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Introduction
Publications
Publications (100)
Assessment of the right ventricular outflow tract and pulmonary arteries (RVOT) for percutaneous pulmonary valve implantation (PPVI) uses discrete measurements (diameters and lengths) from medical images. This multi-centre study identified the 3D RVOT shape features prevalent in patients late after surgical repair of congenital heart disease (CHD)....
Background
. Mitral transcatheter edge-to-edge repair (m-TEER) is a minimally invasive procedure for treating mitral regurgitation (MR). m-TEER is a highly technical procedure, and a steep learning curve needs to be overcome for operators to ensure optimal patient outcomes and minimise procedural complications. Training via online simulation and ob...
Although tissue stiffness is known to play an important role in aortic dilatation, the current guidelines for offering preventative surgery in patients with Marfan syndrome rely solely on the aortic diameter. In this systematic review and meta-analysis, we analyze and compare literature on in vivo aortic stiffness measures in Marfan patients. Our a...
Background and Aims
Central venous lines (CVLs) used for haemodialysis (HD) in children are associated with a high complication rate, leading to inadequate dialysis and need for a line replacement in nearly 45% of children on HD.
This high complication rate may be due to poor CVL configurations, designed without considering specific anatomical diff...
Background
Although the stiffness of tissue is known to play an important role in aortic dilatation, the current guidelines for offering a preventative aortic surgery in patients with Marfan syndrome rely solely on the aortic diameter. In this systematic review and meta-analysis, we analyze and compare literature on in-vivo aortic stiffness measure...
Over recent years, non-invasive imaging of the coronary arteries in children has improved significantly due to technological advances in imaging techniques, particularly echocardiography and CT angiography reserving gold-standard invasive coronagraphy for very small proportion of cases. Visualisation of the coronary arteries in a fetus is now possi...
It has been over 20 years since the first-in-human PPVI procedure by Phillip Bonhoeffer et al., the possibilities for transcatheter heart valve replacement have boomed and many lives have been saved or enhanced. The transcatheter valve market has opened to dozens of solutions which are collectively able to treat any of the four human heart valves,...
Computational fluid dynamics (CFD) can be used to simulate vascular haemodynamics and analyse potential treatment options. CFD has shown to be beneficial in improving patient outcomes. However, the implementation of CFD for routine clinical use is yet to be realised. Barriers for CFD include high computational resources, specialist experience neede...
In silico medicine describes the application of computational modelling and simulation (CM&S) to the study, diagnosis, treatment or prevention of a disease. Tremendous research advances have been achieved to facilitate the use of CM&S in clinical applications. Nevertheless, the uptake of CM&S in clinical practice is not always timely and accurately...
Tetralogy of Fallot (ToF) is the most common congenital heart disease. In this work, hemodynamics of pulmonary arteries (PA) in ToF patients was investigated using patient-specific image-based models. The study included the investigation of right and left pulmonary arteries (RPA and LPA, respectively). Numerical and experimental tools were used to...
Background
Computational fluid dynamics (CFD) is increasingly used for the assessment of blood flow conditions in patients with congenital heart disease (CHD). This requires patient-specific anatomy, typically obtained from segmented 3D cardiovascular magnetic resonance (CMR) images. However, segmentation is time-consuming and requires expert input...
Background
Haemodialysis is a life-saving treatment for children with kidney failure. The majority of children have haemodialysis through central venous lines (CVLs). The use of CVLs in pediatric patients is often associated to complications which can lead to their replacement. The aim of this study is to investigate haemodynamics of pediatric CVLs...
Background: Computational fluid dynamics (CFD) is increasingly used to assess blood flow conditions in patients with congenital heart disease (CHD). This requires patient-specific anatomy, usually obtained from segmented 3D cardiovascular magnetic resonance (CMR) images. However, segmentation is time-consuming and needs expert input. This study aim...
Computational fluid dynamics (CFD) can be used to simulate vascular haemodynamics and analyse potential treatment options. CFD has shown to be beneficial in improving patient outcomes. However, the implementation of CFD for routine clinical use is yet to be realised. Barriers for CFD include high computational resources, specialist experience neede...
The arterial switch operation has transformed the surgical management transposition of great arteries. Despite current excellent survival, its long-term sequelae remain a concern. Major late complications are all related to the loss of spiral nature of the great vessels, Lecompt manoeuvre, great vessel translocation and coronary re-implantation. Mu...
