ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1586134
Quantitative comparisons of pulmonary artery hemodynamics before and after Pulsta valve implantation in patients with Tetralogy of Fallot using computational fluid dynamics
Provisionally accepted
- 1Seoul National University Children's Hospital, Seoul, Republic of Korea
- 2Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Seoul, Seoul, Republic of Korea
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The evaluation of percutaneous pulmonary valve implantation (PPVI) performance has been predominantly confined to assessing changes in the right ventricular volume using magnetic resonance imaging (MRI). This study aimed to evaluate the hemodynamic changes in the pulmonary arteries following PPVI using computational fluid dynamics (CFD) in patients with Tetralogy of Fallot.We conducted CFD analysis based on MRI scans performed before and after PPVI using Pulsta valve in nine patients who underwent PPVI between 2016 to 2021. Statistical analysis, including Wilcoxon rank-sum tests and multivariable linear regression, was performed to examine the associations between CFD data and non-CFD factors, as well as changes in these parameters after PPVI.Results: Before PPVI, forward and backward flow velocities in the right pulmonary artery (RPA) were higher than those in the left pulmonary artery (LPA) and main pulmonary artery (MPA) (forward: MPA/RPA/LPA = 19.9/32.7/19.3 cm/s, backward: MPA/RPA/LPA = 10.1/17.0/9.1 cm/s). After PPVI, velocities decreased (forward: MPA/RPA/LPA = 13.3/14.2/8.3 cm/s, backward: MPA/RPA/LPA = 2.3/2.6/1.7 cm/s), reducing the differences among PAs. After PPVI, the vorticity (RPA; 3.9 to 1.6 /s, p = 0.008, LPA; 4.4 to 1.8 /s, p = 0.011, MPA; 5.4 to 1.5 /s, p = 0.008), and energy dissipation (104.1 to 38.1 mW, p = 0.028) decreased significantly, whereas changes in the Womersley and Reynolds numbers were not statistically significant. There was no correlation between the right ventricular end-diastolic volume index and energy dissipation, and the changes in each of them were also unrelated to each other.A deeper understanding of the hemodynamics of pulmonary arteries using CFD can aid in evaluating the effectiveness of PPVI and refining its indications in patients with Tetralogy of Fallot.
Keywords: computational fluid dynamics, percutaneous pulmonary valve implantation, Tetralogy of Fallot, cardiac magnetic resonance imaging, Pulmonary regurgitation
Received: 07 Mar 2025; Accepted: 26 May 2025.
Copyright: © 2025 Baek, Choi, Lee, Lim, Kim and Seo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Gi Beom Kim, Seoul National University Children's Hospital, Seoul, Republic of Korea
Jongmin Seo, Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Seoul, Seoul, Republic of Korea
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