Joao Filipe Fernandes

Pressure Fields by Flow-Sensitive, 4D, Velocity-Encoded CMR in Patients With Aortic Coarctation

This study compared pressure fields by 4-dimensional (4D), velocity-encoded cine (VEC) cardiac magnetic resonance imaging (CMR) with pressures measured by the clinical gold standard catheterization. Thirteen patients (n = 7 male, n = 6 female) with coarctation were studied. The 4D-VEC-CMR pressure fields were computed by solving the Pressure-Poisson equation. The agreement between catheterization and CMR-based methods was determined at 5 different measurement sites along the aorta. For all sites, the correlation coefficients between measures varied between 0.86 and 0.97 (p < 0.001). The Bland-Altman test showed good agreement between peak systolic pressure gradients across the coarctation. The nonsignificant (p > 0.2) bias was +2.3 mm Hg (± 6.4 mm Hg, 2 SDs) for calibration with dynamic pressures and +1.5 mm Hg (± 4.6 mm Hg, 2 SDs) for calibration with static pressure. In a clinical setting of coarctation, pressure fields can be accurately computed from 4D-VEC-CMR-derived flows. In patients with coarctation, this noninvasive technique might evolve to an alternative to invasive catheterization.

Hemodynamic and energetic aspects of the left ventricle in patients with mitral regurgitation before and after mitral valve surgery

The role of intracardiac blood flow behavior within the context of manifestation and interventional success in patients with mitral regurgitation is unknown to date. The present study aims to assess left ventricular blood flow behavior characterized by kinetic energy (KE) in patients with mitral regurgitation before and after mitral valve surgery.

Patient-specific modeling of left ventricular electromechanics as a driver for haemodynamic analysis

Aims Models of blood flow in the left ventricle (LV) and aorta are an important tool for analysing the interplay between LV deformation and flow patterns. Typically, image-based kinematic models describing endocardial motion are used as an input to blood flow simulations. While such models are suitable for analysing the hemodynamic status quo, they are limited in predicting the response to interventions that alter afterload conditions. Mechano-fluidic models using biophysically detailed electromechanical (EM) models have the potential to overcome this limitation, but are more costly to build and compute. We report our recent advancements in developing an automated workflow for the creation of such CFD ready kinematic models to serve as drivers of blood flow simulations. Methods and results EM models of the LV and aortic root were created for four pediatric patients treated for either aortic coarctation or aortic valve disease. Using MRI, ECG and invasive pressure recordings, anatomy as well as electrophysiological, mechanical and circulatory model components were personalized. Results The implemented modeling pipeline was highly automated and allowed model construction and execution of simulations of a patient’s heartbeat within 1 day. All models reproduced clinical data with acceptable accuracy. Conclusion Using the developed modeling workflow, the use of EM LV models as driver of fluid flow simulations is becoming feasible. While EM models are costly to construct, they constitute an important and nontrivial step towards fully coupled electro-mechano-fluidic (EMF) models and show promise as a tool for predicting the response to interventions which affect afterload conditions.

Model-Based Therapy Planning Allows Prediction of Haemodynamic Outcome after Aortic Valve Replacement

Optimizing treatment planning is essential for advances in patient care and outcomes. Precisely tailored therapy for each patient remains a yearned-for goal. Cardiovascular modelling has the potential to simulate and predict the functional response before the actual intervention is performed. The objective of this study was to proof the validity of model-based prediction of haemodynamic outcome after aortic valve replacement. In a prospective study design virtual (model-based) treatment of the valve and the surrounding vasculature were performed alongside the actual surgical procedure (control group). The resulting predictions of anatomic and haemodynamic outcome based on information from magnetic resonance imaging before the procedure were compared to post-operative imaging assessment of the surgical control group in ten patients. Predicted vs. post-operative peak velocities across the valve were comparable (2.97 ± 1.12 vs. 2.68 ± 0.67 m/s; p = 0.362). In wall shear stress (17.3 ± 12.3 Pa vs. 16.7 ± 16.84 Pa; p = 0.803) and secondary flow degree (0.44 ± 0.32 vs. 0.49 ± 0.23; p = 0.277) significant linear correlations (p < 0.001) were found between predicted and post-operative outcomes. Between groups blood flow patterns showed good agreement (helicity p = 0.852, vorticity p = 0.185, eccentricity p = 0.333). Model-based therapy planning is able to accurately predict post-operative haemodynamics after aortic valve replacement. These validated virtual treatment procedures open up promising opportunities for individually targeted interventions.

