Hemodynamic changes of the fetal circulation in Twin-to-Twin Transfusion Syndrome: a computational modelling study

Monochorionic pregnancies are those in which identical twins share a single placenta. These twins are at increased risk for adverse outcomes due to the vascular connections that may be produced in the placenta, which can lead to severe complications such as Twin-to-Twin Transfusion Syndrome (TTTS). TTTS is characterized by a predominance of arterio-venous connections, that results in the chronic net flow of blood from one twin, defined as the donor, to the other, defined as the recipient. Without treatment, the donor presents growth restriction, while the recipient is at higher risk of suffering volume overload, brain injury and cardiac failure, which can lead to the death of one or both fetuses.

The clinical diagnosis of TTTS is challenging due to the small size of the twins’ connections, which cannot be directly assessed by imaging. In this thesis, we propose to expand our current single-fetus model of the cardiovascular system to represent both twins and use it to identify and analyze the hemodynamic alterations that occur in TTTS. This will be done in collaboration with obstetricians from Hospital Sant Joan de Déu and Maternitat de Barcelona, who will provide real clinical data.

Requisites:

  • Python and Matlab programming.
  • Basic knowledge of cardiac physiology.

References:

  • Villanueva, M. I., López, M., Sánchez, S., Garcia-Cañadilla, P., Randanne, P. C., Hawkins, A., Eixarch, E., Bonet-Carne, E., Gratacós, E., Crispi, F., Bijnens, B., & Bernardino, G. (2022). Haemodynamic Changes in the Fetal Circulation Post-connection to an Artificial Placenta: A Computational Modelling Study. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 13593 LNCS, 46–55. https://doi.org/10.1007/978-3-031-23443-9_5.
  • Garcia-Canadilla, P., Crispi, F., Cruz-Lemini, M., Triunfo, S., Nadal, A., Valenzuela-Alcaraz, B., Rudenick, P. A., Gratacos, E., & Bijnens, B. H. (2015). Patient-specific estimates of vascular and placental properties in growth-restricted fetuses based on a model of the fetal circulation. Placenta, 36(9), 981–989. https://doi.org/10.1016/j.placenta.2015.07.130.
  • Miller JL (2021). Twin to twin transfusion syndrome. Translational Pediatrics, 10(5), 1518-1529. https://doi.org/10.21037/tp-20-264.

Contact: [email protected], [email protected], [email protected]