Patients with congenital heart disease may have complex hemodynamic circuits. Computer modeling derived from a mathematical concept could help to improve our understanding of how changes in hemodynamic variables influence the circulation.
For example, in Fontan patients, it has been shown that an increase in central venous pressure during exercise is necessary for adequate pulmonary flow, but the same increase limits the reserve capacity for cardiac output. Computer modeling can go one step further and help with surgical decision-making by simulating different surgical interventions. Geometric and hemodynamic variables are adapted at once, and the effect on the circulation is evaluated immediately. However, computer modeling does not predict clinical outcome, does not account for all biological processes, does not dictate clinical decisions, and cannot replace the bedside.
Computer modeling might also serve as a platform for innovation and can test hemodynamic models that no one would attempt in humans. The validation of this computer-based concept can be done in-silico or in-vitro, and might reduce the number of animal tests. However, computer modeling simulates not only hemodynamic data, but can also be applied to study the myocardium itself, or to unravel the electro-mechanical activation of the heart. The latter has progressed quite far in patients after tetralogy of Fallot repair and might open avenues towards a better understanding of the final result of interventions.
Computer modeling is evolving rapidly, and will presumably be a part of our daily practice in the future. However, models need to be developed with accurate and continuously updated data sets. Validation in clinical practice by a close cooperation between engineers, computer scientists, and clinicians is mandatory.
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