There is marked anatomical variability present in those with double outlet right ventricle, often posing a challenge to the interpretation of the 3D anatomy from 2D imaging. Rapid prototyping has certainly found a niche in presurgical planning for double outlet right ventricle, specifically aiding in better understanding of the best potential pathw...
Aims
We aim to determine any additional benefit of virtual reality (VR) experience if compared to conventional cross-sectional imaging and standard 3D modelling when deciding on surgical strategy in patients with complex double outlet right ventricle (DORV).
Methods and results
We retrospectively selected ten consecutive patients with DORV and com...
The hemodynamic environment of the pulmonary bifurcation is of great importance for adult patients with repaired tetralogy of Fallot (rTOF) due to possible complications in the pulmonary valve and narrowing of the left pulmonary artery (LPA). The aim of this study was to computationally investigate the effect of geometrical variability and flow spl...
Computational Fluid Dynamics (CFD) simulations of blood flow are widely used to compute a variety of hemodynamic indicators such as velocity, time-varying wall shear stress, pressure drop, and energy losses. One of the major advances of this approach is that it is non-invasive. The accuracy of the cardiovascular simulations depends directly on the...
Congenital heart disease (CHD) is the most common defect at birth. Effective training for clinical professionals is essential in order to provide a high standard of care for patients. Visual aids for teaching complex CHD have remained mostly unchanged in recent years, with traditional methods such as diagrams and specimens still essential for deliv...
Aims
The aortic valve (AV) neocuspidization (Ozaki procedure) is a novel surgical technique for AV disease that preserves the natural motion and cardiodynamics of the aortic root. In this study, we sought to evaluate, by 4D-flow magnetic resonance imaging, the aortic blood flow characteristics after AV neocuspidization in paediatric patients.
Meth...
PurposeComputational models of cardiovascular structures rely on their accurate mechanical characterization. A validated method able to infer the material properties of patient-specific large vessels is currently lacking. The aim of the present study is to present a technique starting from the flow-area (QA) method to retrieve basic material proper...
Transcatheter aortic valve implantation (TAVI) still presents complications: paravalvular leakage (PVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14...
Funding Acknowledgements
La Fondation Dassault Systèmes, British Heart Foundation
Background
Virtual reality (VR) provides a unique possibility to interact with three-dimensional objects. Still in its infancy, the integration of VR with advanced cardiovascular imaging technology allows users to handle patient-specific cardiac models.
Purpose
The...
The mechanics of the mitral valve (MV) are the result of the interaction of different anatomical structures complexly arranged within the left heart (LH), with the blood flow. MV structure abnormalities might cause valve regurgitation which in turn can lead to heart failure. Patient-specific computational models of the MV could provide a personalis...
Computational simulations represent a powerful tool for the pre-procedural clinical assessment of minimally invasive cardiovascular interventions. Patient-specific simulations rely on the accurate numerical implementation of both geometrical and mechanical features. While current imaging techniques are able to depict accurately patient-specific ana...
The development of accurate replicas of the circulatory and cardiac system is fundamental for a deeper understanding of cardiovascular diseases and the testing of new devices. Although numerous works concerning mock circulatory loops are present in the current state of the art, still some limitations are present. In particular, a pumping system abl...
In light of growing interest for three-dimensional printing technology in the cardiovascular community, this study focused on exploring the possibilities of providing training for cardiovascular three-dimensional printing in the context of a relevant international congress and providing considerations on the delivery of such courses. As a second ob...
The study herein combines the use of fused filament fabrication (FFF) with finite element analysis (FEA) to enhance the understanding of certain manufacturing parameters (i.e. material, infill density, infill pattern, and outer vertical shell) in the design process of a lumbar fusion cage. Three FFF materials with distinct mechanical properties nam...
Background
Marfan syndrome is a multi-systemic disorder characterized by progressive aortic dilation. Follow-up imaging is performed to monitor aortic dimensions, traditionally assessed by 2D diameter measurements, which cannot capture complex aortic shape variations. Statistical shape analysis is a novel technique that allows for a more comprehens...
Mitral valve (MV) function is the result of the mechanical interaction of different anatomical structures complexly arranged within the left heart (LH), with the blood flow. MV or LV structural abnormalities might cause valve regurgitation which in turn can lead to cardiac muscle overload and heart failure. Surgery remains the standard of care for...
