Swanson Liam, Owen Benjamin, Keshmiri Amir, Deyranlou Amin, Aldersley Thomas, Lawrenson John, Human Paul, De Decker Rik, Fourie Barend, Comitis George, Engel Mark E, Keavney Bernard, Zühlke Liesl, Ngoepe Malebogo, Revell Alistair
Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa.
Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, United Kingdom.
Front Bioeng Biotechnol. 2020 Jun 3;8:409. doi: 10.3389/fbioe.2020.00409. eCollection 2020.
Congenital heart disease (CHD) is the most common birth defect globally and coarctation of the aorta (CoA) is one of the commoner CHD conditions, affecting around 1/1800 live births. CoA is considered a CHD of critical severity. Unfortunately, the prognosis for a child born in a low and lower-middle income country (LLMICs) with CoA is far worse than in a high-income country. Reduced diagnostic and interventional capacities of specialists in these regions lead to delayed diagnosis and treatment, which in turn lead to more cases presenting at an advanced stage. Computational fluid dynamics (CFD) is an important tool in this context since it can provide additional diagnostic data in the form of hemodynamic parameters. It also provides an framework, both to test potential procedures and to assess the risk of further complications arising post-repair. Although this concept is already in practice in high income countries, the clinical infrastructure in LLMICs can be sparse, and access to advanced imaging modalities such as phase contrast magnetic resonance imaging (PC-MRI) is limited, if not impossible. In this study, a pipeline was developed in conjunction with clinicians at the Red Cross War Memorial Children's Hospital, Cape Town and was applied to perform a patient-specific CFD study of CoA. The pipeline uses data acquired from CT angiography and Doppler transthoracic echocardiography (both much more clinically available than MRI in LLMICs), while segmentation is conducted via SimVascular and simulation is realized using OpenFOAM. The reduction in cost through use of open-source software and the use of broadly available imaging modalities makes the methodology clinically feasible and repeatable within resource-constrained environments. The project identifies the key role of Doppler echocardiography, despite its disadvantages, as an intrinsic component of the pipeline if it is to be used routinely in LLMICs.
先天性心脏病（CHD）是全球最常见的出生缺陷，主动脉缩窄（CoA）是较常见的先天性心脏病之一，影响约1/1800的活产婴儿。CoA被认为是一种严重的先天性心脏病。不幸的是，低收入和中低收入国家（LLMICs）出生的患有CoA的儿童的预后比高收入国家要差得多。这些地区专科医生的诊断和介入能力下降导致诊断和治疗延迟，进而导致更多病例在晚期出现。在这种情况下，计算流体动力学（CFD）是一种重要工具，因为它可以以血流动力学参数的形式提供额外的诊断数据。它还提供了一个框架，用于测试潜在的手术方法并评估修复后出现进一步并发症的风险。尽管这一概念在高收入国家已经在实践中应用，但LLMICs的临床基础设施可能很薄弱，即使不是无法获得，获得相衬磁共振成像（PC-MRI）等先进成像方式的机会也有限。在本研究中，与开普敦红十字战争纪念儿童医院的临床医生合作开发了一个流程，并将其应用于对CoA进行患者特异性CFD研究。该流程使用从CT血管造影和经胸多普勒超声心动图获取的数据（在LLMICs中，这两种检查在临床上比MRI更常用），同时通过SimVascular进行分割，并使用OpenFOAM进行模拟。通过使用开源软件和广泛可用的成像方式降低成本，使得该方法在资源有限的环境中具有临床可行性和可重复性。该项目确定了多普勒超声心动图的关键作用，尽管它有缺点，但如果要在LLMICs中常规使用，它是该流程的一个固有组成部分。
