Patient-specific computational fluid dynamics for hypertrophic obstructive cardiomyopathy

Area of Science:

• Cardiovascular Imaging
• Medical Simulation
• Computational Fluid Dynamics

Background:

• Hypertrophic obstructive cardiomyopathy (HOCM) exhibits heterogeneous morphology and function, challenging traditional imaging assessments.
• Multimodality imaging is crucial but can yield uncertain results in HOCM evaluation.
• Existing imaging modalities struggle to fully capture the complex hemodynamics in HOCM.

Purpose of the Study:

• To develop and validate a patient-specific hemodynamic assessment using cardiac computed tomography angiography (CCTA) and computational fluid dynamics (CFD) for HOCM patients.
• To demonstrate the usability of CCTA-based CFD in a cohort of HOCM patients.
• To explore the potential of virtual myectomy guided by CFD for surgical planning.

Main Methods:

• Retrospective analysis of eight HOCM patients undergoing septal myectomy with pre- and post-operative CCTA and transthoracic echocardiography (TTE).
• Three-dimensional model reconstruction from CCTA data for patient-specific CFD simulations.
• Estimation of blood velocity, pressure gradient, and wall shear stress using CFD, with comparison to TTE findings.
• Performance of virtual myectomy based on CFD simulations to predict optimal resection volumes.

Main Results:

• Successful 3D reconstruction of complex HOCM anatomy in all patients.
• CFD simulations accurately assessed pressure gradients and flow velocities, showing good correlation with TTE (peak pressure gradient r=0.87/0.84, flow velocity r=0.87/0.90 pre/post-op).
• CFD-predicted minimal resection volumes for virtual myectomy aligned with actual surgical resection volumes.

Conclusions:

• CCTA-based CFD offers a unique approach for assessing patient-specific morphology and hemodynamics in HOCM.
• Integrating CFD with virtual myectomy can optimize therapeutic planning for septal myectomy.
• This technology shows promise as a complement to existing imaging strategies for HOCM management.