Abstract
BackgroundPatient-specific active fluid–structure interactions (FSI) model is a useful approach to non-invasively investigate the hemodynamics in the heart. However, it takes a lot of effort to obtain the proper external force boundary conditions for active models, which heavily restrained the time-sensitive clinical applications of active computational models.MethodsThe simulation results of 12 passive FSI models based on 6 patients’ pre-operative and post-operative CT images were compared with corresponding active models to investigate the differences in hemodynamics and cardiac mechanics between these models.ResultsIn comparing the passive and active models, it was found that there was no significant difference in pressure difference and shear stress on mitral valve leaflet (MVL) at the pre-SAM time point, but a significant difference was found in wall stress on the inner boundary of left ventricle (endocardium). It was also found that pressure difference on the coapted MVL and the shear stress on MVL were significantly decreased after successful surgery in both active and passive models.ConclusionOur results suggested that the passive models may provide good approximated hemodynamic results at 5% RR interval, which is crucial for analyzing the initiation of systolic anterior motion (SAM). Comparing to active models, the passive models decrease the complexity of the modeling construction and the difficulty of convergence significantly. These findings suggest that, with proper boundary conditions and sufficient clinical data, the passive computational model may be a good substitution model for the active model to perform hemodynamic analysis of the initiation of SAM.
Highlights
Patient-specific active fluid–structure interactions (FSI) model is a useful approach to non-invasively investigate the hemodynamics in the heart
It was found that there was a significant difference in wall stress between the passive and active models
Since the goal of our study was to perform hemodynamic analysis of left ventricle (LV) to investigate the mechanisms of systolic anterior motion (SAM), and the passive models provided good approximated hemodynamic simulations, the passive models may be used as a good substitution model to active models to investigate the initiation of SAM
Summary
Patient-specific active fluid–structure interactions (FSI) model is a useful approach to non-invasively investigate the hemodynamics in the heart. Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by hypertrophic myocardium and obstruction in the left ventricular outflow. Patients with this disease might suffer from severe heart failure and even sudden death. Septal myectomy is the golden standard treatment for the symptomatic patients [1, 2] This is a very challenging procedure as the extent of myectomy is very difficult to be determined. This is because that inadequate excision cannot abolish left ventricular outflow obstruction, while the excessive myectomy might produce ventricular septal defect or irregular heart rhythms, such as complete heart block. A non-invasive method for helping surgeons make the optimal design of the surgery is significantly required
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