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Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study

Sanjay Pant Orcid Logo, Aleksander Sizarov, Angela Knepper, Gaëtan Gossard, Alberto Noferi, Younes Boudjemline, Irene Vignon-Clementel

Biomechanics and Modeling in Mechanobiology, Volume: 21, Issue: 2, Pages: 471 - 511

Swansea University Authors: Sanjay Pant Orcid Logo, Angela Knepper

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DOI (Published version): 10.1007/s10237-021-01545-2

Abstract

Potts shunt (PS) was suggested as palliation for patients with suprasystemic pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. PS, however, can result in poorly understood mortality. Here, a patient-specic geometrical multiscale model of PAH physiology and PS is developed for...

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Published in: Biomechanics and Modeling in Mechanobiology
ISSN: 1617-7959 1617-7940
Published: Springer Science and Business Media LLC 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa58939
first_indexed 2021-12-07T09:48:20Z
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PS, however, can result in poorly understood mortality. Here, a patient-specic geometrical multiscale model of PAH physiology and PS is developed for a paediatric PAH patient with stent-based PS. In the model, 7.6mm-diameter PS produces near-equalisation of the aortic and PA pressures and Qp=Qs (oxygenated vs deoxygenated blood flow) ratio of 0.72 associated with a 16% decrease of left ventricular (LV) output and 18% increase of RV output. The flow from LV to aortic arch branches increases by 16%, while LV contribution to the lower body flow decreases by 29%. Total flow in the descending aorta (DAo) increases by 18% due to RV contribution through the PS with flow into the distal PA branches decreasing. PS induces 18%increase of RV work due to its larger stroke volume pumped against lower afterload. Nonetheless, larger RV work does not lead to increased RV end-diastolic volume. Three-dimensional flow assessment demonstrates the PS jet impinging with a high velocity and wall shear stress on the opposite DAo wall with the most of the shunt flow being diverted to the DAo. Increasing the PS diameter from 5mm up to 10mm results in a nearly linear increase in post-operative shunt flow and a nearly linear decrease in shunt pressure-drop. In conclusion, this model reasonably represents patient-specic haemodynamics pre- and post-creation of the PS, providing insights into physiology ofthis complex condition, and presents a predictive tool that could be useful for clinical decision-making regarding suitability for PS in PAH patients with drug-resistant suprasystemic PAH.</abstract><type>Journal Article</type><journal>Biomechanics and Modeling in Mechanobiology</journal><volume>21</volume><journalNumber>2</journalNumber><paginationStart>471</paginationStart><paginationEnd>511</paginationEnd><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1617-7959</issnPrint><issnElectronic>1617-7940</issnElectronic><keywords>Pulmonary artery hypertension, Potts shunt, lumped parameter model, multiscale model, computa-tional haemodynamics</keywords><publishedDay>1</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-04-01</publishedDate><doi>10.1007/s10237-021-01545-2</doi><url/><notes/><college>COLLEGE NANME</college><department>Aerospace, Civil, Electrical, and Mechanical Engineering</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>ACEM</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>Open Access funding enabled and organized by Projekt DEAL. 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spelling 2022-10-31T19:17:48.1253689 v2 58939 2021-12-07 Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study 43b388e955511a9d1b86b863c2018a9f 0000-0002-2081-308X Sanjay Pant Sanjay Pant true false 216f299f43b63efda7a79bf280b37c66 Angela Knepper Angela Knepper true false 2021-12-07 ACEM Potts shunt (PS) was suggested as palliation for patients with suprasystemic pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. PS, however, can result in poorly understood mortality. Here, a patient-specic geometrical multiscale model of PAH physiology and PS is developed for a paediatric PAH patient with stent-based PS. In the model, 7.6mm-diameter PS produces near-equalisation of the aortic and PA pressures and Qp=Qs (oxygenated vs deoxygenated blood flow) ratio of 0.72 associated with a 16% decrease of left ventricular (LV) output and 18% increase of RV output. The flow from LV to aortic arch branches increases by 16%, while LV contribution to the lower body flow decreases by 29%. Total flow in the descending aorta (DAo) increases by 18% due to RV contribution through the PS with flow into the distal PA branches decreasing. PS induces 18%increase of RV work due to its larger stroke volume pumped against lower afterload. Nonetheless, larger RV work does not lead to increased RV end-diastolic volume. Three-dimensional flow