A pipeline for image based intracardiac CFD modeling and application to the evaluation of the PISA method

Mitral regurgitation is one of the most prevalent valvular heart disease. Proper evaluation of its severity is necessary to choose appropriate treatment. The PISA method, based on Color Doppler echocardiography, is widely used in the clinical setting to estimate various relevant quantities related to the severity of the disease. In this paper, the use of a pipeline to quickly generate image-based numerical simulation of intracardiac hemodynamics is investigated. The pipeline capabilities are evaluated on a database of twelve volunteers. Full pre-processing is achieved completely automatically in 55 min, on average, with small registration errors compared to the image spatial resolution. This pipeline is then used to study the intracardiac hemodynamics in the presence of diseased mitral valve. A strong variability among the simulated cases, mainly due to the valve geometry and regurgitation specifics, is found. The results from those numerical simulations are used to assess the potential limitations of the PISA method with respect to different MR types. While the PISA method provides reasonable estimates in the case of a simple circular regurgitation, it is shown that unsatisfying estimates are obtained in the case of non-circular leakage. Moreover, it is shown that the choice of high aliasing velocities can lead to difficulties in quantifying MR. (C) 2019 ElsevierB.V. All rights reserved.