AUTHOR=Wang Liping , Liu Jinlong , Zhong Yumin , Zhang Mingjie , Xiong Jiwen , Shen Juanya , Tong Zhirong , Xu Zhuoming 

TITLE=Medical Image-Based Hemodynamic Analyses in a Study of the Pulmonary Artery in Children With Pulmonary Hypertension Related to Congenital Heart Disease

JOURNAL=Frontiers in Pediatrics

VOLUME=8

YEAR=2020

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2020.521936

DOI=10.3389/fped.2020.521936

ISSN=2296-2360

ABSTRACT=<p><bold>Objective:</bold> Pulmonary hypertension related to congenital heart disease (PH-CHD) is a devastating disease caused by hemodynamic disorders. Previous hemodynamic research in PH-CHD mainly focused on wall shear stress (WSS). However, energy loss (EL) is a vital parameter in evaluation of hemodynamic status. We investigated if EL of the pulmonary artery (PA) is a potential biomechanical marker for comprehensive assessment of PH-CHD.</p><p><bold>Materials and Methods:</bold> Ten PH-CHD patients and 10 age-matched controls were enrolled. Subject-specific 3-D PA models were reconstructed based on computed tomography. Transient flow, WSS, and EL in the PA were calculated using non-invasive computational fluid dynamics. The relationship between body surface area (BSA)-normalized EL (<inline-formula><mml:math id="M1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover class="overset"><mml:mrow><mml:mi>E</mml:mi></mml:mrow><mml:mrow><mml:mo>.</mml:mo></mml:mrow></mml:mover></mml:math></inline-formula>) and PA morphology and PA flow were analyzed.</p><p><bold>Results:</bold> Morphologic analysis indicated that the BSA-normalized main PA (MPA) diameter (D<sub>MPAnorm</sub>), MPA/aorta diameter ratio (D<sub>MPA</sub>/D<sub>AO</sub>), and MPA/(left PA + right PA) [D<sub>MPA</sub>/D<sub>(LPA+RPA)</sub>] diameter ratio were significantly larger in PH-CHD patients. Hemodynamic results showed that the velocity of the PA branches was higher in PH-CHD patients, in whom PA flow rate usually increased. WSS in the MPA was lower and <inline-formula><mml:math id="M2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover class="overset"><mml:mrow><mml:mi>E</mml:mi></mml:mrow><mml:mrow><mml:mo>.</mml:mo></mml:mrow></mml:mover></mml:math></inline-formula> was higher in PH-CHD patients. <inline-formula><mml:math id="M3" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover class="overset"><mml:mrow><mml:mi>E</mml:mi></mml:mrow><mml:mrow><mml:mo>.</mml:mo></mml:mrow></mml:mover></mml:math></inline-formula> was positively correlated with D<sub>MPAnorm</sub>, D<sub>MPA</sub>/D<sub>AO</sub>, and D<sub>MPA</sub>/D<sub>(LPA+RPA)</sub> ratios and the flow rate in the PA. <inline-formula><mml:math id="M4" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover class="overset"><mml:mrow><mml:mi>E</mml:mi></mml:mrow><mml:mrow><mml:mo>.</mml:mo></mml:mrow></mml:mover></mml:math></inline-formula> was a sensitive index for the diagnosis of PH-CHD.</p><p><bold>Conclusion:</bold><inline-formula><mml:math id="M5" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover class="overset"><mml:mrow><mml:mi>E</mml:mi></mml:mrow><mml:mrow><mml:mo>.</mml:mo></mml:mrow></mml:mover></mml:math></inline-formula> is a potential biomechanical marker for PH-CHD assessment. This hemodynamic parameter may lead to new directions for revealing the potential pathophysiologic mechanism of PH-CHD.</p>