Candidate's Plans/Training: The candidate plans a career as a patient-oriented researcher leveraging knowledge in fluid dynamics and image processing to further the practice of pediatric cardiology and cardiovascular imaging. My major research interest involves using fluid dynamic analysis in order to better understand the physiology of congenital heart disease, especially single ventricle physiology. Training will include formal imaging and computational fluid dynamics coursework, and closely mentored completion of the research protocol from both experienced clinical and technical mentors. Research: The group of patients with single ventricle physiology has probably seen more advancement in surgical technique and management than any other group of patients with congenital heart disease in the last two decades. However, they remain the most challenging group of patients to manage. The currently accepted technique of managing single ventricle patients generally involves three stages of surgery which culminate in the total cavopulmonary connection (TCPC). Because relatively small energy losses in the TCPC might result in the long-term failure of this physiology, it is becoming increasingly clear that these losses cannot be ignored. To this end, the primary aims of this proposal are: 1) to characterize the power loss of the TCPC of anatomical Fontan reconstructions under both resting and exercise conditions and to determine whether this power loss relates to exercise performance;2) study the differences in the flow fields and power loss of extracardiac and lateral tunnel Fontans to determine if one is energetically more favorable;3) to utilize exercise testing during cardiac magnetic resonance (CMR) using an MRI-compatible exercise bicycle to further our understanding of the Fontan physiology under resting and exercise conditions.
These aims will be studied using a combination of patient data (MRI's and exercise tests) and MRI-derived anatomically correct computer models of blood flow through these patients'TCPC using finite element computational fluid dynamic analysis.

Public Health Relevance

Public Health: The proposed research will add to our knowledge of how to care for patients with complex birth defects involving the heart, specifically patients with a single ventricle. These patients make up a growing population of adults as about 2000 per year are saved and most are surviving into adulthood.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL089647-05
Application #
8317727
Study Section
Special Emphasis Panel (ZHL1-CSR-R (M1))
Program Officer
Scott, Jane
Project Start
2008-09-15
Project End
2014-08-31
Budget Start
2012-09-01
Budget End
2014-08-31
Support Year
5
Fiscal Year
2012
Total Cost
$138,480
Indirect Cost
$9,480
Name
Children's Hospital of Philadelphia
Department
Type
DUNS #
073757627
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Avitabile, Catherine M; Leonard, Mary B; Zemel, Babette S et al. (2014) Lean mass deficits, vitamin D status and exercise capacity in children and young adults after Fontan palliation. Heart 100:1702-7
Tang, Elaine; Restrepo, Maria; Haggerty, Christopher M et al. (2014) Geometric characterization of patient-specific total cavopulmonary connections and its relationship to hemodynamics. JACC Cardiovasc Imaging 7:215-24
Glatz, Andrew C; Rome, Jonathan J; Small, Adam J et al. (2012) Systemic-to-pulmonary collateral flow, as measured by cardiac magnetic resonance imaging, is associated with acute post-Fontan clinical outcomes. Circ Cardiovasc Imaging 5:218-25
Dasi, Lakshmi P; Whitehead, Kevin; Pekkan, Kerem et al. (2011) Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac. J Thorac Cardiovasc Surg 141:207-14
Whitehead, Kevin K; Gillespie, Matthew J; Harris, Matthew A et al. (2009) Noninvasive quantification of systemic-to-pulmonary collateral flow: a major source of inefficiency in patients with superior cavopulmonary connections. Circ Cardiovasc Imaging 2:405-11
Whitehead, Kevin K; Sundareswaran, Kartik S; Parks, W James et al. (2009) Blood flow distribution in a large series of patients having the Fontan operation: a cardiac magnetic resonance velocity mapping study. J Thorac Cardiovasc Surg 138:96-102