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.

中文翻译：

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使用基于图像的双心室建模框架对右心室辅助装置对肺动脉高压的影响进行计算机评估

肺动脉高压 (PAH) 是一种以肺动脉 (PA) 异常高压为特征的心脏病。虽然右心室辅助装置 (RVAD) 最近被认为是终末期 PAH 患者的一种治疗选择，但它对双心室力学的影响在很大程度上是未知的。为了解决这个问题，我们开发了一个基于图像的建模框架，该框架由双心室有限元 (FE) 模型组成，该模型与描述闭环系统中肺循环和体循环的集总模型耦合。双心室几何结构是从显示不同程度 RV 重塑和正常受试者的两名 PAH 患者的磁共振图像中重建的。该框架经过校准以匹配左心室 (LV) 和 RV 容积和压力波形的患者特定测量值。将 RVAD 模型纳入校准框架，并以不同的泵速进行模拟。结果表明，RVAD 可减轻 RV 负荷，改善心输出量并增加隔膜曲率，这在伴有严重 RV 重构的 PAH 患者中更为明显。然而，这些改进也伴随着 PA 压力的不利增加。这些结果表明，RVAD 植入可能需要根据疾病进展进行优化。这在有严重 RV 重塑的 PAH 患者中更为明显。然而，这些改进也伴随着 PA 压力的不利增加。这些结果表明，RVAD 植入可能需要根据疾病进展进行优化。这在有严重 RV 重塑的 PAH 患者中更为明显。然而，这些改进也伴随着 PA 压力的不利增加。这些结果表明，RVAD 植入可能需要根据疾病进展进行优化。