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A Patient-Specific CFD Pipeline Using Doppler Echocardiography for Application in Coarctation of the Aorta in a
Liam Swanson1, Benjamin Owen2, Amir Keshmiri2
1Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa.
Insights
A new computational fluid dynamics (CFD) pipeline using CT angiography and Doppler echocardiography was developed for congenital heart defect (CHD) coarctation of the aorta (CoA) in low-resource settings. This approach offers a feasible and repeatable method for improved diagnosis and treatment planning in underserved regions.
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Computational Biology
Background:
- Congenital heart disease (CHD), specifically coarctation of the aorta (CoA), is a common and severe birth defect.
- Prognosis for children with CoA is significantly worse in low and lower-middle income countries (LLMICs) due to limited diagnostic and interventional resources.
- Advanced imaging like phase contrast magnetic resonance imaging (PC-MRI) is often inaccessible in LLMICs, hindering patient-specific analysis.
Purpose of the Study:
- To develop and validate a patient-specific computational fluid dynamics (CFD) pipeline for coarctation of the aorta (CoA).
- To adapt CFD analysis for resource-constrained environments using widely available imaging modalities.
- To assess the feasibility of integrating Doppler echocardiography into a CFD pipeline for CoA management in LLMICs.
Main Methods:
- A novel CFD pipeline was created in collaboration with clinicians at Red Cross War Memorial Children's Hospital, Cape Town.
- The pipeline utilizes data from CT angiography and Doppler transthoracic echocardiography, which are more accessible in LLMICs than MRI.
- Segmentation was performed using SimVascular, and simulations were executed with OpenFOAM, leveraging open-source software to reduce costs.
Main Results:
- The developed pipeline successfully performed patient-specific CFD studies for coarctation of the aorta (CoA).
- The methodology demonstrated clinical feasibility and repeatability within resource-constrained settings by using accessible imaging and open-source tools.
- Doppler echocardiography was identified as a crucial component for routine use within the pipeline in LLMICs.
Conclusions:
- This CFD pipeline offers a cost-effective and accessible solution for analyzing coarctation of the aorta (CoA) in LLMICs.
- The integration of CT angiography and Doppler echocardiography makes advanced hemodynamic analysis feasible in environments with limited infrastructure.
- The study highlights the potential of this approach to improve diagnostic accuracy and treatment planning for CHD patients in underserved regions.
Abstract:
Congenital heart disease (CHD) is the most common birth defect globally and coarctation of the aorta (CoA) is one of the commoner CHD conditions, affecting around 1/1800 live births. CoA is considered a CHD of critical severity. Unfortunately, the prognosis for a child born in a low and lower-middle income country (LLMICs) with CoA is far worse than in a high-income country. Reduced diagnostic and interventional capacities of specialists in these regions lead to delayed diagnosis and treatment, which in turn lead to more cases presenting at an advanced stage. Computational fluid dynamics (CFD) is an important tool in this context since it can provide additional diagnostic data in the form of hemodynamic parameters. It also provides an in silico framework, both to test potential procedures and to assess the risk of further complications arising post-repair. Although this concept is already in practice in high income countries, the clinical infrastructure in LLMICs can be sparse, and access to advanced imaging modalities such as phase contrast magnetic resonance imaging (PC-MRI) is limited, if not impossible. In this study, a pipeline was developed in conjunction with clinicians at the Red Cross War Memorial Children's Hospital, Cape Town and was applied to perform a patient-specific CFD study of CoA. The pipeline uses data acquired from CT angiography and Doppler transthoracic echocardiography (both much more clinically available than MRI in LLMICs), while segmentation is conducted via SimVascular and simulation is realized using OpenFOAM. The reduction in cost through use of open-source software and the use of broadly available imaging modalities makes the methodology clinically feasible and repeatable within resource-constrained environments. The project identifies the key role of Doppler echocardiography, despite its disadvantages, as an intrinsic component of the pipeline if it is to be used routinely in LLMICs.
