Mata Quiñonez Luis René, Cheng Leon, Marini Andrew, Joshi Srujana, Karnik Shweta, Dasi Lakshmi P, Bauser-Heaton Holly D
Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
Children's Healthcare of Atlanta (CHOA), Atlanta, GA, USA.
Pediatr Cardiol. 2025 Jun 12. doi: 10.1007/s00246-025-03909-2.
Patent Ductus Arteriosus (PDA) stenting is a minimally invasive procedure used to maintain pulmonary blood flow in patients with ductal-dependent cyanotic congenital heart disease. However, because of its high complexity, anatomic variability, and frequent need for reinterventions, improved pre-procedural planning is necessary. In this retrospective study, we developed a physics-based computational framework to simulate PDA stenting using patient-specific data. We applied this method to two patients from a single center: Patient 1 had a type I PDA with a single stent implantation, while Patient 2 had a type II PDA and underwent placement of two stents. We segmented pre-procedural CT scans, modeled guidewire tracking and the bent pre-deployment configurations of the angioplasty balloon and stent, and simulated stent deployment within patient-specific PDA anatomies. Quantitative validation against post-procedural segmentations showed an average distance error of less than 1 mm, demonstrating high accuracy in replicating real-world outcomes. The pipeline effectively captured key mechanical interactions among the stent, balloon, guidewire, and PDA, highlighting phenomena, such as PDA straightening, changes in diameter and orientation, and the displacement of surrounding vasculature during deployment. Future work will integrate semiautomatic tools to predict the best-suited procedural parameters, including stent length, diameter, positioning, and vascular access and predicted risk of complications. Ultimately, our goal is to develop a predictive platform that enhances clinical decision-making, optimizes procedural efficiency, and reduces complications and reinterventions, thereby improving outcomes for pediatric patients undergoing PDA stenting.
动脉导管未闭（PDA）支架植入术是一种微创手术，用于维持依赖导管的青紫型先天性心脏病患者的肺血流。然而，由于其高度复杂性、解剖变异性以及频繁需要再次干预，改进术前规划是必要的。在这项回顾性研究中，我们开发了一个基于物理的计算框架，使用患者特异性数据模拟PDA支架植入术。我们将这种方法应用于来自单一中心的两名患者：患者1为I型PDA，植入单个支架，而患者2为II型PDA，植入两个支架。我们对术前CT扫描进行分割，对导丝跟踪以及血管成形术球囊和支架的预部署弯曲配置进行建模，并在患者特异性PDA解剖结构内模拟支架部署。与术后分割的定量验证显示平均距离误差小于1毫米，表明在复制实际结果方面具有高精度。该流程有效地捕捉了支架、球囊、导丝和PDA之间的关键机械相互作用，突出了诸如PDA伸直、直径和方向变化以及部署过程中周围血管系统位移等现象。未来的工作将整合半自动工具，以预测最适合的手术参数，包括支架长度、直径、定位、血管通路以及预测的并发症风险。最终，我们的目标是开发一个预测平台，以增强临床决策、优化手术效率、减少并发症和再次干预，从而改善接受PDA支架植入术的儿科患者的治疗效果。
