Purpose

Surgical planning has shown great potential for optimizing outcomes for patients affected by single ventricle (SV) malformations. Phase-contrast magnetic resonance imaging (PC-MRI) is the routine technique used for flow acquisition in the surgical planning paradigm. However, PC-MRI may suffer from possible artifacts in certain cases; furthermore, this technology may not be readily available for patients in low and lower-middle-income countries. Therefore, this study aims to investigate the effectiveness of using Doppler echocardiography (echo-Doppler) for flow acquisitions of SV surgical planning.

Methods

This study included eight patients whose blood flow data was acquired by both PC-MRI and echo-Doppler. A virtual surgery platform was used to generate two surgical options for each patient: (1) a traditional Fontan conduit and (2) a Y-graft. Computational fluid dynamics (CFD) simulations were conducted using the two flow acquisitions to assess clinically relevant hemodynamic metrics: indexed power loss (iPL) and hepatic flow distribution (HFD).

Results

Differences exist in flow data acquired by PC-MRI and echo-Doppler, but no statistical significance was obtained. Flow fields, therefore, exhibit discrepancies between simulations using flow acquisitions by PC-MRI and echo-Doppler. In virtual surgery, the two surgical options were ranked based on these metrics. No difference was observed in the ranking of surgical options between using different flow acquisitions.

Conclusion

Doppler echocardiography is an adequate alternative approach to acquire flow data for SV surgical planning. This finding encourages broader usage of SV surgical planning with echo-Doppler when MRI may present artifacts or is not available, especially in low and lower-middle-income countries.

中文翻译：

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多普勒超声心动图是否适合单心室患者的手术计划？

目的

手术计划在优化受单心室 (SV) 畸形影响的患者的结果方面显示出巨大潜力。相衬磁共振成像 (PC-MRI) 是手术规划范例中用于流量采集的常规技术。然而，在某些情况下，PC-MRI 可能会出现伪影；此外，低收入和中低收入国家的患者可能不容易获得这项技术。因此，本研究旨在调查使用多普勒超声心动图 (echo-Doppler) 进行 SV 手术计划的血流采集的有效性。

方法

这项研究包括八名患者，他们的血流数据是通过 PC-MRI 和回声多普勒采集的。虚拟手术平台用于为每位患者生成两种手术选择：（1）传统 Fontan 导管和（2）Y 型移植物。使用两个流量采集进行计算流体动力学 (CFD) 模拟，以评估临床相关的血流动力学指标：指数功率损失 (iPL) 和肝流量分布 (HFD)。

结果

PC-MRI 和回波多普勒采集的血流数据存在差异，但未获得统计学意义。因此，流场在使用 PC-MRI 和回声多普勒的流采集的模拟之间表现出差异。在虚拟手术中，根据这些指标对两种手术选项进行排名。使用不同血流采集的手术选择排名没有差异。

结论

多普勒超声心动图是获取用于 SV 手术计划的血流数据的适当替代方法。这一发现鼓励在 MRI 可能出现伪影或不可用时，特别是在低收入和中低收入国家，更广泛地使用带有回波多普勒的 SV 手术计划。