Application of computational simulations for percutaneous pulmonary valve implantation: (Percutaneous pulmonary valve computer analysis)

Abstract

Percutaneous pulmonary valve implantation is an innovative, successful alternative to open-heart surgery for the treatment of pulmonary valve dysfunction. However, this minimally-invasive procedure still presents some limitations: stent fracture and availability to a limited group of patients with very specific anatomy. Computational simulations, together with advanced cardiovascular imaging techniques can be used to help understand these limitations in order to improve the success of percutaneous pulmonary valve implantation and ultimately to broaden the range of patients suitable for this procedure. In this review, we show how three-dimensional image reconstruction of patients' right ventricular outflow tract, derived from magnetic resonance data, can be used to assess implantation site anatomy, and define a morphological classification to analyse the criteria for subject selection and to outline the design and mechanical requirements for the next generation of percutaneous pulmonary valve devices. We also show how the finite element method can be used to virtually model different stents (current stent and new possible stent designs) to evaluate their mechanical performance, risk of fracture, and optimise the design of the next generation device. Finite element inflation of these stents into selected right ventricular outflow tract models allowed for the evaluation of the in-situ anchoring and performance of the stents in each individual patient specific implantation site. The engineering methodologies reviewed – patient-specific three-dimensional imaging elaboration and finite element modelling – can be used to characterize right ventricular outflow tract morphology, outline the requirements for the next generation percutaneous pulmonary valve device and enable better selection of patients for this procedure, thus enhancing their safety. Such methodologies have the potential to aid and accelerate the design of future stents for percutaneous pulmonary valve implantation, so that a much larger patient population requiring pulmonary valve dysfunction treatment might benefit from this minimally-invasive intervention.