Computer simulation of surgical interventions for the treatment of refractory pulmonary hypertension

TL;DR

This paper develops computer models to simulate surgical interventions for refractory pulmonary hypertension, evaluating their hemodynamic effects and exercise tolerance impacts through numerical simulations.

Contribution

The paper introduces compartmental models of hemodynamics and oxygen transport to analyze surgical shunts in RPH, including effects of shunt size and exercise conditions.

Findings

Different shunt sizes significantly affect oxygen saturation and hemodynamics.

Simulations show potential improvements in exercise tolerance post-intervention.

Models help optimize surgical strategies for RPH treatment.

Abstract

This paper describes computer models of three interventions used for treating refractory pulmonary hypertension (RPH). These procedures create either an atrial septal defect, a ventricular septal defect, or, in the case of a Potts shunt, a patent ductus arteriosus. The aim in all three cases is to generate a right-to-left shunt, allowing for either pressure or volume unloading of the right side of the heart in the setting of right ventricular failure, while maintaining cardiac output. These shunts are created, however, at the expense of introducing de-oxygenated blood into the systemic circulation, thereby lowering the systemic arterial oxygen saturation. The models developed in this paper are based on compartmental descriptions of human hemodynamics and oxygen transport. An important parameter included in our models is the cross-sectional area of the surgically created defect. Numerical simulations are performed to compare different interventions and various shunt sizes and to assess their impact on hemodynamic variables and oxygen saturations. We also create a model for exercise and use it to study exercise tolerance in simulated pre-intervention and post-intervention RPH patients.