Biomechanical modeling combined with pressure-volume loop analysis to aid surgical planning in patients with complex congenital heart disease

Abstract

Patients with congenitally corrected transposition of the great arteries (ccTGA) can be treated with a double switch operation (DSO) to restore the normal anatomical connection of the left ventricle (LV) to the systemic circulation and the right ventricle (RV) to the pulmonary circulation. The subpulmonary LV progressively deconditions over time due to its connection to the low pressure pulmonary circulation and needs to be retrained using a surgical pulmonary artery band (PAB) for 6–12 months prior to the DSO. The subsequent clinical follow-up, consisting of invasive cardiac pressure and non-invasive imaging data, evaluates LV preparedness for the DSO. Evaluation using standard clinical techniques has led to unacceptable LV failure rates of ∼15 % after DSO. We propose a computational modeling framework to (1) reconstruct LV and RV pressure-volume (PV) loops from non-simultaneously acquired imaging and pressure data and gather model-derived mechanical indicators of ventricular function; and (2) perform in silico DSO to predict the functional response of the LV when connected to the high-pressure systemic circulation.