By Lainey Graham ’16 —— Photography by Ashley Jones
In one of the body’s most intricate and difficult systems to heal, researcher and engineer Ethan Kung finds a challenge that motivates his life’s work. He leads Clemson’s Cardiovascular Modeling and Experimentation Research Laboratory, where mechanical and biomedical engineers collaborate with clinicians and the medical device industry to model the future of clinical care.
“There’s too much guesswork in diagnostics right now,” thought Ethan Kung as he walked away from the kitchen table where he’d spent 20 hours poring over academic literature. He was looking to see what his father’s clinicians in Taiwan could do to help with the coronary obstruction they’d found during a screening CT scan.
After listening to multiple doctors recommend different treatments according to
their specialty, he decided to look into the issue himself.
Kung works at the forefront of cardiovascular research. He is the director of the Cardiovascular Modeling and Experimentation Research Laboratory (CMERL) at Clemson, an associate professor of mechanical engineering and bioengineering, and part of an international community of biomedical researchers bringing clinicians and industry together to improve patients’ lives.
While researching coronary obstruction treatment for his father, he found that a variety of procedures were performed for the condition, but they were all invasive and carried their own risks for the patient. In his father’s case, it seemed that strictly limiting the lipids in his diet would be the most effective and low-risk action.
In his research, Kung also searches for the most effective treatment, using the simplest tool possible with the lowest risk. And he uses engineering principles to find it.
CHOOSE TO BE CHALLENGED
“I’ve always been interested in engineering and science,” says Kung, sitting in his office at Clemson. “And when I come to difficult decisions, like what major to choose in college or what path to take professionally, I have always just taken the hardest option. Because if you know you are capable of doing the hardest work you find interesting, you are using your full potential.”
That perspective led Kung to Stanford University for a master’s degree and a Ph.D. in bioengineering. There, he began work that continues today — work that applies engineering principles and modeling to clinical diagnostics and treatments. Work that helps clinicians know, rather than hope, that their recommendations for patients like his father will provide the best possible outcome.
At Clemson, Kung’s work crosses disciplines, but it centers on the heart.
He works with clinicians at the Medical University of South Carolina and in hospital systems as far away as Belgium to identify current clinical needs. He leads graduate and undergraduate students to develop new treatment methods — sometimes creating first-stage prototypes to gain proof of concept. He collaborates with cardiovascular medical device manufacturers to test existing devices for new applications in the body, and he teaches multiple engineering courses, too.
For Kung, the intersection of current clinical needs and existing medical resources represents an area of exciting potential. He wants to see industry, academia and clinicians collaborate more effectively to reach their full potential and provide better patient care.
VIRTUAL PATIENTS. IRL ANSWERS.
In his lab, Kung is developing a unique type of modeling-based personalized medicine, which could shift the current clinical paradigm for highly complex cardiovascular operations. The hybrid model he has created addresses the “hardware-in-the-loop” challenge, which answers specific clinical questions involving devices connected to the heart and/or blood vessels.
In 2018, Kung succeeded in developing this novel technique combining a physical experiment with a computational simulation to gather two-way feedback. And since 2018, his lab has created four new versions of the coupling algorithm, each contributing additional capabilities. This enables him to study high-risk clinical situations like heart failure.
When a patient has heart failure, clinicians must make multiple decisions:
➀ Does this patient require a blood pump?
➁ If so, what type of pump should I put in?
➂ Where should I connect the pump to the heart and the artery?
➃ What RPM (revolution per minute) setting should I use?
➄ What are the risks of installing a blood pump for this patient?
Until now, the information physicians have had to make those decisions has been generalized. They know about the statistics on different types of pumps, settings that have been successful in the past and different pump placement options. But they use intuition to gauge how all those factors apply to the current patient’s condition.
INDIVIDUALIZE TREATMENT PLANNING
The idea of virtual patients is a popular conversation among cardiovascular researchers and surgeons today, but currently, simulated patients and the physical devices available to treat them are disconnected.
The novel process Kung has developed allows him to take a physical device, like a blood pump, and connect it to a computer that simulates a real patient based on the patient’s data. Through this connection, he can run hundreds of simulations and make predictions about the outcomes of different clinical plans and procedures.
“Our goal was to create a way to test out scenarios without actually testing on the patient,” Kung says. “This process allows us to try different things and see what the relative outcomes are. It can even help with procedure planning because we can model different processes and outcomes first.”
For Kung, removing trial and error from real patients is of utmost importance. He wants patients like his father to receive the most effective treatment possible on the first try. This technique creates a foundation for hyperpersonalized treatment planning in the future and expands opportunities for his engineering students to serve patients and their families today.
