were used to generate personalized mathematic models of 4 patients with different prognoses after stage I of the Norwood procedures. Two of these patients were also modeled after stage II. Numeric simulations were performed to analyze the interaction between blood flow and the myocardium during diastole.
Results:
The filling dynamics were characterized by the formation of an organized structure of swirling blood (vortex ring). This was strongly influenced by the ventricular shape and the timing of the E and A wave. Biphasic rather than fused inflows and more elliptical than spherical cavities were found to increase the intraventricular pressure gradients and the filling capacity by optimizing the energy transfer between blood flow and the myocardium. This resulted in a better flow propagation and higher tissue velocities and displacements.
Conclusions:
The variations in the kinetic energy associated with the blood motion reflected the base-to-apex pressure difference and can therefore be used to quantify the efficiency of filling, providing a potential new metric to assess diastolic function in these patients.
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