Semi-Automated Generation and Hemodynamic Assessment of Surgical Baffle Geometry for Biventricular Repair

Abstract

Patient-specific computational modeling has emerged as a powerful tool for surgical planning in complex congenital heart disease. One promising application is complex biventricular repair, which often requires construction of a custom intraventricular baffle to establish a physiologic left ventricle-to-aorta outflow pathway. In current practice, baffle geometry is designed and shaped intraoperatively and preoperative planning remains largely manual, limiting the ability to generate anatomically conformal, watertight models suitable for quantitative hemodynamic assessment. In this work, we present a semi-automated computational framework for the design and assessment of patient-specific intraventricular baffles. The method constructs an explicit VSD-to-aorta flow pathway, preserves native right ventricular geometry, and reshapes only the baffle region using section-wise area constraints along a physiologically aligned centerline. The resulting geometry is integrated into a closed, multi-labeled domain for computational fluid dynamics analysis. We retrospectively applied this framework to four patients with double outlet right ventricle (DORV) who previously underwent biventricular repair. For each case, a patient-specific baffle was generated and its hemodynamic performance was evaluated using CFD. Predicted pressure gradients across the reconstructed outflow were within clinically acceptable ranges and comparable to the patients' postoperative echocardiographs. This approach enables quantitative, pre-operative design and evaluation of candidate baffle geometries and provides a reproducible method for generating simulation-ready models. By combining physiologically constrained geometric design with CFD-based assessment, the framework represents a step toward computational, patient-specific decision support for biventricular flow restoration in a complex heterogeneous patient population.