This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Sundareswaran, K. S. Articles by Yoganathan, A. P. PubMed Articles by Sundareswaran, K. S. Articles by Yoganathan, A. P.

Correction of Pulmonary Arteriovenous Malformation Using Image-Based Surgical Planning

Kartik S. Sundareswaran, MS^_*, Diane de Zélicourt, MS^_*, Shiva Sharma, MD, Kirk R. Kanter, MD, Thomas L. Spray, MD, Jarek Rossignac, PhD^¶, Fotis Sotiropoulos, PhD^#, Mark A. Fogel, MD^||, Ajit P. Yoganathan, PhD^_*,_*

^_* Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
Pediatric Cardiology Services, Atlanta, Georgia
Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^|| Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^¶ College of Computing, Georgia Institute of Technology, Atlanta, Georgia
^# Department of Civil Engineering, University of Minnesota, Minneapolis, Minnesota

^_* Reprint requests and correspondence: Dr. Ajit P. Yoganathan, Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, Georgia 30332-0535 (Email: ajit.yoganathan{at}bme.gatech.edu).

The objectives of this study were to develop an image-based surgical planning framework that 1) allows for in-depth analysis of pre-operative hemodynamics by the use of cardiac magnetic resonance and 2) enables surgeons to determine the optimum surgical scenarios before the operation. This framework is tailored for applications in which post-operative hemodynamics are important. In particular, it is exemplified here for a Fontan patient with severe left pulmonary arteriovenous malformations due to abnormal hepatic flow distribution to the lungs. Patients first undergo cardiac magnetic resonance for 3-dimensional anatomy and flow reconstruction. After analysis of the pre-operative flow fields, the 3-dimensional anatomy is imported into an interactive surgical planning interface for the surgeon to virtually perform multiple surgical scenarios. Associated hemodynamics are predicted by the use of a fully validated computational fluid dynamic solver. Finally, efficiency metrics (e.g., pressure decrease and hepatic flow distribution) are weighted against surgical feasibility to determine the optimal surgical option.

Key Words: Fontan • single ventricle congenital heart defects • phase-contrast cardiac magnetic resonance • computational fluid dynamics

Abbreviations and Acronyms   3D = 3-dimensional   CFD = computational fluid dynamics   CMR = cardiac magnetic resonance   HFD = hepatic flow distribution   IVC = inferior vena cava   LPA = left pulmonary artery   PAVMS = pulmonary arteriovenous malformations   PC CMR = phase-contrast cardiac magnetic resonance   RPA = right pulmonary artery   TCPC = total cavopulmonary connection