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Computational Modeling to Support Surgical Decision Making in Single Ventricle Physiology

  • Tain-Yen Hsia
    Correspondence
    Address correspondence to: T-Y Hsia, MD, Pediatric Cardiac Surgery, Yale New Haven Children's Hospital, LCCI 301, 330 Cedar Street, New Haven, CT 06504.
    Affiliations
    Pediatric Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut
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  • Timothy Conover
    Affiliations
    Department of Mechanical Engineering, Clemson University, Clemson, South Carolina
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  • Richard Figliola
    Affiliations
    Department of Mechanical Engineering, Clemson University, Clemson, South Carolina
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  • for the Modeling of Congenital Hearts Alliance (MOCHA) Investigators
    Author Footnotes
    1 MOCHA Investigators: Andrew Taylor, Sachin Khambadkone, Silvia Schievano, and Marc de Leval (Great Ormond Street Hospital for Children, London, UK); Edward Bove, and Adam Dorfman, (University of Michigan, Ann Arbor, MI); G. Hamilton Baker and Anthony Hlavacek (Medical University of South Carolina, Charleston, SC); Francesco Migliavacca, Giancarlo Pennati, and Gabriele Dubini (Politecnico di Milano, Milan, Italy); Alison Marsden, (Stanford University, CA); Irene Vignon-Clementel (National Institute of Research in Informatics and Automation, Paris, France); Richard Figliola and John McGregor (Clemson University, Clemson, SC); Tain-Yen Hsia (Yale University, New Haven, CT)
  • Author Footnotes
    1 MOCHA Investigators: Andrew Taylor, Sachin Khambadkone, Silvia Schievano, and Marc de Leval (Great Ormond Street Hospital for Children, London, UK); Edward Bove, and Adam Dorfman, (University of Michigan, Ann Arbor, MI); G. Hamilton Baker and Anthony Hlavacek (Medical University of South Carolina, Charleston, SC); Francesco Migliavacca, Giancarlo Pennati, and Gabriele Dubini (Politecnico di Milano, Milan, Italy); Alison Marsden, (Stanford University, CA); Irene Vignon-Clementel (National Institute of Research in Informatics and Automation, Paris, France); Richard Figliola and John McGregor (Clemson University, Clemson, SC); Tain-Yen Hsia (Yale University, New Haven, CT)
      Many of the advances in congenital heart surgery were built upon lessons and insights gained from model simulations. While animal and mock-circuit models have historically been the main arena to test new operative techniques and concepts, the recognition that complex cardiovascular anatomy and circulation can be modeled mathematically ushered a new era of collaboration between surgeons and engineers. In 1996, the computational age in congenital heart surgery began when investigators in London and Milan tapped the power of the computer to simulate the Fontan procedure and introduced operative improvements. Since then, computational modeling has led to numerous contributions in congenial heart surgery as continuing sophistication and advances in numerical and imaging methods furthered the ability to refine anatomic and physiologic details. Idealized generic models have given way to precise patient-specific simulations of the 3-dimensional anatomy, reconstructed circulation, affected hemodynamics, and altered physiology. Tools to perform virtual surgery, and predict flow dynamic and circulatory results, have been developed for some of the most complex defects, such as those requiring single ventricle palliation. In today's quest for personalized medicine and precision care, computational modeling's role to assist surgical planning in complex congenital heart surgery will continue to grow and evolve. With ever closer collaboration between surgeons and engineers, and clear understanding of modeling limitations, computational simulations can be a valuable adjunct to support preoperative surgical decision making.

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