Methods: A virtual, 3D library of clinically-defined normal hearts was compiled from reconstructed CT and MR scans. Non-invasive imaging parameters and patient characteristics were collected and subjected to backward elimination linear regression to define a model relating patient parameters to the total cardiac volume. This regression model was then used to retrospectively accept or reject an ‘ideal’ donor graft from the library for 3 patients that had undergone heart transplantation. Oversized and undersized grafts were also transplanted to qualitatively analyze virtual transplantation specificity.
Results: The backward elimination approach of the data for the 20 patients rejected the factors of BMI, BSA, sex and both end-systolic and end-diastolic left ventricular measurements from echocardiography. Height and weight were included in the linear regression model yielding an adjusted R-squared of 82.5%. Height and weight showed statistical significance with p-values of 0.005 and 0.02 respectively. The final equation for the linear regression model was TCV = -169.320+ 2.874h + 3.578w ± 73 (h=height, w=weight, TCV= total cardiac volume).
Discussion: With the current regression model, height and weight significantly correlate to total cardiac volume. This regression model and virtual normal heart library provide for the possibility of virtual transplant and size-matching for transplantation. The study and regression model is, however, limited due to a small sample size. Additionally, the lack of volumetric resolution from the MR datasets is a potentially limiting factor. Despite these limitations the virtual library has the potential to be a critical tool for clinical care that will continue to grow as normal hearts are added to the virtual library.
Flow diverting devices and stents can be used to treat cerebral aneurysms too difficult to treat with coiling or craniotomy and clipping. However, the hemodynamic effects of these devices have not been studied in depth. The objective of this study was to quantify and understand the fluid dynamic changes that occur within bifurcating aneurysms when treated with different devices and configurations. Two physical models of bifurcating cerebral aneurysms were constructed: an idealized model and a patient-specific model. The models were treated with four device configurations: a single low-porosity Pipeline embolization device (PED) and one, two, and three high-porosity Enterprise stents deployed in a telescoping fashion. Particle image velocimetry was used to measure the fluid dynamics within the aneurysms; pressure was measured within the patient-specific model. The PED resulted in the greatest reductions in fluid dynamic activity within the aneurysm for both models. However, a configuration of three telescoping stents reduced the fluid dynamic activity within the aneurysm similarly to the PED treatment. Pressure within the patient-specific aneurysm did not show significant changes among the treatment configurations; however, the pressure difference across the untreated vessel side of the model was greatest with the PED. Treatment with stents and a flow diverter led to reductions in aneurysmal fluid dynamic activity for both idealized and patient-specific models. While the PED resulted in the greatest flow reductions, telescoping high-porosity stents performed similarly and may represent a viable treatment alternative in situations where the use of a PED is not an option.