In-silico assessment of the effects of right ventricular assist device on pulmonary arterial hypertension using an image based biventricular modeling framework
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Abstract
Pulmonary arterial hypertension (PAH) is a heart disease that is characterized by
an abnormally high pressure in the pulmonary artery (PA). While right ventricular
assist device (RVAD) has been considered recently as a treatment option for the end-stage
PAH patients, its effects on biventricular mechanics are, however, largely unknown.
To address this issue, we developed an image-based modeling framework consisting of
a biventricular finite element (FE) model that is coupled to a lumped model describing
the pulmonary and systemic circulations in a closed-loop system. The biventricular
geometry was reconstructed from the magnetic resonance images of two PAH patients
showing different degree of RV remodeling and a normal subject. The framework was
calibrated to match patient-specific measurements of the left ventricular (LV) and
RV volume and pressure waveforms. An RVAD model was incorporated into the calibrated
framework and simulations were performed with different pump speeds. Results showed
that RVAD unloads the RV, improves cardiac output and increases septum curvature,
which are more pronounced in the PAH patient with severe RV remodeling. These improvements,
however, are also accompanied by an adverse increase in the PA pressure. These results
suggest that the RVAD implantation may need to be optimized depending on disease progression.