Biomechanical Model to Aid Surgical Planning in Complex Congenital Heart Diseases

Abstract

In the patients with congenitally corrected transposition of great arteries (ccTGA) it is important to evaluate the function of the left ventricle (LV) prior to performing a complex surgery establishing normal anatomical connection of LV, RV with systemic, pulmonary circulation, respectively. Current clinical techniques have proven inadequate to promptly assess the LV functionality. We propose using a biomechanical model to (1) estimate the mechanical properties of the LV at baseline, and (2) predict the functional adaptation of the LV to the repair through in silico modeling of surgery. The catheterization and cardiac magnetic resonance imaging data of two patients with ccTGA were used to create patient-specific models of LV – $\mathcal {M}^{\textrm{LV}}_{\textrm{baseline}}$. For an in silico repair, the model $\mathcal {M}^{\textrm{LV}}_{\textrm{baseline}}$ was used while imposing the increased afterload conditions as predicted by the model of systemic circulation. Our results showed that LV contractility at the baseline vs. predicted repaired state was 93 kPa vs. 143 kPa and 136 kPa vs. 145 kPa for Patients 1 and 2, respectively. Therefore, the LV of Patient 1 would require a 54$\%$ augmentation in LV contractility if the surgery was to be successful. In contrary, the model suggests that the LV of Patient 2 is already at a contractile state adequate to sustain its function after the surgery. This work demonstrates that biomechanical modeling is a promising tool to test various hemodynamic conditions in silico. Such predictions have a potential to provide additional insights into procedural success in this population.