Fluid-structure interaction simulations for the prediction of fractional flow reserve in pediatric patients with anomalous aortic origin of a coronary artery

TL;DR

This study develops a fluid-structure interaction modeling approach calibrated with clinical data to accurately predict fractional flow reserve in pediatric patients with anomalous aortic origin of a coronary artery, aiding clinical risk assessment.

Contribution

It introduces a calibration method for boundary conditions in FSI models of pediatric AAOCA, improving FFR prediction accuracy from non-invasive data.

Findings

Model predictions of FFR at stress agree with clinical measurements.

Calibrated models can potentially assist in clinical risk stratification.

The approach enhances non-invasive assessment of coronary hemodynamics in children.

Abstract

Computer simulations of blood flow in patients with anomalous aortic origin of a coronary artery (AAOCA) have the promise to provide insight into this complex disease. They provide an in-silico experimental platform to explore possible mechanisms of myocardial ischemia, a potentially deadly complication for patients with this defect. This paper focuses on the question of model calibration for fluid-structure interaction models of pediatric AAOCA patients. Imaging and cardiac catheterization data provide partial information for model construction and calibration. However, parameters for downstream boundary conditions needed for these models are difficult to estimate. Further, important model predictions, like fractional flow reserve (FFR), are sensitive to these parameters. We describe an approach to calibrate downstream boundary condition parameters to clinical measurements of resting FFR. The calibrated models are then used to predict FFR at stress, an invasively measured quantity that can be used in the clinical evaluation of these patients. We find reasonable agreement between the model predicted and clinically measured FFR at stress, indicating the credibility of this modeling framework for predicting hemodynamics of pediatric AAOCA patients. This approach could lead to important clinical applications since it may serve as a tool for risk stratifying children with AAOCA.