Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector10429910.17816/pmj39174-84Methods of diagnostics and technologiesМетоды диагностики и технологииResearch ArticleProspects of mathematical modelling for optimization of intersystem bypass grafting in congenital heart diseases among childrenПерспективы математического моделирования для оптимизации межсистемного шунтирования при врожденных пороках сердца у детейhttps://orcid.org/0000-0002-8294-662XSinelnikovYu. S.СинельниковЮ. С.
Russian Federation

MD, PhD, cardiovascular surgeon, Chief Physician

доктор медицинских наук, сердечно-сосудистый хирург, главный врач

ysinelnikov@mail.ruhttps://orcid.org/0000-0002-1730-9050ArutyunyanV. B.АрутюнянВ. Б.
Russian Federation

MD, PhD, cardiovascular surgeon, Head of Cardiac Surgery Unit

доктор медицинских наук, сердечно-сосудистый хирург, заведующий кардиохирургическим отделением

ysinelnikov@mail.ruhttps://orcid.org/0000-0003-3624-3226PorodikovA. A.ПородиковАртем Александрович
Russian Federation

cardiovascular surgeon

сердечно-сосудистый хирург

ysinelnikov@mail.ruhttps://orcid.org/0000-0002-9314-3558BiyanovA. N.БияновА. Н.
Russian Federation

Candidate of Medical Sciences, Associate Professor, Department of Pediatrics with Course of Polyclinic Pediatrics

кандидат медицинских наук, доцент кафедры педиатрии с курсом поликлинической педиатрии

ysinelnikov@mail.ruhttps://orcid.org/0000-0003-0075-0226PospelovaN. S.ПоспеловаН. С.
Russian Federation

Candidate of Medical Sciences, Associate Professor, Department of Children’s Infectious Diseases

кандидат медицинских наук, доцент кафедры детских инфекционных болезней

ysinelnikov@mail.ruhttps://orcid.org/0000-0002-0466-175XKuchumovA. G.КучумовА. Г.
Russian Federation

Candidate of Physico-Mathematical Sciences, Associate Professor, Associate Professor of Department of Culculus Mathematics and Biomechanics

кандидат физико-математических наук, доцент, доцент кафедры вычислительной математики, механики и биомеханики; научный сотрудник

ysinelnikov@mail.ruhttps://orcid.org/0000-0002-3994-0388TuktamyshevB. S.ТуктамышевВ. С.
Russian Federation

Candidate of Physico-Mathematical Sciences, Associate Professor, Associate Professor of Department of Culculus Mathematics and Biomechanics

кандидат физико-математических наук, доцент, доцент кафедры вычислительной математики, механики и биомеханики

ysinelnikov@mail.ruS.G. Sukhanov Federal Center for Cardiovascular SurgeryФедеральный центр сердечно-сосудистой хирургии имени С.Г. СухановаE.A. Vagner Perm State Medical UniversityПермский государственный медицинский университет имени академика Е.А. ВагнераPerm National Research Polytechnic UniversityПермский национальный исследовательский политехнический университетKazan Federal UniversityКазанский (Приволжский) федеральный университет1501202239174840203202202032022Copyright ©; 2022, Sinelnikov Y.S., Arutyunyan V.B., Porodikov A.A., Biyanov A.N., Pospelova N.S., Kuchumov A.G., Tuktamyshev B.S.Copyright ©; 2022, Синельников Ю.С., Арутюнян В.Б., Породиков А.А., Биянов А.Н., Поспелова Н.С., Кучумов А.Г., Туктамышев В.С.2022Sinelnikov Y.S., Arutyunyan V.B., Porodikov A.A., Biyanov A.N., Pospelova N.S., Kuchumov A.G., Tuktamyshev B.S.Синельников Ю.С., Арутюнян В.Б., Породиков А.А., Биянов А.Н., Поспелова Н.С., Кучумов А.Г., Туктамышев В.С.http://creativecommons.org/licenses/by-sa/4.0https://permmedjournal.ru/PMJ/article/view/104299

Objective. To study the facilities of mathematical modelling of the system aorta-shunt-pulmonary artery for assessing the efficiency of shunt functioning.

Materials and methods. The risk factors for the development of complications in 35 newborns and infants of the first year of life were analyzed while carrying out the procedure of the modified Blalock-Taussig shunt (MBTShunt). The study lasted from 2016 to 2021. The age median at the time of operation was 10 (Q1–Q3: 3,5–30) days (from 1 to 180), the body mass median – 3,0 (Q1–Q3: 2,8–3,54) kg. The shunt size median was 3,5 mm (Q1–Q3: 3,5–3,5), and the median of shunt size per 1 kg of body mass – 1,11 (Q1–Q3: 1,0–1,21) mm/kg.

The shunt size was increased for 4 out of 35 (11.4%) patients. As a result of cooperation with Perm Polytechnic University, in the frameworks of the program of hydrodynamic modelling evaluation, the data from 4 patients were processed mathematically to assess blood flowing through the MBTShunt.

Results. Three (9 %) out of thirty five patients died in 3 (Q1–Q3: 2,5–11,0) (min–max 2–19) days because of cardiorespiratory decompensation. The only prognostically unfavorable risk factor for death was a large value of shunt size to body mass ratio (p=0.023). It was stated according to mathematical modelling data that the blood flow through the pulmonary arteries in all the analyzed types of shunts was not symmetric. An increase in the diameter of a shunt permits to improve a symmetry of blood flow through the left and right branches of the pulmonary artery.

Conclusions. The procedure of MBTShunt remains the procedure of high risk that is associated with a significant sickness rate and death rate in the early postoperative period. Mathematical modelling of the system aorta-shunt-pulmonary artery prior to the operation makes it possible to choose an optimal diameter of shunt and place of its implantation and will become one of the stages to personified surgery of congenital heart diseases in the future.

Цель. Проведен анализ факторов риска развития осложнений у 35 новорожденных и детей первого года жизни при проведении процедуры модифицированного шунтирования Блэлока – Тауссига (МБТШ). Изучены возможности математического моделирования системы «аорта – шунт – легочная артерия» для оценки эффективности функционирования шунта.

Материалы и методы. Исследование проводилось с 2016 по 2021 г. Медиана возраста на момент операции составила 10 (3,5–30) дней (от 1 до 180), медиана массы тела – 3,0 (2,8–3,54) кг. Медиана размера шунта составляла 3,5 мм (3,5–3,5), а медиана размера шунта на 1 кг массы тела – 1,11 (1,0–1,21) мм/кг. Увеличение размера шунта потребовалось 4 (11,4 %) пациентам из 35. В сотрудничестве с Пермским политехническим университетом в рамках программы оценки гидродинамического моделирования для оценки кровотока через МБТШ данные 4 пациентов были обработаны математически.

Результаты. Три (9 %) пациента из 35 умерли через 3 (2,5–11,0) дня из-за кардиореспираторной декомпенсации. Единственным прогностически неблагоприятным фактором риска смертности стали большие величины отношения – размер шунта к массе тела (p = 0,023). По данным математического моделирования было установлено, что поток крови по легочным артериям во всех анализируемых типах шунтов был не симметричен.

Выводы. Процедура МБТШ продолжает оставаться процедурой высокого риска, что связано со значительной заболеваемостью и смертностью в раннем послеоперационном периоде. Математическое моделирование системы «аорта – шунт – легочная артерия» перед операцией позволит выбрать оптимальный диаметр шунта и место его имплантации и станет одним из этапов к персонифицированной хирургии врожденных пороков сердца в будущем.

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