Computational Models Predict Heart Valve Leakage in Children

Hypoplastic left heart syndrome is a serious birth defect in which the left side of a baby’s heart is underdeveloped and ineffective at pumping blood, forcing the right side to handle the circulation to both the lungs and the rest of the body. Without a series of three open-heart surgeries, this defect is usually fatal. Another related condition, the atrioventricular canal defect, involves a congenital hole in the septum separating the heart's chambers. Although surgeries to correct these issues are generally effective, they often lead to future complications such as valve leakage. In cases of hypoplastic left heart syndrome, approximately 25% of children develop leaky valves by preschool age. Children with atrioventricular canal defects may experience valve leakage six months to two years post-surgery for reasons that have yet to be fully understood.

These follow-up surgeries are typically only about half as effective as the original procedure, and unsuccessful repairs might necessitate the placement of a mechanical heart valve, creating further risks and complications. During these surgeries, the heart, which is stopped and placed on a bypass machine, fails to retain its natural shape as it would if it were pumping blood, thus complicating the procedures. Surgeons attempt to mitigate this by inflating the valves to enhance visibility, yet the time-limited nature of heart surgery allows little room for adjustment. Now, a computational model could predict future problematic areas of the heart valves, enabling preemptive corrective actions to prevent subsequent leakage.

A multidisciplinary research team at the University of Oklahoma (Oklahoma City, OK, USA) is pioneering research that could potentially enable pediatric cardiologists and surgeons to anticipate and strengthen the future structural integrity of a child’s heart valves during the initial surgeries. The advanced computational models aim to provide a detailed understanding of the unique characteristics of individual hearts. Unlike traditional echocardiograms, which merely show the heart in motion, these computational models simulate the valve shapes, identify potential weak points, and illustrate how blood moves through these valves, thereby suggesting surgical interventions to avert future complications. The researchers began their studies with hypoplastic left heart syndrome and have published around 10 papers on their computational modeling for the condition. They are now developing computational models for atrioventricular canal defects and will continue to gather data from patients at multiple time points over the next several years.

“This is truly translational medicine,” said OU Health pediatric heart surgeon Harold Burkhart, M.D. “Because of our multidisciplinary collaboration, we have the knowledge together to create a computational model that goes beyond what we are able to see with both 2D and 3D echocardiogram. It allows us to go a step further and visualize the heart as it would be in real life with the characteristics of each individual. With that understanding, we can test what would happen if we put a stitch here or tighten a valve there — does it put too much stress on the valve, or does it address the problem? It can potentially give us a lot more direction before we even go into the operating room.”

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