Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study.
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| Title: | Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study. |
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| Authors: | Pant, Sanjay1 (AUTHOR) Sanjay.Pant@swansea.ac.uk, Sizarov, Aleksander2,3 (AUTHOR), Knepper, Angela1 (AUTHOR), Gossard, Gaëtan4 (AUTHOR), Noferi, Alberto4 (AUTHOR), Boudjemline, Younes5 (AUTHOR), Vignon-Clementel, Irene4 (AUTHOR) |
| Source: | Biomechanics & Modeling in Mechanobiology. Apr2022, Vol. 21 Issue 2, p471-511. 41p. |
| Subjects: | Pulmonary hypertension, Multiscale modeling, Potts model, Palliative treatment, Pulmonary arterial hypertension, Pulmonary artery, Left heart ventricle |
| Abstract: | Potts shunt (PS) was suggested as palliation for patients with suprasystemic pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. PS, however, can result in poorly understood mortality. Here, a patient-specific geometrical multiscale model of PAH physiology and PS is developed for a paediatric PAH patient with stent-based PS. In the model, 7.6mm-diameter PS produces near-equalisation of the aortic and PA pressures and Q p / Q s (oxygenated vs deoxygenated blood flow) ratio of 0.72 associated with a 16% decrease of left ventricular (LV) output and 18% increase of RV output. The flow from LV to aortic arch branches increases by 16%, while LV contribution to the lower body flow decreases by 29%. Total flow in the descending aorta (DAo) increases by 18% due to RV contribution through the PS with flow into the distal PA branches decreasing. PS induces 18% increase of RV work due to its larger stroke volume pumped against lower afterload. Nonetheless, larger RV work does not lead to increased RV end-diastolic volume. Three-dimensional flow assessment demonstrates the PS jet impinging with a high velocity and wall shear stress on the opposite DAo wall with the most of the shunt flow being diverted to the DAo. Increasing the PS diameter from 5mm up to 10mm results in a nearly linear increase in post-operative shunt flow and a nearly linear decrease in shunt pressure-drop. In conclusion, this model reasonably represents patient-specific haemodynamics pre- and post-creation of the PS, providing insights into physiology of this complex condition, and presents a predictive tool that could be useful for clinical decision-making regarding suitability for PS in PAH patients with drug-resistant suprasystemic PAH. [ABSTRACT FROM AUTHOR] |
| Copyright of Biomechanics & Modeling in Mechanobiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
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| Header | DbId: egs DbLabel: Engineering Source An: 155913459 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Pant%2C+Sanjay%22">Pant, Sanjay</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> Sanjay.Pant@swansea.ac.uk</i><br /><searchLink fieldCode="AR" term="%22Sizarov%2C+Aleksander%22">Sizarov, Aleksander</searchLink><relatesTo>2,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Knepper%2C+Angela%22">Knepper, Angela</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gossard%2C+Gaëtan%22">Gossard, Gaëtan</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Noferi%2C+Alberto%22">Noferi, Alberto</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Boudjemline%2C+Younes%22">Boudjemline, Younes</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vignon-Clementel%2C+Irene%22">Vignon-Clementel, Irene</searchLink><relatesTo>4</relatesTo> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Biomechanics+%26+Modeling+in+Mechanobiology%22">Biomechanics & Modeling in Mechanobiology</searchLink>. Apr2022, Vol. 21 Issue 2, p471-511. 41p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Pulmonary+hypertension%22">Pulmonary hypertension</searchLink><br /><searchLink fieldCode="DE" term="%22Multiscale+modeling%22">Multiscale modeling</searchLink><br /><searchLink fieldCode="DE" term="%22Potts+model%22">Potts model</searchLink><br /><searchLink fieldCode="DE" term="%22Palliative+treatment%22">Palliative treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Pulmonary+arterial+hypertension%22">Pulmonary arterial hypertension</searchLink><br /><searchLink fieldCode="DE" term="%22Pulmonary+artery%22">Pulmonary artery</searchLink><br /><searchLink fieldCode="DE" term="%22Left+heart+ventricle%22">Left heart ventricle</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Potts shunt (PS) was suggested as palliation for patients with suprasystemic pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. PS, however, can result in poorly understood mortality. Here, a patient-specific geometrical multiscale model of PAH physiology and PS is developed for a paediatric PAH patient with stent-based PS. In the model, 7.6mm-diameter PS produces near-equalisation of the aortic and PA pressures and Q p / Q s (oxygenated vs deoxygenated blood flow) ratio of 0.72 associated with a 16% decrease of left ventricular (LV) output and 18% increase of RV output. The flow from LV to aortic arch branches increases by 16%, while LV contribution to the lower body flow decreases by 29%. Total flow in the descending aorta (DAo) increases by 18% due to RV contribution through the PS with flow into the distal PA branches decreasing. PS induces 18% increase of RV work due to its larger stroke volume pumped against lower afterload. Nonetheless, larger RV work does not lead to increased RV end-diastolic volume. Three-dimensional flow assessment demonstrates the PS jet impinging with a high velocity and wall shear stress on the opposite DAo wall with the most of the shunt flow being diverted to the DAo. Increasing the PS diameter from 5mm up to 10mm results in a nearly linear increase in post-operative shunt flow and a nearly linear decrease in shunt pressure-drop. In conclusion, this model reasonably represents patient-specific haemodynamics pre- and post-creation of the PS, providing insights into physiology of this complex condition, and presents a predictive tool that could be useful for clinical decision-making regarding suitability for PS in PAH patients with drug-resistant suprasystemic PAH. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Biomechanics & Modeling in Mechanobiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10237-021-01545-2 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 41 StartPage: 471 Subjects: – SubjectFull: Pulmonary hypertension Type: general – SubjectFull: Multiscale modeling Type: general – SubjectFull: Potts model Type: general – SubjectFull: Palliative treatment Type: general – SubjectFull: Pulmonary arterial hypertension Type: general – SubjectFull: Pulmonary artery Type: general – SubjectFull: Left heart ventricle Type: general Titles: – TitleFull: Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Pant, Sanjay – PersonEntity: Name: NameFull: Sizarov, Aleksander – PersonEntity: Name: NameFull: Knepper, Angela – PersonEntity: Name: NameFull: Gossard, Gaëtan – PersonEntity: Name: NameFull: Noferi, Alberto – PersonEntity: Name: NameFull: Boudjemline, Younes – PersonEntity: Name: NameFull: Vignon-Clementel, Irene IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 04 Text: Apr2022 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 16177959 Numbering: – Type: volume Value: 21 – Type: issue Value: 2 Titles: – TitleFull: Biomechanics & Modeling in Mechanobiology Type: main |
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