Impact of surgical ventricular restoration on intracardiac hemodynamics: An in silico study using CCT data

Lukas Obermeier; Moritz Wiegand; Titus Kuehne; Volkmar Falk; Christoph Knosalla; Natalia Solowjowa; Leonid Goubergrits; Katharina Vellguth

doi:10.1016/j.compbiomed.2025.110227

Impact of surgical ventricular restoration on intracardiac hemodynamics: An in silico study using CCT data

Comput Biol Med. 2025 Jun;192(Pt B):110227. doi: 10.1016/j.compbiomed.2025.110227. Epub 2025 May 16.

Authors

Lukas Obermeier¹, Moritz Wiegand², Titus Kuehne³, Volkmar Falk⁴, Christoph Knosalla⁵, Natalia Solowjowa⁶, Leonid Goubergrits⁷, Katharina Vellguth⁸

Affiliations

¹ Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany. Electronic address: lukas.obermeier@dhzc-charite.de.
² Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
³ Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany; German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.
⁴ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany; German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Department of Health Science and Technology, Translational Cardiovascular Technology, ETH Zurich, Zurich, Switzerland.
⁵ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany; German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
⁶ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
⁷ Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany; Einstein Center Digital Future, Berlin, Germany.
⁸ Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany. Electronic address: katharina.vellguth@dhzc-charite.de.

PMID: 40381474
DOI: 10.1016/j.compbiomed.2025.110227

Abstract

Surgical ventricular restoration (SVR) excludes scarred myocardium after myocardial infarction to restore shape and contractility of dilated, aneurysmal left ventricles (LVs). Detailed changes in intracardiac hemodynamics following the surgery are not fully investigated. In this study, digital replicas of the patient's LV were used to study the hemodynamic impact of successful SVR. The digital replicas were built based on pre-operative and post-operative cardiac computed tomography data of nine patients (3females, 60 ± 13years) who underwent successful SVR (significant reduction in heart failure symptoms). The computational framework was used to calculate LV morphology, dynamics, and intracardiac hemodynamics using image-based computational fluid dynamics (CFD). SVR successfully reduced the LV volumes. Morphological analysis showed restoration of myocardial wall thickness in aneurysmal regions (5.5 ± 2.0 vs. 8.6 ± 3.0 mm) and an increased end-diastolic sphericity (sphericity index 0.39 ± 0.07 vs. 0.46 ± 0.07). No distinct flow alterations could be linked thereto. CFD revealed a higher post-operative kinetic energy level (diastolic maximum 10.0 ± 7.6 vs. 16.8 ± 9.1mJ) and an improved global washout (29.5 ± 9.7 vs. 10.3 ± 6.4% after five cycles), which correlated to increases in volume-curve-derived diastolic energy gain and ejection fraction, respectively. Flow efficiency improved by means of an increased end-diastolic surface-averaged vortex strength (16.2 ± 5.1 vs. 30.0 ± 15.01/s) and a decreased normed diastolic energy loss (18.9 ± 3.9 vs. 15.0 ± 3.7%). The hemodynamic filling forces in diastole were aligned with the LV long axis before and after surgery and correlated with LV contractility. In summary, the digital patient replicas facilitated a detailed analysis and showed favorable flow changes with successful SVR.

Keywords: Cardiac computed tomography; Computational fluid dynamics; Fluid–structure interaction; Intracardiac hemodynamics; Left ventricle; Surgical ventricular restoration; Virtual digital twin.

MeSH terms

Aged
Computer Simulation
Female
Heart Ventricles* / diagnostic imaging
Heart Ventricles* / physiopathology
Heart Ventricles* / surgery
Hemodynamics*
Humans
Male
Middle Aged
Models, Cardiovascular*
Tomography, X-Ray Computed*