Model-based indices of early-stage cardiovascular failure and its therapeutic management in Fontan patients

Bram Ruijsink (1) , Konrad Zugaj (1) , Kuberan Pushparajah (2, 1) , Radomir Chabiniok (3, 4, 1)

1 King‘s College London
2 Imaging Sciences and Biomedical Engineering Division [London]
3 M3DISIM - Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine
4 LMS - Laboratoire de mécanique des solides

Investigating the causes of failure of Fontan circulation in individual patients remains challenging despite detailed combined inva-sive cardiac catheterisation and magnetic resonance (XMR) exams at rest and during stress. In this work, we use a biomechanical model of the heart and Fontan circulation with the components of systemic and pulmonary beds to augment the diagnostic assessment of the patients undergoing the XMR stress exam. We apply our model in 3 Fontan patients and one biventricular "control" case. In all subjects, we obtained important biophysical factors of cardiovascular physiology-contractil-ity, contractile reserve and changes in systemic and pulmonary vascular resistance-which contribute to explaining the mechanism of failure in individual patients. Finally, we used the patient-specific model of one Fontan patient to investigate the impact of changes in pulmonary vas-cular resistance, aiming at in silico testing of pulmonary vasodilation treatments.

Mots clés: Pulmonary vascular resistance; Heart failure; Fontan circulation; Pulmonary vasodilation therapy; Dobutamine stress

Domaines: Imagerie; Cardiologie et système cardiovasculaire

Bram Ruijsink, Konrad Zugaj, Kuberan Pushparajah, Radomir Chabiniok. Model-based indices of early-stage cardiovascular failure and its therapeutic management in Fontan patients. FIMH 2019 - 10th Functional Imaging and Modeling of Heart, Jun 2019, Bordeaux, France. pp.379-387. ⟨hal-02186819⟩