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Blood Flow Simulations for the Design of Stented Valve Reducer in Enlarged Ventricular Outflow Tracts

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Abstract

Tetralogy of Fallot is a congenital heart disease characterized over time, after the initial repair, by the absence of a functioning pulmonary valve, which causes regurgitation, and by progressive enlargement of the right ventricle outflow tract (RVOT). Due to this pathological anatomy, available transcatheter valves are usually too small to be deployed there. To avoid surgical valve replacement, an alternative consists in implanting a reducer prior to or in combination with the valve. It has been shown in animal experiments to be promising, but with some limitations. The effect of a percutaneous pulmonary valve reducer on hemodynamics in enlarged RVOT is thus studied by computational modeling. To this aim, blood flow in the RVOT is modeled with CFD coupled to a simplified valve model and 0D downstream models. Simulations are performed in an image-based geometry and boundary conditions tuned to reproduce the pathological flow without the device. Different device designs are built and compared with the initial device-free state, or with the reducer alone. Results suggest that pressure loss is higher for the reducer alone than for the full device, and that the latter successfully restores hemodynamics to a healthy state and induces a more symmetric flow in the pulmonary arteries. Moreover, pressure forces on the reducer and on the valve have the same magnitudes. Migration would occur towards the right ventricle rather than the pulmonary arteries. Results support the thesis that the reducer does not introduce clinically significant pressure gradients, as was found in animal experiments. Such study could help transfer to patients.

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Notes

  1. https://www-roc.inria.fr/gamma/gamma/ghs3d/ghs.php.

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Acknowledgments

The authors gratefully acknowledge Kristin McLeod, formerly at Asclepios project team, INRIA Sophia-Antipolis Mediterranée, France, now at Simula Research Laboratory, Oslo, for the device-free geometry reconstruction from MRI and Jean-Frédéric Gerbeau, REO project team, INRIA Paris-Rocquencourt, France, for initiating the SIRAP project. A. Caiazzo, R. Guibert, Y. Boudjemline and I. E. Vignon-Clementel declare that they have no conflict of interest. No human studies were carried out by the authors for this article. No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Weierstrass Institute for Applied Analysis and Stochastics, Mohrenstrasse 39, Berlin, 10117, Germany

    Alfonso Caiazzo

  2. Institut de Mécanique des Fluides de Toulouse, INPT, UPS, Université de Toulouse, Toulouse, France

    Romain Guibert

  3. Service de Cardiologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France

    Younes Boudjemline

  4. INRIA Paris-Rocquencourt and Sorbonne Universités UPMC Univ. Paris 6, Laboratoire J.-L. Lions, Paris, France

    Irene E. Vignon-Clementel

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  1. Alfonso Caiazzo
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  2. Romain Guibert
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  3. Younes Boudjemline
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  4. Irene E. Vignon-Clementel
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Correspondence to Alfonso Caiazzo.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Caiazzo, A., Guibert, R., Boudjemline, Y. et al. Blood Flow Simulations for the Design of Stented Valve Reducer in Enlarged Ventricular Outflow Tracts. Cardiovasc Eng Tech 6, 485–500 (2015). https://doi.org/10.1007/s13239-015-0240-z

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