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A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients

Sanjay Pant Orcid Logo, Chiara Corsini, Catriona Baker, Tain-Yen Hsia, Giancarlo Pennati, Irene E. Vignon-Clementel

IEEE Transactions on Biomedical Engineering, Volume: 65, Issue: 11, Pages: 2450 - 2458

Swansea University Author: Sanjay Pant Orcid Logo

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DOI (Published version): 10.1109/tbme.2018.2797999

Abstract

Goal: This manuscript evaluates atrioventricular valve regurgitation (AVVR) in babies born with an already very challenging heart condition, i.e. with single ventricle physiology. Although the second surgery that single ventricle patients undergo is thought to decrease AVVR, there is much controvers...

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Published in: IEEE Transactions on Biomedical Engineering
ISSN: 0018-9294 1558-2531
Published: 2018
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URI: https://cronfa.swan.ac.uk/Record/cronfa38236
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spelling 2023-02-08T17:19:26.3752639 v2 38236 2018-01-22 A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients 43b388e955511a9d1b86b863c2018a9f 0000-0002-2081-308X Sanjay Pant Sanjay Pant true false 2018-01-22 MECH Goal: This manuscript evaluates atrioventricular valve regurgitation (AVVR) in babies born with an already very challenging heart condition, i.e. with single ventricle physiology. Although the second surgery that single ventricle patients undergo is thought to decrease AVVR, there is much controversy in the clinical literature about AVVR treatment. Methods: The effect of atrioventricular valve regurgitation (AVVR) on Stage 1 haemodynamics and resulting acute changes from conversion to Stage 2 circulation in single ventricle patients are analysed through lumped parameter models. Several degrees of AVVR severity are analysed, for two types of valve regurgitation: incomplete leaflet closure and valve prolapse. Results: The models show that increasing AVVR in Stage 1 induces the following effects: i) higher stroke volume and associated decrease in ventricular end-systolic volume; ii) increase in atrial volumes with V-loop enlargement in pressure-volume curves; iii) pulmonary venous hypertension. The Stage 2 surgery results in volume unloading of the ventricle thereby driving a decrease in AVVR. However, this effect is offset by an increase in ventricular pressures resulting in a net increase in regurgitation fraction (RF) of approximately 0.1 (for example, in severe AVVR, the pre-operative RF increases from ~60% to ~70% post-operatively). Moreover, despite some improvements to sarcomere function early after Stage 2 surgery, it may deteriorate in cases of severe AVVR. Conclusion: In patients with moderate to severe AVVR, restoration of atrioventricular valve competence prior to, or at the time of, Stage 2 surgery would likely lead to improved haemodynamics and clinical outcome as the models suggest that uncorrected AVVR can worsen across Stage 2 surgery. This was found to be independent of the AVVR degree and mechanisms. Journal Article IEEE Transactions on Biomedical Engineering 65 11 2450 2458 0018-9294 1558-2531 1 11 2018 2018-11-01 10.1109/tbme.2018.2797999 COLLEGE NANME Mechanical Engineering COLLEGE CODE MECH Swansea University 2023-02-08T17:19:26.3752639 2018-01-22T10:49:55.3851382 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Mechanical Engineering Sanjay Pant 0000-0002-2081-308X 1 Chiara Corsini 2 Catriona Baker 3 Tain-Yen Hsia 4 Giancarlo Pennati 5 Irene E. Vignon-Clementel 6 38236__7812__5fd0e1055af84f7381e585584ac47a33.pdf pant2018(2).pdf 2018-01-23T11:47:34.6530000 Output 414318 application/pdf Accepted Manuscript true 2018-01-23T00:00:00.0000000 true eng
title A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
spellingShingle A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
Sanjay Pant
title_short A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
title_full A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
title_fullStr A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
title_full_unstemmed A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
title_sort A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients
author_id_str_mv 43b388e955511a9d1b86b863c2018a9f
author_id_fullname_str_mv 43b388e955511a9d1b86b863c2018a9f_***_Sanjay Pant
author Sanjay Pant
author2 Sanjay Pant
Chiara Corsini
Catriona Baker
Tain-Yen Hsia
Giancarlo Pennati
Irene E. Vignon-Clementel
format Journal article
container_title IEEE Transactions on Biomedical Engineering
container_volume 65
container_issue 11
container_start_page 2450
publishDate 2018
institution Swansea University
issn 0018-9294
1558-2531
doi_str_mv 10.1109/tbme.2018.2797999
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Mechanical Engineering{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Mechanical Engineering
document_store_str 1
active_str 0
description Goal: This manuscript evaluates atrioventricular valve regurgitation (AVVR) in babies born with an already very challenging heart condition, i.e. with single ventricle physiology. Although the second surgery that single ventricle patients undergo is thought to decrease AVVR, there is much controversy in the clinical literature about AVVR treatment. Methods: The effect of atrioventricular valve regurgitation (AVVR) on Stage 1 haemodynamics and resulting acute changes from conversion to Stage 2 circulation in single ventricle patients are analysed through lumped parameter models. Several degrees of AVVR severity are analysed, for two types of valve regurgitation: incomplete leaflet closure and valve prolapse. Results: The models show that increasing AVVR in Stage 1 induces the following effects: i) higher stroke volume and associated decrease in ventricular end-systolic volume; ii) increase in atrial volumes with V-loop enlargement in pressure-volume curves; iii) pulmonary venous hypertension. The Stage 2 surgery results in volume unloading of the ventricle thereby driving a decrease in AVVR. However, this effect is offset by an increase in ventricular pressures resulting in a net increase in regurgitation fraction (RF) of approximately 0.1 (for example, in severe AVVR, the pre-operative RF increases from ~60% to ~70% post-operatively). Moreover, despite some improvements to sarcomere function early after Stage 2 surgery, it may deteriorate in cases of severe AVVR. Conclusion: In patients with moderate to severe AVVR, restoration of atrioventricular valve competence prior to, or at the time of, Stage 2 surgery would likely lead to improved haemodynamics and clinical outcome as the models suggest that uncorrected AVVR can worsen across Stage 2 surgery. This was found to be independent of the AVVR degree and mechanisms.
published_date 2018-11-01T03:48:21Z
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