A Planning Tool for Left Ventricular Reconstruction in Patients with Severe Ischemic Cardiomyopathy

Abstract

Surgical ventricular reconstruction aims to restore the ideal left ventricular geometry and function and is used as a treatment modality for patients with severe ischemic cardiomyopathy. This study addresses the clinical need for in-silico modelling to estimate the effect of left ventricular reconstruction through Revivent Myocardial Anchoring System on the function and geometry of the residual left ventricle. The planning tool developed in this study corrects for slice misalignment produced due to breathing motion and patient movement during Cardiac MR image acquisition. The extent and the location of the scar are identified on the contrast enhanced Cardiac MR images and subsequently used to classify the left ventricular short axis contour points into scarred and healthy segments. The reconstruction surgery is simulated by estimating each short axis contour of the residual LV as a circle obtained from the healthy segment. Functional analysis consisted of comparing the simulated residual left ventricular volumes at end-diastolic and end-systolic phase, stroke volume and ejection fraction with the baseline characteristics. Geometrical analysis consisted of quantifying the occlusion of the Right Ventricular Outflow Tract by the plicated scar and comparing the curvedness values of the residual LV with two geometrical models - Modified Simpson’s Model and Biplane Ellipsoid model. The required functional end-points are met for all four patients. A more localized approach is required for the geometrical analysis. The presented approach shows promising results but needs to be clinically validated by comparing with a larger database of post surgical scans to obtain higher accuracy and a more comprehensive understanding of the surgery.