Integrated Open-Source Framework for Simulation of Transcatheter Pulmonary Valves in Native Right Ventricular Outflow Tracts
Journal:
arXiv
Published Date:
Jul 8, 2025
Abstract
Background - Pulmonary insufficiency is a consequence of transannular patch
repair in Tetralogy of Fallot (ToF), leading to late morbidity and mortality.
Transcatheter native outflow tract pulmonary valve replacement (TPVR) has
become common, but assessment of patient candidacy and selection of the optimal
device remains challenging. We demonstrate an integrated open-source workflow
for simulation of TPVR in image-derived models to inform device selection.
Methods - Machine learning-based segmentation of CT scans was implemented to
define the right ventricular outflow tract (RVOT). A custom workflow for device
positioning and pre-compression was implemented in SlicerHeart. Resulting
geometries were exported to FEBio for simulation. Visualization of results and
quantification were performed using custom metrics implemented in SlicerHeart
and FEBio.
Results - RVOT model creation and device placement could be completed in
under 1 minute. Virtual device placement using FE simulations visually mimicked
actual device placement and allowed quantification of vessel strain, stress,
and contact area. Regions of higher strain and stress were observed at the
proximal and distal end locations of the TPVs where the devices impinge the
RVOT wall. No other consistent trends were observed across simulations. The
observed variability in mechanical metrics across RVOTS, stents, and locations
in the RVOT highlights that no single device performs optimally in all
anatomies, thereby reinforcing the need for simulation-based patient-specific
assessment.
Conclusions - This study demonstrates the feasibility of a novel open-source
workflow for the rapid simulation of TPVR which with further refinement may
inform assessment of patient candidacy and optimal device selection.
