3D MRI-Based Modeling for Computer-Aided Right Ventricle Remodeling Surgery

基于 3D MRI 的计算机辅助右心室重塑手术建模

• 批准号: 8076813
• 负责人: Tal Geva
• 金额: $ 41.17万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8076813
• 关键词: Accounting; Activities of Daily Living; Adult; Blood Pressure; Blood flow; Cardiac; Cardiac Surgery procedures; Cardiology; Cessation of life; Chronic; Cicatrix; Clinical; Clinical Trials; Computer Assisted; Computer Simulation; Congenital Heart Defects; Conventional Surgery; Data; Development; Dilatation - action; Excision; Failure; Fiber; Flowcharts; Functional disorder; Funding; Goals; Health; Heart; Heart failure; Image; Imaging Techniques; Imaging technology; Lead; Liquid substance; Magnetic Resonance; Magnetic Resonance Imaging; Mathematics; Mechanics; Methodology; Methods; Modeling; Morphology; Motion; Myocardial; National Heart, Lung, and Blood Institute; Operative Surgical Procedures; Outcome; Patient Care; Patients; Postoperative Period; Principal Investigator; Procedures; Process; Property; Protocols documentation; Pulmonary Valve Insufficiency; Pulmonary valve structure; Randomized; Recovery; Research Personnel; Right Ventricular Dysfunction; Right Ventricular Function; Right Ventricular Outflow Obstruction; Right ventricular structure; Shapes; Simulate; Stress; Structure; Surgical Management; Surgical incisions; Testing; Tetralogy of Fallot; Time; Validation; Ventricular; Ventricular Remodeling; Ventricular Septal Defects; base; congenital heart disorder; design; experience; heart motion; hemodynamics; improved; infancy; innovation; multidisciplinary; novel; premature; prospective; pulmonary valve replacement; repaired; tool; trial comparing; virtual

DESCRIPTION (provided by applicant): Right ventricular dysfunction developing late after congenital cardiac surgery is one of the most common causes of heart failure in adults with congenital heart disease. In tetra logy of Fallot (ToF), the most common cyanotic heart defect, initial repair in infancy involves an incision and patch in the RV outflow, including the pulmonary valve, which often results in late development of severe RV dilatation and dysfunction due to chronic pulmonary regurgitation and RV scarring/patch dilatation. Current surgical management of late RV dysfunction, consisting of pulmonary valve insertion and reduction of the RV outflow patch, reduces RV volume but does not result in a predictable improvement in RV function. A more radical procedure, which includes extensive removal of scar and outflow patch, is being evaluated in an NHLBI sponsored randomized prospective trial. However, there is no currently available method for predicting outcome after either procedure or what the optimal procedure is for a given pt., i.e. no clinically useful tools for determining patient-specific therapy. In this project, we propose to develop a computational modeling approach to determine the efficacy and suitability of the various reconstructive options to treat failing RV in ToF pts. We will use non-invasive cardiac magnetic resonance imaging (CMR) to provide patient-specific RV/LV morphology, deformation, and flow data for the construction and validation of computational models. 3D CMR-based RV/LV combination models will be constructed, which include fluid-structure interactions (RV/LV and RV patch), two-layer RV/LV structure, anisotropic material properties, fiber orientation, and active contraction to simulate blood flow, heart motion, and stress/strain distribution to evaluate the effect of different remodeling procedures on RV function, and to seek an optimal RV volume and patch design to improve post-operative RV function. Clinical imaging and hemodynamic data from an ongoing NHLBI-funded clinical trial will be used to build and validate the model. Our ultimate goal is to apply this methodology in patient- specific computer-aided cardiac surgery planning to reach optimal surgical procedure design and outcome in patients with RV dysfunction from congenital heart defects. A multidisciplinary group of experienced investigators in congenital cardiac surgery, cardiology and computational mathematics will conduct this project. PUBLIC HEALTH RELEVANCE: This project aims to use MRI images obtained from patients with repair tetralogy of Fallot that are being evaluated for surgery to develop computational models of right ventricular function. The ultimate goal is to develop models that will predict outcomes and optimize right ventricular function after surgery. The MRI's to be used for this study are clinically indicated studies as part of the care of these patients and are currently obtained under an approved protocol where Dr. Tal Geva is the principal investigator.

描述（由申请人提供）：先天性心脏手术后较晚发生的右心室功能障碍是先天性心脏病成人心力衰竭的最常见原因之一。在法洛（TOF）的tetra logy中，最常见的cyanotic心脏缺陷，婴儿期的初始修复涉及RV流出的切口和斑块，包括肺动脉瓣，这通常会导致严重的RV扩张和由于慢性肺部反流和RV Scarring/Patch Scarring/Patch/Patch Sakarring/Patch siplation而导致严重的RV扩张和功能障碍。晚期RV功能障碍的当前手术管理，包括肺动脉瓣插入和RV流出贴片的减少，可减少RV体积，但不能可预测地改善RV功能。在NHLBI赞助的随机前瞻性试验中，正在评估一种更加激进的程序，其中包括广泛清除疤痕和流出贴片。但是，目前尚无可用的方法来预测程序后的结果或给定PT的最佳程序，即没有用于确定患者特异性治疗的临床上有用的工具。在这个项目中，我们建议开发一种计算建模方法，以确定各种重建选项的功效和适用性，以治疗TOF PT中的RV失败。我们将使用非侵入性心脏磁共振成像（CMR）来提供患者特异性的RV/LV形态，变形和流量数据，以构建和验证计算模型。 3D CMR-based RV/LV combination models will be constructed, which include fluid-structure interactions (RV/LV and RV patch), two-layer RV/LV structure, anisotropic material properties, fiber orientation, and active contraction to simulate blood flow, heart motion, and stress/strain distribution to evaluate the effect of different remodeling procedures on RV function, and to seek an optimal RV volume and patch design to improve术后RV功能。来自正在进行的NHLBI资助的临床试验的临床成像和血流动力学数据将用于构建和验证模型。我们的最终目标是将这种方法应用于患者特定的计算机辅助心脏手术计划，以在先天性心脏缺陷的RV功能障碍的患者中达到最佳的手术程序设计和结果。先天性心脏外科，心脏病学和计算数学的经验丰富的研究人员组成的多学科研究人员将进行该项目。公共卫生相关性：该项目旨在使用从法洛修复四边形患者获得的MRI图像，这些患者正在接受手术评估，以开发右心室功能的计算模型。最终目标是开发将预测结果并在手术后优化右心室功能的模型。在临床上，将用于本研究的MRI作为这些患者的护理的一部分，目前是根据批准的方案获得的，其中Tal Geva博士是主要研究员。