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Hemodynamically Unloading the Distal Pulmonary Circulation in Pulmonary Hypertension: A Modeling Study.

Authors
  • Walter, Rachelle1
  • Hunter, Kendall2
  • Stenmark, Kurt3
  • Kheyfets, Vitaly O2
  • 1 Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.
  • 2 Department of Bioengineering and Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO 80045.
  • 3 Division of Pediatric Critical Care Medicine and Cardiovascular Pulmonary Research, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO 80045.
Type
Published Article
Journal
Journal of Biomechanical Engineering
Publisher
ASME International
Publication Date
Feb 01, 2022
Volume
144
Issue
2
Identifiers
DOI: 10.1115/1.4051719
PMID: 34251418
Source
Medline
Language
English
License
Unknown

Abstract

Pulmonary hypertension (PH) is a progressive disease that is characterized by a gradual increase in both resistive and reactive pulmonary arterial (PA) impedance. Previous studies in a rodent model of PH have shown that reducing the hemodynamic load in the left lung (by banding the left PA) reverses this remodeling phenomenon. However, banding a single side of the pulmonary circulation is not a viable clinical option, so-using in silico modeling-we evaluated if the banding effect can be recreated by replacing the proximal vasculature with a compliant synthetic PA. We developed a computational model of the pulmonary circulation by combining a one-dimensional model of the proximal vasculature with a zero-dimensional line transmission model to the 12th generation. Using this model, we performed four simulations: (1) Control; (2) PH; (3) PH with a stenosis in the left PA; and (4) PH with proximal vessel compliance returned to Control levels. Simulations revealed that vascular changes associated with PH result in an increase in pulse pressure (PP), maximum pressure (Pmax), maximum wall shear stress (WSS), and maximum circumferential stress (σθθ) relative to controls, in the distal circulation. Banding the left PA reduced these measurements of hemodynamic stress in the left lung, but increases them in the right lung. Furthermore, left PA banding increased reactive PA impedance. However, returning the proximal PA compliance to Control levels simultaneously decreased all measures of hemodynamic stress in both lungs, and returned reactive PA impedance to normal levels. In conclusion, if future in vivo studies support the idea of hemodynamic unloading as an effective therapy for PH, this can be surgically achieved by replacing the proximal PA with a compliant prosthesis, and it will have the added benefit of reducing reactive right ventricular afterload. Copyright © 2022 by ASME.

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