Computational simulation of postoperative pulmonary flow distribution in Alagille patients with peripheral pulmonary artery stenosis

Congenit Heart Dis. 2018 Mar;13(2):241-250. doi: 10.1111/chd.12556. Epub 2017 Dec 1.


Background: Up to 90% of individuals with Alagille syndrome have congenital heart diseases. Peripheral pulmonary artery stenosis (PPS), resulting in right ventricular hypertension and pulmonary flow disparity, is one of the most common abnormalities, yet the hemodynamic effects are ill-defined, and optimal patient management and treatment strategies are not well established. The purpose of this pilot study is to use recently refined computational simulation in the setting of multiple surgical strategies, to examine the influence of pulmonary artery reconstruction on hemodynamics in this population.

Materials and methods: Based on computed tomography angiography and cardiac catheterization data, preoperative pulmonary artery models were constructed for 4 patients with Alagille syndrome with PPS (all male, age range: 0.6-2.9 years), and flow simulations with deformable walls were performed. Surgeon directed virtual surgery, mimicking the surgical procedure, was then performed to derive postoperative models. Postoperative simulation-derived hemodynamics and blood flow distribution were then compared with the clinical results.

Results: Simulations confirmed substantial resistance, resulting from preoperative severe ostial stenoses, and the use of newly developed adaptive outflow boundary conditions led to excellent agreement with in vivo measurements. Relief of PPS decreased pulmonary artery pressures and improved pulmonary flow distribution both in vivo and in silico with good correlation.

Conclusions: Using adaptive outflow boundary conditions, computational simulations can estimate postoperative overall pulmonary flow distribution in patients with Alagille syndrome after pulmonary artery reconstruction. Obstruction relief along with pulmonary artery vasodilation determines postoperative pulmonary flow distribution and newer methods can incorporate these physiologic changes. Evolving blood flow simulations may be useful in surgical or transcatheter planning and in understanding the complex interplay among various obstructions in patients with peripheral pulmonary stenosis.

Keywords: Alagille syndrome (ALGS); blood flow simulation; peripheral pulmonary artery stenosis (PPS); pulmonary adaptation and remodeling; pulmonary flow; virtual surgery.

MeSH terms

  • Abnormalities, Multiple
  • Alagille Syndrome / diagnosis
  • Alagille Syndrome / physiopathology
  • Alagille Syndrome / surgery*
  • Blood Flow Velocity / physiology*
  • Cardiac Catheterization
  • Cardiac Surgical Procedures*
  • Child, Preschool
  • Computed Tomography Angiography
  • Computer Simulation*
  • Humans
  • Image Processing, Computer-Assisted
  • Infant
  • Male
  • Pilot Projects
  • Postoperative Period
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / physiopathology*
  • Pulmonary Circulation / physiology*
  • Stenosis, Pulmonary Artery / diagnosis
  • Stenosis, Pulmonary Artery / physiopathology
  • Stenosis, Pulmonary Artery / surgery*
  • Vascular Resistance / physiology