Ingmar Voigt

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Robust Heart Valve Modeling & Advanced Computational Decision Support

Valvular heart disease (VHD) is a major public health problem with a prevalence of 2.5% in the US. Tens of thousands of minimally invasive procedures are performed every year and new therapeutical approaches are continuously developed at a rapid pace. Major clinical decisions and therapies are nowadays guided by peri- and intraoperative imaging with an increasing emphasis on 3D. Given the complexity of pathology and therapies in VHD, there is a strong need for fast, precise and reproducible quantification. To this end, several contributions are proposed in this thesis across various aspects of VHD management. These are structured into two parts: i) Mitral valve (MV) modeling and ii) advanced computational decision support. The first part starts with describing a comprehensive MV model obtained from 3D+t transesophageal echocardiography (TEE). An original methodology combines robust machine learning (ML) techniques and biomechanical constraints to obtain a temporally consistent estimate of model parameters. Extensive experiments on a large data set of 195 3D+t TEE volumes — comprising 3026 3D frames — demonstrate, that this automatic method is highly competitive in terms of speed and accuracy and outperforms purely data-driven methods in terms of robustness. Clinical evaluation in numerous centers around the world shows the applicability of its versatile quantification capabilities to various aspects of disease characterization and therapy planning. Subsequently a more lightweight alternative enables for robust 3D tracking of the MV annulus at high frame rates. Two parallel components based on ML and image-based tracking complement each other in robustness and speed. Experiments with emulated probe motion suggest suitability towards an interventional setting for guiding transcatheter mitral valve repair (TMVR) procedures. The second part proposes computational approaches for advanced decision support throughout the clinical workflow. First, the previously described valve modeling is combined with chamber models into a holistic and detailed model of the left heart. This enables for estimating patient-specific computational hemodynamics by serving as boundary condition for a level-set based computational fluid dynamics (CFD) solver. A validation concept using clinically acquired Doppler measurements is proposed and shows high agreement. Finally, a framework is presented for post-operative modeling of self-expandable stent devices for monitoring in transcatheter aortic valve implantation (TAVI) procedures. The technique is based on deformable simplex meshes, geometrical constraints and ML. Evaluation on postoperative computed tomography (CT) data shows promising accuracy.