An interactive simulation tool for patient-specific clinical decision support in single-ventricle physiology

Area of Science:

• Cardiovascular Physiology
• Medical Simulation
• Computational Biology

Background:

• Single-ventricle circulations present unique physiological challenges.
• Mathematical modeling has provided insights into these complex flow dynamics.
• Current clinical practice requires effective tools for managing single-ventricle palliation stages.

Purpose of the Study:

• To translate a sophisticated mathematical model into an interactive, patient-specific web-based simulation tool.
• To validate the simulator's accuracy across all three stages of single-ventricle palliation.
• To enhance clinical decision-making, training, and consultation for single-ventricle physiology.

Main Methods:

• A validated lumped parameter method was used to create complete cardiovascular-pulmonary circulatory models.
• The univentricular heart model incorporates growth scaling and respiratory effects.
• Patient-specific parameters were input via a user-friendly interface, and simulation outputs were compared against clinical catheterization data (Qp:Qs, SaO2, mPAp, SaO2-SvO2).

Main Results:

• Simulator results showed no significant difference compared to clinical values for mean Qp:Qs, SaO2, and mPAp (P > .09).
• A statistically significant but clinically insignificant difference was observed in average SaO2-SvO2 (1% difference, P < .01).
• Linear regression demonstrated good predictive accuracy for all variables (R² values ranging from 0.64 to 0.93).

Conclusions:

• The simulator provides rapid and clinically accurate patient-specific hemodynamic predictions.
• It can assist in predicting outcomes for interventions and in various clinical settings.
• Further refinement and validation will expand the simulator's bedside applicability.