Three-dimensional (3D) printing technology in congenital cardiology and cardiac surgery has experienced a rapid development over the last decade. In presence of complex cardiac and extra-cardiac anatomies, the creation of a physical, patient-specific model is attractive to most clinicians. However, at the present time, there is still a lack of stro...
Microfocus computed tomography (micro-CT) is an imaging method that provides three dimensional (3D) digital datasets with comparable resolution to light microscopy. Although it has traditionally been used for non-destructive testing in engineering, aerospace industries and in preclinical animal studies, new applications are rapidly becoming availab...
Patient-specific computational models are an established tool to support device development and test under clinically relevant boundary conditions. Potentially, such models could be used to aid the clinical decision-making process for percutaneous valve selection; however, their adoption in clinical practice is still limited to individual cases. To...
Here we describe methods for creating tissue-mimicking ultrasound phantoms based on patient anatomy using a soft material called gel wax. To recreate acoustically realistic tissue properties, two additives to gel wax were considered: paraffin wax to increase acoustic attenuation, and solid glass spheres to increase backscattering. The frequency dep...
Three-dimensional printed models have been increasingly used in many fields of medicine. The most common benefits have been reported in relation to a better understanding of anatomical details, an improved communication between clinicians and patients, and a more accurate planning of treatments. In the cardiovascular field, in particular for congen...
Patient-specific computational models have been extensively developed over the last decades and applied to investigate a wide range of cardiovascular problems. However, translation of these technologies into clinical applications, such as planning of medical procedures, has been limited to a few single case reports. Hence, the use of patient-specif...
Modelling the mitral valve can be beneficial in understanding the physiological and pathological conditions and testing medical procedures or devices. FSI method was implemented to study the functional response of the MV by the interaction of blood based on SPH approach. The aim of this study is i) to validate the use of SPH against the gold standa...
This pilot study aimed to assess the impact of using patient-specific three-dimensional (3D) models of congenital heart disease (CHD) during consultations with adolescent patients. Adolescent CHD patients (n = 20, age 15–18 years, 15 male) were asked to complete two questionnaires during a cardiology transition clinic at a specialist centre. The fi...
Surgical aortic valve replacement is the most common procedure of choice for the treatment of severe aortic stenosis. Bioprosthetic valves are traditionally sewed-in the aortic root by means of pledget-armed sutures during open-heart surgery. Recently, novel bioprostheses which include a stent-based anchoring system have been introduced to allow ra...
Computational models of congenital heart disease (CHD) have become increasingly sophisticated over the last 20 years. They can provide an insight into complex flow phenomena, allow for testing devices into patient-specific anatomies (pre-CHD or post-CHD repair) and generate predictive data. This has been applied to different CHD scenarios, includin...
Objective:
To develop a participatory approach in the evaluation of 3D printed patient-specific models of congenital heart disease (CHD) with different stakeholders who would potentially benefit from the technology (patients, parents, clinicians and nurses).
Methods:
Workshops, focus groups and teaching sessions were organised, targeting differe...
Background:
Nurse education and training are key to providing congenital heart disease (CHD) patients with consistent high standards of care as well as enabling career progression. One approach for improving educational experience is the use of 3D patient-specific models.
Objectives:
To gather pilot data to assess the feasibility of using 3D mod...
Spinal fusion is the gold standard surgical procedure for degenerative spinal conditions when conservative therapies have been unsuccessful in rehabilitation of patients. Novel strategies are required to improve biocompatibility and osseointegration of traditionally used materials for lumbar cages. Furthermore, new design and technologies are neede...
This chapter presents the experience of the cardiac engineering team within the Centre for Cardiovascular Imaging at Great Ormond Street Hospital for Children (London, UK) in using three-dimensional (3D) printing technology. 3D models can serve different functions towards implementing a patient-specific approach for studying and potentially treatin...
Background:
Medical image analysis in clinical practice is commonly carried out on 2D image data, without fully exploiting the detailed 3D anatomical information that is provided by modern non-invasive medical imaging techniques. In this paper, a statistical shape analysis method is presented, which enables the extraction of 3D anatomical shape fe...