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

Background In aortic coarctation, current guidelines recommend reducing pressure gradients that exceed given thresholds. From a physiological standpoint this should ideally improve the energy expenditure of the heart and thus prevent long term organ damage. Objectives The aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization. Methods In a collective of 52 patients with aortic coarctation 25 patients received stenting and/or balloon angioplasty, and 20 patients underwent MRI before and after an interventional treatment procedure. EHP and IHP were computed based on catheterization and MRI measurements. Along with the power efficiency these were combined in a cardiac energy profile. Results By intervention, the catheter gradient was significantly reduced from 21.8±9.4 to 6.2±6.1mmHg (p<0.001). IHP was significantly reduced after intervention, from 8.03±5.2 to 4.37±2.13W (p < 0.001). EHP was 1.1±0.3 W before and 1.0±0.3W after intervention, p = 0.044. In patients initially presenting with IHP above 5W intervention resulted in a significant reduction in IHP from 10.99±4.74 W to 4.94±2.45W (p<0.001), and a subsequent increase in power efficiency from 14 to 26% (p = 0.005). No significant changes in IHP, EHP or power efficiency were observed in patients initially presenting with IHP < 5W. Conclusion It was demonstrated that interventional treatment of coarctation resulted in a decrease in IHP. Pressure gradients, as the most widespread clinical parameters in coarctation, did not show any correlation to changes in EHP or IHP. This raises the question of whether they should be the main focus in coarctation interventions. Only patients with high IHP of above 5W showed improvement in IHP and power efficiency after the treatment procedure. Trial Registration clinicaltrials.gov NCT02591940

The Shell-Like Spherical Induction Motor for Low-Speed Traction: Electromagnetic Design, Analysis, and Experimental Tests

This paper analyzes the electromechanical characteristics of a novel shell-like spherical induction machine with multiple degrees-of-freedom (DOF), formed by a shell stator and a spherical hollow rotor. The shell-like induction machine is evaluated using n-harmonic analytical models for its electromechanical characteristics. The electromechanical model includes the distribution of the copper windings in the stator slots, incorporating the currents harmonic content to describe its spatial distribution. The distribution of the magnetic potential vector and the components of the magnetic flux density are computed using the real source-current distribution. A small prototype was built to validate the analytical model. To do so, experimental tests were done to the magnetic flux density and the torque. The shell-like induction motor is concretized as traction motor in an electric wheel-chair. Its results are compared with a finite-element analysis tool.

MRI as a tool for non-invasive vascular profiling: a pilot study in patients with aortic coarctation

Aim: While the overall concept of aortic coarctation has changed from one of simple obstruction to one that includes significant vascular dysfunction, this has not yet been translated into the diagnostic and treatment process. To close this gap, we sought to demonstrate the usefulness of an additional non-invasive vascular profile. Method: During a pilot study in eight coarctation patients, aortic area compliance, aortic distensibility, time phase shift and blood flow (distribution) were calculated from cine-MRI and 2D-/4D-velocity-encoded MRI sequences. Results: Compared to healthy individuals, a significantly lower aortic compliance and reduced flow to the descending aorta were found in patients with coarctation. Discussion: These differences underline the potential usefulness of a combined vascular profile in coarctation patients. Conclusion: It was successfully shown that functional vascular profiling of the aorta is feasible to be acquired non-invasively in a clinical setting and can provide additional diagnostic information. These can be the key input parameters for computational fluid dynamics-modeling.

A Shell-Like Induction Electrical Machine

This paper proposes to recover the concept of spherical induction electrical machines to conceive a shell-like actuator with multi-DOF (Degrees-Of-Freedom). The actuator is formed by a shell stator and a spherical rotor. This work contains the feasibility study of that solution when applied as an active joint actuator in assistive devices. Its electromechanical characteristics are first analyzed using an analytic model that includes: the distribution of the magnetic potential vector and thus the components of the magnetic flux density in the airgap due to a sinusoidal current distribution imposed in the stator; the model also shows the induced electromotive forces and associated current density distribution in the rotor; and at last the radial and tangential components of the force density in the rotor. The shell-like actuator is concretized as an active joint for assisting movement of the lower leg of a typical 70kg person. Based on its requirements, the joint actuator electromechanical characteristics are analyzed according to its sensitivity to a set of electrical and mechanical variables.

CMR-Based and Time-Shift Corrected Pressure Gradients Provide Good Agreement to Invasive Measurements in Aortic Coarctation

In aortic coarctation (CoA), clinical guidelines recommend treatment in the presence of a relevant pressure gradient [(1)][1]. Although reliable noninvasive measurement approaches would be crucial, the accuracy of currently available methods is limited and cardiac catheterization has remained a

Magnetic Field Analysis in Shell-Like Spherical Induction Machines with Zenithal Traveling Waves

In this paper, a magnetic field analysis is done for spherical shell-like induction machines with a zenithal progressive magnetic traveling wave, using an analytical model in spherical coordinates. These analytical models have major importance in the simulation, project, and preliminary optimization of devices due to its analytical solutions and physical insight. The magnetic field analysis is made for a shell-like induction machine for the study of its electromagnetic and mechanical quantities, as the magnetic field, induced currents, and electromagnetic torque. The developed model is validated, first with a set of generic windings distributions using the results of a commercial finite element analysis (FEA) tool and, second, validated by comparing with the results from the shell-like induction machine prototype. The results obtained from the analytical model are very close to the ones obtained by the FEA tool and from the prototype tests.