Symposium 10 (II-S10)
Novel Simulation Methods in Pediatric Cardiology and Cardiac Surgery: Its Potential and Limitation

[II-S10-03] Simulation Medicine and Blood Flow Imaging Developed in Japan

^○Keiichi Itatani¹, Masaaki Yamagishi², Takako Miyazaki², Nobuyoshi Maeda², Satoshi Taniguchi², Shuhei Fujita², Hisayuki Hongu², Satoshi Numata¹, Sachiko Yamazaki¹, Tomoya Inoue¹, Kazuki Morimoto¹, Suguru Ohira¹, Kaichiro Manabe¹, Rina Makino¹, Hiroko Morichi¹, Kosuke Nakaji³, Kei Yamada³, Shohei Miyazaki⁴, Toyoki Furusawa⁴, Teruyasu Nishino⁴, Hitoshi Yaku¹ (1.Department of Cardiovascular Surgery, Cardiovascular Imaging Research Labo. Kyoto Prefectural University of Medicine, Japan, 2.Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Japan, 3.Department of Radiology, Kyoto Prefectural University of Medicine, Japan, 4.Cardio Flow Design Inc., Japan)

Background: Recent progress in imaging and computer technology has provided novel imaging technology in cardiovascular medicine: simulation medicine. Simulation medicine is a kind of “virtual therapy” based on imaging or hemodynamic data. Because congenital heart disease has complicated anatomy and physiology, simulation medicine has been applied in the earliest days in cardiology especially related to the hemodynamics of Fontan circulation. I introduce the recent development of simulation medicine and blood flow imaging in Japan.
Method and Results: Blood flow imaging is based on several modalities. We has developed echocardiography blood flow visualization software VFM (vector flow mapping), which visualizes vortex flow patterns and evaluates its efficiency. 4D flow MRI is another noninvasive flow visualization tool, which has advantages on evaluation in the right ventricle. CFD (computational fluid dynamics) is a computer flow calculation tool, and patient specific CFD model not only provides detail information of hemodynamics, but also enables virtual surgery in a computer. We have developed a CFD model that realizes physiological flow. Flow energy loss is a parameter of cardiac workload and is a predictor of ventricular deterioration, and wall shear stress (WSS) is a stress on intima, and abnormal WSS causes intimal thickening or dilatation.
Conclusions: Several types of blood flow imaging and simulation medicine are developed in Japan. Evaluation of blood flow in patients with long-term after arch repair, RVOTR, and Fontan procedures is a good application for these new technologies.