Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA.
Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
Cardiovasc Eng Technol. 2021 Dec;12(6):606-617. doi: 10.1007/s13239-021-00533-y. Epub 2021 Apr 30.
Surgical planning has shown great potential for optimizing outcomes for patients affected by single ventricle (SV) malformations. Phase-contrast magnetic resonance imaging (PC-MRI) is the routine technique used for flow acquisition in the surgical planning paradigm. However, PC-MRI may suffer from possible artifacts in certain cases; furthermore, this technology may not be readily available for patients in low and lower-middle-income countries. Therefore, this study aims to investigate the effectiveness of using Doppler echocardiography (echo-Doppler) for flow acquisitions of SV surgical planning.
This study included eight patients whose blood flow data was acquired by both PC-MRI and echo-Doppler. A virtual surgery platform was used to generate two surgical options for each patient: (1) a traditional Fontan conduit and (2) a Y-graft. Computational fluid dynamics (CFD) simulations were conducted using the two flow acquisitions to assess clinically relevant hemodynamic metrics: indexed power loss (iPL) and hepatic flow distribution (HFD).
Differences exist in flow data acquired by PC-MRI and echo-Doppler, but no statistical significance was obtained. Flow fields, therefore, exhibit discrepancies between simulations using flow acquisitions by PC-MRI and echo-Doppler. In virtual surgery, the two surgical options were ranked based on these metrics. No difference was observed in the ranking of surgical options between using different flow acquisitions.
Doppler echocardiography is an adequate alternative approach to acquire flow data for SV surgical planning. This finding encourages broader usage of SV surgical planning with echo-Doppler when MRI may present artifacts or is not available, especially in low and lower-middle-income countries.
心脏外科手术规划在优化单心室（SV）畸形患者的治疗效果方面具有很大的潜力。相位对比磁共振成像（PC-MRI）是用于手术规划范式中获取血流的常规技术。然而，在某些情况下，PC-MRI 可能会出现伪影；此外，对于低收入和中下收入国家的患者来说，这项技术可能无法普及。因此，本研究旨在探讨使用多普勒超声心动图（echo-Doppler）获取 SV 手术规划血流数据的有效性。
本研究纳入了 8 名患者，他们的血流数据通过 PC-MRI 和 echo-Doppler 两种方式获取。使用虚拟手术平台为每位患者生成两种手术方案：（1）传统 Fontan 管道；（2）Y 型移植物。使用两种血流采集方法进行计算流体动力学（CFD）模拟，以评估与临床相关的血流动力学指标：指数功率损耗（iPL）和肝血流分布（HFD）。
PC-MRI 和 echo-Doppler 采集的血流数据存在差异，但无统计学意义。因此，在使用 PC-MRI 和 echo-Doppler 采集的血流进行模拟时，流场存在差异。在虚拟手术中，根据这些指标对两种手术方案进行了排名。使用不同的血流采集方法，手术方案的排名没有差异。
多普勒超声心动图是获取 SV 手术规划血流数据的一种可行替代方法。当 MRI 存在伪影或不可用时，这一发现鼓励更广泛地使用 SV 手术规划与 echo-Doppler，尤其是在低收入和中下收入国家。
