Marsden Alison L
Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, California 92093, USA.
Phys Fluids (1994). 2013 Oct;25(10):101303. doi: 10.1063/1.4825031. Epub 2013 Oct 23.
Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.
血流动力学在心血管疾病的进展和治疗中起着至关重要的作用。然而，尽管医学成像提供了越来越详细的解剖学信息，但临床医生通常难以获取对患者风险评估和治疗规划可能至关重要的血流动力学数据。现在，计算模拟可以提供详细的血流动力学数据，以增强成人和儿科应用中的临床知识。由于先天性心脏病患者的解剖学和生理学存在广泛差异，需要个性化的治疗方案，因此儿科心脏病学对模拟工具有着特别的需求。尽管医学成像取得了巨大进展，能够从磁共振和超声成像中提取血流信息，但模拟提供了单独成像无法提供的预测能力。针对患者的模拟可用于测试新的手术设计、治疗规划、设备测试和患者风险分层。此外，模拟可以在不对患者造成直接风险的情况下进行。在本文中，我们概述了心血管血流模拟和虚拟手术方法的当前技术水平。然后，我们逐步探讨该领域面临的紧迫挑战，包括多尺度建模、边界条件选择、优化和不确定性量化。最后，我们总结了儿科心脏病学两个代表性例子的模拟结果：单心室生理和川崎病引起的冠状动脉瘤。这些例子说明了计算建模工具在临床环境中的潜在影响。