assessment demonstrates the PS jet impinging with a high velocity and wall shear stress on the opposite DAo wall with the most of the shunt flow being diverted to the DAo. Increasing the PS diameter from 5mm up to 10mm results in a nearly linear increase in post-operative shunt flow and a nearly linear decrease in shunt pressure-drop. In conclusion, this model reasonably represents patient-specic haemodynamics pre- and post-creation of the PS, providing insights into physiology ofthis complex condition, and presents a predictive tool that could be useful for clinical decision-making regarding suitability for PS in PAH patients with drug-resistant suprasystemic PAH. Journal Article Biomechanics and Modeling in Mechanobiology 21 2 471 511 Springer Science and Business Media LLC 1617-7959 1617-7940 Pulmonary artery hypertension, Potts shunt, lumped parameter model, multiscale model, computa-tional haemodynamics 1 4 2022 2022-04-01 10.1007/s10237-021-01545-2 COLLEGE NANME Aerospace, Civil, Electrical, and Mechanical Engineering COLLEGE CODE ACEM Swansea University SU Library paid the OA fee (TA Institutional Deal) Open Access funding enabled and organized by Projekt DEAL. European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Grant agreement No. 864313). This work is supported by the EPSRC Grant Number EP/R010811/1. 2022-10-31T19:17:48.1253689 2021-12-07T09:42:19.1202431 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Mechanical Engineering Sanjay Pant 0000-0002-2081-308X 1 Aleksander Sizarov 2 Angela Knepper 3 Gaëtan Gossard 4 Alberto Noferi 5 Younes Boudjemline 6 Irene Vignon-Clementel 7 58939__22317__3cffcf189f264f128f75066adbcc650c.pdf 58939.pdf 2022-02-07T16:29:51.0470731 Output 8276409 application/pdf Version of Record true © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License true eng http://creativecommons.org/licenses/by/4.0/
title Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
spellingShingle Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
Sanjay Pant
Angela Knepper
title_short Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
title_full Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
title_fullStr Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
title_full_unstemmed Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
title_sort Multiscale modelling of Potts shunt as a potential palliative treatment for suprasystemic idiopathic pulmonary artery hypertension: a paediatric case study
author_id_str_mv 43b388e955511a9d1b86b863c2018a9f
216f299f43b63efda7a79bf280b37c66
author_id_fullname_str_mv 43b388e955511a9d1b86b863c2018a9f_***_Sanjay Pant
216f299f43b63efda7a79bf280b37c66_***_Angela Knepper
author Sanjay Pant
Angela Knepper
author2 Sanjay Pant
Aleksander Sizarov
Angela Knepper
Gaëtan Gossard
Alberto Noferi
Younes Boudjemline
Irene Vignon-Clementel
format Journal article
container_title Biomechanics and Modeling in Mechanobiology
container_volume 21
container_issue 2
container_start_page 471
publishDate 2022
institution Swansea University
issn 1617-7959
1617-7940
doi_str_mv 10.1007/s10237-021-01545-2
publisher Springer Science and Business Media LLC
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 Potts shunt (PS) was suggested as palliation for patients with suprasystemic pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. PS, however, can result in poorly understood mortality. Here, a patient-specic geometrical multiscale model of PAH physiology and PS is developed for a paediatric PAH patient with stent-based PS. In the model, 7.6mm-diameter PS produces near-equalisation of the aortic and PA pressures and Qp=Qs (oxygenated vs deoxygenated blood flow) ratio of 0.72 associated with a 16% decrease of left ventricular (LV) output and 18% increase of RV output. The flow from LV to aortic arch branches increases by 16%, while LV contribution to the lower body flow decreases by 29%. Total flow in the descending aorta (DAo) increases by 18% due to RV contribution through the PS with flow into the distal PA branches decreasing. PS induces 18%increase of RV work due to its larger stroke volume pumped against lower afterload. Nonetheless, larger RV work does not lead to increased RV end-diastolic volume. Three-dimensional flow assessment demonstrates the PS jet impinging with a high velocity and wall shear stress on the opposite DAo wall with the most of the shunt flow being diverted to the DAo. Increasing the PS diameter from 5mm up to 10mm results in a nearly linear increase in post-operative shunt flow and a nearly linear decrease in shunt pressure-drop. In conclusion, this model reasonably represents patient-specic haemodynamics pre- and post-creation of the PS, providing insights into physiology ofthis complex condition, and presents a predictive tool that could be useful for clinical decision-making regarding suitability for PS in PAH patients with drug-resistant suprasystemic PAH.
published_date 2022-04-01T05:12:04Z
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