Medical Image-Based Hemodynamic Analyses in a Study of the Pulmonary Artery in Children With Pulmonary Hypertension Related to Congenital Heart Disease

Liping Wang; Jinlong Liu; Yumin Zhong; Mingjie Zhang; Jiwen Xiong; Juanya Shen; Zhirong Tong; Zhuoming Xu

doi:10.3389/fped.2020.521936

Medical Image-Based Hemodynamic Analyses in a Study of the Pulmonary Artery in Children With Pulmonary Hypertension Related to Congenital Heart Disease

Front Pediatr. 2020 Dec 2:8:521936. doi: 10.3389/fped.2020.521936. eCollection 2020.

Authors

Liping Wang¹, Jinlong Liu^{1

2

3}, Yumin Zhong⁴, Mingjie Zhang¹, Jiwen Xiong¹, Juanya Shen^{1

2

3}, Zhirong Tong^{1

2

3}, Zhuoming Xu¹

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Pediatric Translational Medicine Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Objective: Pulmonary hypertension related to congenital heart disease (PH-CHD) is a devastating disease caused by hemodynamic disorders. Previous hemodynamic research in PH-CHD mainly focused on wall shear stress (WSS). However, energy loss (EL) is a vital parameter in evaluation of hemodynamic status. We investigated if EL of the pulmonary artery (PA) is a potential biomechanical marker for comprehensive assessment of PH-CHD. Materials and Methods: Ten PH-CHD patients and 10 age-matched controls were enrolled. Subject-specific 3-D PA models were reconstructed based on computed tomography. Transient flow, WSS, and EL in the PA were calculated using non-invasive computational fluid dynamics. The relationship between body surface area (BSA)-normalized EL ( $\dot{E}$ ) and PA morphology and PA flow were analyzed. Results: Morphologic analysis indicated that the BSA-normalized main PA (MPA) diameter (D_MPAnorm), MPA/aorta diameter ratio (D_MPA/D_AO), and MPA/(left PA + right PA) [D_MPA/D_(LPA+RPA)] diameter ratio were significantly larger in PH-CHD patients. Hemodynamic results showed that the velocity of the PA branches was higher in PH-CHD patients, in whom PA flow rate usually increased. WSS in the MPA was lower and $\dot{E}$ was higher in PH-CHD patients. $\dot{E}$ was positively correlated with D_MPAnorm, D_MPA/D_AO, and D_MPA/D_(LPA+RPA) ratios and the flow rate in the PA. $\dot{E}$ was a sensitive index for the diagnosis of PH-CHD. Conclusion: $\dot{E}$ is a potential biomechanical marker for PH-CHD assessment. This hemodynamic parameter may lead to new directions for revealing the potential pathophysiologic mechanism of PH-CHD.

Keywords: computational fluid dynamics; congenital heart disease; energy loss; pulmonary hypertension; wall shear stress.