Key result
Patient-specific computational modeling indicated that pulmonary valve replacement with a smaller patch and aggressive scar removal reduced stress/strain and may improve right ventricular function.
Why the study?
Does PVR with a smaller patch and aggressive scar removal improve RV mechanics compared to conventional patch techniques in patients needing PVR?
Does PVR with a smaller patch and aggressive scar removal improve RV mechanics compared to conventional patch techniques in patients needing PVR?
Patient-specific CMR-based computational modeling suggests that PVR with aggressive scar trimming and a smaller patch reduces local stress/strain, potentially improving RV function recovery.
A patient-specific right/left ventricle and patch (RV/LV/patch) combination model with fluid-structure interactions (FSIs) was introduced to evaluate and optimize human pulmonary valve replacement/insertion (PVR) surgical procedure and patch design. Cardiac magnetic resonance (CMR) imaging studies were performed to acquire ventricle geometry, flow velocity, and flow rate for healthy volunteers and patients needing RV remodeling and PVR before and after scheduled surgeries. CMR-based RV/LV/patch FSI models were constructed to perform mechanical analysis and assess RV cardiac functions. Both pre- and postoperation CMR data were used to adjust and validate the model so that predicted RV volumes reached good agreement with CMR measurements (error <3%). Two RV/LV/patch models were made based on preoperation data to evaluate and compare two PVR surgical procedures: (i) conventional patch with little or no scar tissue trimming, and (ii) small patch with aggressive scar trimming and RV volume reduction. Our modeling results indicated that (a) patient-specific CMR-based computational modeling can provide accurate assessment of RV cardiac functions, and (b) PVR with a smaller patch and more aggressive scar removal led to reduced stress/strain conditions in the patch area and may lead to improved recovery of RV functions. More patient studies are needed to validate our findings.
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Tang et al. (2008) studied Patients needing right ventricle remodeling and pulmonary valve replacement. Small patch with aggressive scar trimming and RV volume reduction vs. Conventional patch with little or no scar tissue trimming was evaluated on Stress/strain conditions in the patch area and RV cardiac functions. Patient-specific computational modeling indicated that pulmonary valve replacement with a smaller patch and aggressive scar removal reduced stress/strain and may improve right ventricular function.
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