THINK SMALL
When a baby is born with half of his or her heart, he or she has a condition known as single ventricle defect, which requires three major surgeries. Kung is part of an international network of researchers partnering with hospitals to improve care for single ventricle patients, and he invites students to learn about this work in his class.
Typically, the heart has two sides. The left side of the heart pumps blood through the systemic circulation, where blood supplies oxygen to the body. The right side pumps blood through the pulmonary circulation, where blood is re-oxygenated. Each half of the heart is responsible for one of the two circulations, but if half of the heart is not there, then one of the circulations will not have anything to pump. To survive, babies born with half of a heart require a shunting procedure that generates blood flow in both circulations.
Clinicians need to control the amount of flow with the shunting procedure. This is where Kung’s research comes in.
His lab has been testing the efficacy of a device called the FloWatch to see if it could be used in this surgical condition. The FloWatch can clamp the shunt to different levels, controlling the amount of blood flowing through it. It does not need to be charged and is wireless, meaning its settings can be adjusted as needed without an invasive procedure.
Kung and his students developed ways to test the device and a model simulating the different conditions in which it would need to perform.
Their findings will help guide clinicians and manufacturers of the FloWatch device as they seek to apply it in infant-sized shunt grafts.
MAKE TECHNICAL WORK PERSONAL
Kung is a husband and father to two young children, so he can begin to imagine the emotional challenges children with single ventricles and their parents face. They live every day with a terminal diagnosis looming overhead.
Through church, Kung met the Walton family, whose son, Yahya, was born with a single ventricle. After they expressed willingness to participate, he recorded an interview with them for his classes so the future engineers could make a human connection to their technical work.
“I want my students to know that our work is going to help real people,” Kung says. “Often, our immediate goal might be to make an algorithm or do some specific experiments, but the big-picture goal is to create new methods and tools so that clinicians, patients and their families have an easier time.”
“Ethan is committed to delivering solutions to the community of clinicians and patients. He has provided ideas and dossiers for project funding, brought a unique innovative approach to the scientific side of our project, and assembled a team of experts and engineers needed to achieve our goals.”
Florence Porte Thomé, PharmD
Founder and Chief Scientific Officer, EspeRare Foundation
For Kung’s students, it was eye-opening. And for the Waltons — who heard that there are rooms full of future engineers and researchers who could help create treatments for patients like their son — it was encouraging.
Today, it is possible for people living with a single ventricle to live up to 50 years before requiring a heart transplant. But sadly, Yahya passed away a few months after Kung conducted the interviews with his parents. He was 5 years old, and his surgeon happened to be the doctor with whom Kung works directly at the Medical University of South Carolina.
For Kung, speaking with Yahya’s parents and the surgeon who tried to save him reinforced the importance of developing devices like the FloWatch and reliable models to improve personalized patient care. But it also emphasized the unpredictability of cardiovascular conditions.
“Many things are outside the control of engineering models and skilled surgeons,” Kung remarks. “But we are working to reduce uncertainty in this area day by day.”
In developed countries, cardiovascular disease is the most prevalent killer. And in the lives of patients and their clinicians, Kung finds a calling.
DON’T SET LIMITS. WORK WITH EVERYONE.
“In CMERL, we partner with the American Heart Association, The Children’s Heart Foundation and EspeRare, a nonprofit in Europe, to research solutions for rare diseases,” Kung says.
Because it is often difficult to procure funding to work on diseases with small patient populations, there are currently groups of patients without care. And that is something Kung is trying to change with his lab, his students and the international network of researchers he partners with.
Finding ways to adapt existing devices to help in the case of rare diseases leads to new treatment methods. Connecting existing medical devices with real patient data in a computer simulation and modeling the effect of thousands of different actions gives clinicians a strong idea of how to begin treating diseases that are not yet addressed in textbooks. Creating the technology and processes for personalized modeling, diagnosing and treating levels the playing field for clinical care. Because when a doctor has a treatment recommendation created with thousands of simulations run using the current patient’s medical records, even rare diseases have science-backed treatment options.
“It’s hard to say what is going to make the biggest impact,” remarks Kung when asked about the future of his work.
“We have projects in process that will affect very large numbers of people, but at the same time, work like our single ventricle project will impact fewer people in a different way,” he says. “I think the idea is that you do things that will help people one way or another.
“You help the person who’s in front of you.”
It is inspiring to read this! As a former engineering student who transferred to a different major many years ago because of the perceived disconnect between what my education and its impact on the people who would benefit from my education, I highly support Dr. Kung’s teaching methodology. More of this please! And as a staff member at Clemson, it makes me proud to be a part of an institution that supports groundbreaking innovation and poignant education practices. May we all contribute to a better society!
Great article! I deal with mechanical equipment failures, and I’ve always thought that clinicians need to find and fix the root cause of human body issues. The movie Lorenzo’s Oil comes to mind.