Cilia and Nodal Flow in Asymmetry: An Engineering Perspective.

Over the past several years, cilia in the primitive node have become recognized more and more for their contribution to development, and more specifically, for their role in axis determination. Although many of the mechanisms behind their influence remain undocumented, it is known that their presence and motion in the primitive node of developing embryos is the determinant of the left-right axis. Studies on cilial mechanics and nodal fluid dynamics have provided clues as to how this asymmetry mechanism works, and more importantly, have shown that direct manipulation of the flow field in the node can directly influence physiology.

Conjugate Multimode Heat Transfer Analysis of Cryogenic EXLO Manipulation.

In this study, a conjugate radiation/conduction multimode heat transfer analysis of cryogenic focused ion beam (FIB) milling steps necessary for producing ex situ lift out specimens under cryogenic conditions (cryo-EXLO) is performed. Using finite volume for transient heat conduction and enclosure theory for radiation heat transfer, the analysis shows that as long as the specimen is attached or touching the FIB side wall trenches, the specimen will remain vitreous indefinitely, while actively cooled at liquid nitrogen (LN2) temperatures. To simulate the time needed to perform a transfer step to move the bulk sample containing the FIB-thinned specimen from the cryo-FIB to the cryo-EXLO cryostat, the LN2 temperature active cooling is turned off after steady-state conditions are reached and the specimen is monitored over time until the critical devitrification temperature is reached.

Patient-Specific Multi-Scale Model Analysis of Hemodynamics Following the Hybrid Norwood Procedure for Hypoplastic Left Heart Syndrome: Effects of Reverse Blalock-Taussig Shunt Diameter.

Introduction: The hybrid Norwood (HN) is a relatively new first stage palliative procedure for neonates with hypoplastic left heart syndrome, in which a sustainable uni-ventricular circulation is established in a less invasive manner than with the standard Norwood procedure. A computational multiscale model of the circulation following the HN procedure was used to obtain detailed hemodynamics. Implementation of a reverse-BT shunt (RBTS), a synthetic bypass from the main pulmonary to the innominate artery placed to counteract aortic arch stenosis, and its effects on local and global hemodynamics were studied.

Computational Investigation of a Self-Powered Fontan Circulation.

Children born with anatomic or functional "single ventricle" must progress through two or more major operations to sustain life. This management sequence culminates in the total cavopulmonary connection, or "Fontan" operation. A consequence of the "Fontan circulation", however, is elevated central venous pressure and inadequate ventricular preload, which contribute to continued morbidity.

Experimental Study of Anisotropic Stress/Strain Relationships of Aortic and Pulmonary Artery Homografts and Synthetic Vascular Grafts.

Homografts and synthetic grafts are used in surgery for congenital heart disease (CHD). Determining these materials' mechanical properties will aid in understanding tissue behavior when subjected to abnormal CHD hemodynamics. Homograft tissue samples from anterior/posterior aspects, of ascending/descending aorta (AA, DA), innominate artery (IA), left subclavian artery (LScA), left common carotid artery (LCCA), main/left/right pulmonary artery (MPA, LPA, RPA), and synthetic vascular grafts, were obtained in three orientations: circumferential, diagonal (45 deg relative to circumferential direction), and longitudinal.

Developmental dysplasia of the hip: A computational biomechanical model of the path of least energy for closed reduction.

This study utilized a computational biomechanical model and applied the least energy path principle to investigate two pathways for closed reduction of high grade infantile hip dislocation. The principle of least energy when applied to moving the femoral head from an initial to a final position considers all possible paths that connect them and identifies the path of least resistance. Clinical reports of severe hip dysplasia have concluded that reduction of the femoral head into the acetabulum may occur by a direct pathway over the posterior rim of the acetabulum when using the Pavlik harness, or by an indirect pathway with reduction through the acetabular notch when using the modified Hoffman-Daimler method.

Comparison Between Bench-Top and Computational Modelling of Cerebral Thromboembolism in Ventricular Assist Device Circulation.

Despite improvements in ventricular assist devices (VAD) design, VAD-induced stroke rates remain remarkably high at 14-47%. We previously employed computational fluid dynamics (CFD) to propose adjustment of VAD outflow graft (VAD-OG) implantation to reduce stoke. Herein, we present an in-vitro model of cerebral vessel embolization in VAD-assisted circulation, and compare benchtop results to CFD predictions.

