Thesis

Patient-specific mathematical modelling if the hybrid procedure in the treatment of hypoplastic left heart syndrome

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Awarding institution
  • University of Strathclyde
Date of award
  • 2014
Thesis identifier
  • T13747
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Abstract
  • Hypoplastic Left Heart Syndrome (HLHS) is a rare congenital heart disease characterised by the underdevelopment of the left sided structures of the heart, compromising systemic blood supply. The Hybrid Procedure is a palliative repair that delays cardiopulmonary bypass surgery and allows the opportunity for left ventricular growth and biventricular repair. The ductus arteriosus is stented open via catheter, which allows the right ventricle to supply the systemic circulation. In order to balance the pulmonary-systemic flow ratio, branch pulmonary arterial bands are surgically placed. Currently, banding (and stent) dimensions are based on surgical experience, intuition and limited Doppler measurements. In mathematically modelling the Hybrid Procedure, it is possible to optimise the dimensions based on haemodynamic and ventricular data. These simulated results are often difficult and invasive to measure clinically. Due to the broad spectrum of abnormalities observed in HLHS, creating patient-specific models is an area for development. Therefore a thorough investigation of routinely collected clinical data was undertaken, assessing the potential collaboration between biomedical engineering and clinical protocols. A lumped circulation model of the post-Hybrid circulation was produced and clinically validated following novel investigation. An external band diameter of 3 mm was optimal, with 3.5 mm appropriate for larger patients. A patient-specific three-dimensional geometry was constructed and virtual surgery performed for a range of band diameters for steady state analysis. Boundary conditions were determined using matching patient-specific and literature data. This model was coupled to the lumped circulation model in a multiscale model. This highlighted the conflict of definition between internal and external diameter band dimensions. It was shown that the 2 mm internal band diameter was optimal. Regarding patient-specificity, it was demonstrated that current clinical practices are not conducive to mathematical modelling with many steps required in the processing of data. The quality of the data is suboptimal and will require multidisciplinary cooperation for future improvement. Due to the incompleteness of the data sets and the inconsistent data collection, full patient-specificity and predictive modelling was not achieved.
Resource Type
DOI
Date Created
  • 2014
Former identifier
  • 1032711

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