Integrated Open-Source Framework for Simulation of Transcatheter Pulmonary Valves in Native Right Ventricular Outflow...

Area of Science:

• Cardiovascular Engineering
• Medical Imaging
• Computational Biology

Background:

• Transannular patch repair for Tetralogy of Fallot (ToF) can lead to pulmonary insufficiency, impacting long-term patient health.
• Transcatheter pulmonary valve replacement (TPVR) is increasingly used, but patient selection and device choice remain complex challenges.

Purpose of the Study:

• To develop and validate an integrated, open-source computational workflow for simulating TPVR.
• To utilize this workflow to inform patient candidacy assessment and optimal device selection for TPVR.

Main Methods:

• Machine learning was used for segmenting CT scans to define the right ventricular outflow tract (RVOT).
• A custom workflow in SlicerHeart facilitated virtual device positioning and pre-compression, with geometries exported to FEBio for finite element analysis.
• Custom metrics in SlicerHeart and FEBio were employed for result visualization and quantification.

Main Results:

• The workflow enabled rapid RVOT model creation and virtual device placement in under a minute.
• FE simulations accurately mimicked physical device placement, quantifying vessel strain, stress, and contact area.
• High strain and stress were noted at the impingement points of devices on the RVOT wall, indicating anatomical variability impacts device performance.

Conclusions:

• The study successfully demonstrated a novel, open-source workflow for rapid TPVR simulation.
• Further refinement of this workflow holds promise for improving patient selection and device choice in TPVR procedures.