Computational analysis of pediatric ventricular assist device implantation to decrease cerebral particulate embolization.

Stroke is the most devastating complication after ventricular assist device (VAD) implantation with a 19% incidence and 65% mortality in the pediatric population. Current pediatric VAD technology and anticoagulation strategies alone are suboptimal. VAD implantation assisted by computational methods (CFD) may contribute reducing the risk of cerebral embolization.

A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip.

A physics-based computational model of neonatal Developmental Dysplasia of the Hip (DDH) following treatment with the Pavlik Harness (PV) was developed to obtain muscle force contribution in order to elucidate biomechanical factors influencing the reduction of dislocated hips. Clinical observation suggests that reduction occurs in deep sleep involving passive muscle action. Consequently, a set of five (5) adductor muscles were identified as mediators of reduction using the PV.

Experimental study of anisotropic stress/strain relationships of the piglet great vessels and relevance to pediatric congenital heart disease.

Background: Determining material mechanical properties of neonatal aorta and pulmonary artery will aid understanding tissue behavior when subjected to abnormal hemodynamics of congenital heart disease.

Methods: Aorta and pulmonary arteries were harvested from 6 neonatal piglets (mean weight 3.5 kg).

External counterpulsation of a systemic-to-pulmonary artery shunt increases coronary blood flow in neonatal piglets.

Background: Systemic-to-pulmonary artery shunt (SPS) palliation reduces coronary blood flow (CBF), which may precipitate myocardial ischemia postoperatively.

Hypothesis: Counterpulsation (CP) of SPS augments CBF.

Methods: Seven neonatal piglets (4.

Mathematical modeling of patient-specific ventricular assist device implantation to reduce particulate embolization rate to cerebral vessels.

Stroke is the most devastating complication after ventricular assist device (VAD) implantation, with an incidence of 14%-47% despite improvements in device design and anticoagulation. This complication continues to limit the widespread implementation of VAD therapy. Patient-specific computational fluid dynamics (CFD) analysis may elucidate ways to reduce this risk.

Mechanics of hip dysplasia reductions in infants using the Pavlik harness: a physics-based computational model.

Biomechanical factors influencing the reduction of dislocated hips with the Pavlik harness in patients of Developmental Dysplasia of the Hip (DDH) were studied using a three-dimensional computer model simulating hip reduction dynamics in (1) subluxated and (2) fully dislocated hip joints. Five hip adductor muscles were identified as key mediators of DDH prognosis, and the non-dimensional force contribution of each in the direction necessary to achieve concentric hip reductions was determined. Results point to the adductor muscles as mediators of subluxated hip reductions, as their mechanical action is a function of the degree of hip dislocation.

Computational fluid dynamics in congenital heart disease.

Computational fluid dynamics has been applied to the design, refinement, and assessment of surgical procedures and medical devices. This tool calculates flow patterns and pressure changes within a virtual model of the cardiovascular system. In the field of paediatric cardiac surgery, computational fluid dynamics is being used to elucidate the optimal approach to staged reconstruction of specific defects and study the haemodynamics of the resulting anatomical configurations after reconstructive or palliative surgery.

Computational analysis of hybrid Norwood circulation with distal aortic arch obstruction and reverse Blalock-Taussig shunt.

Background: The hemodynamics characteristics of the hybrid Norwood (HN) procedure differ from those of the conventional Norwood and are not fully understood. We present a multiscale model of HN circulation to understand local hemodynamics and effects of aortic arch stenosis and a reverse Blalock-Taussig shunt (RBTS) on coronary and carotid perfusion.

Methods: Four 3-dimensional models of four HN anatomic variants were developed, with and without 90% distal preductal arch stenosis and with and without a 4-mm RBTS.

Computational fluid dynamics analysis of surgical adjustment of left ventricular assist device implantation to minimise stroke risk.

Background: Currently, mechanical support is the most promising alternative to cardiac transplantation. Ventricular assist devices (VADs) were originally used to provide mechanical circulatory support in patients awaiting planned heart transplantation ('bridge-to-transplantation' therapy). The success of short-term bridge devices led to clinical trials evaluating the clinical suitability of long-term support ('destination' therapy) with left ventricular assist devices (LVADs).