Optimization of surgical ventricular restoration by in-silico simulations

Abstract

Objective: A hypothesis on left ventricular aneurysms states that there is better preservation of contractile myocardium when the aneurysm geometry is rectangular as opposed to circular. Pre-surgical planning of surgical ventricular restoration was performed on the basis of this hypothesis.

Methods: The intraventricular patch used to exclude scarred or aneurysmal myocardium remains akinetic, hence it was used to define aneurysm geometry as circular or rectangular. Hausdorff distance analysis was carried out by mathematical computational methods on the baseline cardiac magnetic resonance images of 5 patients.

Results: The mean Hausdorff distance for the full range of frequencies was significantly greater after endoventricular linear patch plasty (0.474 ± 0.190 vs. 0.722 ± 0.221 mm, p = 0.047), whereas after endoventricular circular patch plasty, the difference was not significant (0.474 ± 0.190 vs. 0.594 ± 0.193, p = 0.175). The mean Hausdorff distance <0.5 mm was also significantly greater after endoventricular linear patch plasty than after endoventricular circular patch plasty: 0.258 ± 0.03 mm at baseline vs. 0.40 ± 0.16 mm after linear patch plasty (p = 0.039) and 0.258 ± 0.03 vs. 0.32 ± 0.10 mm (p = 0.130) after circular patch plasty.

Conclusions: In-silico technology using the Hausdorff distance enables pre-surgical planning and optimization of the technique for surgical ventricular restoration.

Keywords: Heart aneurysm; cardiovascular; heart ventricles; models; myocardial infarction; prostheses and implants; ventricular remodeling.