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. 2021 Mar:66:101780.
doi: 10.1016/j.epsc.2021.101780. Epub 2021 Jan 6.

Computational fluid dynamics modeling aiding surgical planning in a toddler with Parkes Weber syndrome

Josiah M Peñalver  1 , James T Bennett  2 , Zoe Nelson  2 , Randall A Bly  3 , Jonathan A Perkins  3 , Catherine V Bull  3 , Alberto Aliseda  4 , Fanette Chassagne  4 , Giridhar M Shivaram  5 , Antoinette W Lindberg  6 , John H T Waldhausen  7 , Muhammad A K Nuri  8
Affiliations

Computational fluid dynamics modeling aiding surgical planning in a toddler with Parkes Weber syndrome

Josiah M Peñalver et al. J Pediatr Surg Case Rep. 2021 Mar.

Abstract

Parkes Weber syndrome is a fast-flow and slow-flow vascular anomaly with limb overgrowth that can lead to congestive heart failure and limb ischemia. Current management strategies have focused on symptom management with focal embolization. A pediatric case with early onset heart failure is reported. We discuss the use of computational fluid dynamics (CFD) modeling to guide a surgical management strategy in a toddler with an MAP2K1 mutation.

Keywords: Arterial banding; Computational fluid dynamics modeling; Congestive heart failure; MAP2K1 mutation; Parkes Weber syndrome.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1.
Image 1.. Neonatal Lesion:
Vascular anomaly identified at 4 days of age.
Image 2.
Image 2.. Chest Radiograph:
obtained at 2 months of age demonstrating cardiomegaly and pulmonary edema, consistent with over-circulation and resultant congestive heart failure.
Image 3.
Image 3.. Magnetic Resonance Angiogram:
Demonstrates extensive left upper extremity vascular anomaly. Notice that the left subclavian artery (red arrow) is larger than the aorta (yellow arrow).
Image 4.
Image 4.. Computational Fluid Dynamics (CFD) Model:
Model used to determine appropriate sizing for the subclavian artery band. Initial flow dynamics showeds 73% of total cardiac output traveling to the left subclavian (Qtot = total cardiac output; Qlsa = left subclavian artery flow; Qda = descending aortic flow; Qba + lca = flow to the brachiocephalic artery and left carotid artery).
Image 5.
Image 5.. Graph of CFD Modeling:
Indicates reduction of the internal diameter of the left subclavian artery to 3 mm was required to decrease subclavian arterial flow and consequently improve descending aortic and brachiocephalic arterial flows.
See this image and copyright information in PMC

References

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