OUTCOME MEASURES: Physiologic measure: Gait deviation index (GDI) score, Gait profile score (GPS). METHODS: Consecutive patients with high-grade spondylolisthesis underwent pre-and post-operative 3D gait analysis studies. RESULTS: All four patients had Meyerding grade 4 spondylolisthesis pre-operatively. Mean age was 14.5 years and all were female....
Spinal fusion is performed for degenerative spinal condition when conservative measures fail. Implant size and shape are not standardised between manufacturers, and best match often means compromises. Bioprinting offers a unique opportunity to create a tailor-made solution. PURPOSE: The goal of this study was to design and manufacture a 3D-printed...
BACKGROUND CONTEXT: Spinal fusion is designed to reduce movements between vertebrae and therefore pain. The most used devices for this procedure are mainly made of titanium or polyether ether ketone (PEEK). However, the mismatch between devices, with standard shapes and materials, and the surrounding bones can lead to suboptimal outcomes. Computati...
Left ventricular ejection fraction (LVEF) late after arterial
switch operation (ASO) is often normal. However, some
studies have shown increased indexed end diastolic
volume (iEDV) and ventricular mass when compared to
healthy controls. We sought to identify LV morphological differences between patients with transposition of the
great arteries (TGA...
Coarctation of the Aorta (CoA) is a cardiac defect that requires surgical intervention aiming to restore an unobstructed aortic arch shape. Many patients suffer from complications post-repair, which are commonly associated with arch shape abnormalities. Determining the degree of shape abnormality could improve risk stratification in recommended scr...
Aims: We report the application of patient-specific computational models to plan the treatment of complex aortic re-coarctation (rCoA) with a proximal aberrant right subclavian artery in a patient who had previously undergone bare metal stenting. Methods and results: Clinically acquired images were used to set up patient-specific computational mode...
In this paper, we perform a comparative analysis between two computational methods for virtual stent deployment: a novel fast virtual stenting method, which is based on a spring–mass model, is compared with detailed finite element analysis in a sequence of in silico experiments. Given the results of the initial comparison, we present a way to optim...
Objectives To assess the communication potential of three-dimensional (3D) patient-specific models of congenital heart defects and their acceptability in clinical practice for cardiology consultations.
Design This was a questionnaire-based study in which participants were randomised into two groups: the ‘model group’ received a 3D model of the card...
Patient-specific finite element (FE) simulations were used to assess different transcatheter valve devices and help select the most appropriate treatment strategy for a patient (17-year-old male) with borderline dimensions for Melody® percutaneous pulmonary valve implantation (PPVI).
Patient-specific implantation site morphology was derived from ca...
In this paper, we perform a comparative analysis between two computational methods for virtual stent deployment: a novel fast virtual stenting method, which is based on a spring-mass model, is compared with detailed finite element analysis in a sequence of in silico experiments. Given the results of the initial comparison, we present a way to optim...
Introduction: Communication in medical consultations is recognised as an important factor in optimising patient satisfaction and health outcomes. Patient-specific (PS) plastic models of congenital heart lesions may offer benefits for education and communication purposes. This study aimed to quantitatively test the translational potential of PS mode...
The arterial switch operation (ASO) is widely used nowadays as the surgical strategy of choice to repair transposition of the great arteries (TGA). Residual morphological and geometrical abnormalities of the aorta, pulmonary arteries and coronary arteries, however, have not been fully studied in a three-dimensional (3D) domain. These morphometric c...
Background:
Patients treated with the Melody device (Medtronic) for percutaneous pulmonary valve implantation experience stent fractures in ≈25% of the cases. The aim of this study is to identify the risk factors associated with fracture using 3-dimensional (3D) analyses.
Methods and results:
In situ 3D shape of the Melody stent was reconstructe...
Patient-specific models have been recently applied to investigate a wide range of cardiovascular problems including cardiac mechanics, hemodynamic conditions and structural interaction with devices [1]. The development of dedicated computational tools which combined the advances in the field of image elaboration, finite element (FE) and computation...
Aortic arch geometry is linked to abnormal blood pressure (BP) response to maximum exercise. This study aims to quantitatively assess whether aortic arch geometry plays a role in blood pressure (BP) response to exercise.
60 age- and BSA-matched subjects -- 20 post-aortic coarctation (CoA) repair, 20 transposition of great arteries post arterial swi...