Hemodynamic Effects of A Simplified Venturi Conduit for Fontan Circulation: A Pilot, In Silico Analysis

Objectives: To study the effects of a self-powered Fontan circulation in both idealized Fontan models and patient-specific models. Methods: In silico, a conduit with a nozzle was introduced from ascending aorta into the anastomosis of superior vena cava and pulmonary artery. Computational fluid dynamics (CFD) simulation was applied to calculate the fluid fields of models. Three 3-dimentional idealized models with different offsets were reconstructed by computer-aided design to evaluate the effects of the self-powered conduit. Furthermore, to validate the effects in patient-specific models, the conduit was introduced to three reconstructed models with different offsets. Results: The pressures at superior venae cavae and inferior venae cavae were decreased in both idealized models (0.4 mmHg) and patient-specific models (0.7 mmHg). In idealized models, the flows to left lungs were decreased (70%) by the jets from the conduits. However, in patient-specific models, the reductions of blood to the left lungs were relatively limited (30%) comparing to idealized models. Conclusions: CFD simulation was applied to analyze the effectiveness of the Fontan self-powered conduit. This self-powered conduit may help to decrease the venae cavae pressures and increase the flow to pulmonary arteries.

[1]  F. Fontan,et al.  Surgical repair of tricuspid atresia , 1971, Thorax.

[2]  H. Iseki,et al.  Effects of nonpulsatile and pulsatile right ventricular bypass on pulmonary circulation. , 1988, ASAIO transactions.

[3]  J. Raj,et al.  Effect of pulsatile flow on microvascular resistance in adult rabbit lungs. , 1992, Journal of applied physiology.

[4]  M. Rosenthal,et al.  Comparison of cardiopulmonary adaptation during exercise in children after the atriopulmonary and total cavopulmonary connection Fontan procedures. , 1995, Circulation.

[5]  E. M. Pedersen,et al.  Flow during exercise in the total cavopulmonary connection measured by magnetic resonance velocity mapping , 2002, Heart.

[6]  A. Yoganathan,et al.  The effects of different mesh generation methods on computational fluid dynamic analysis and power loss assessment in total cavopulmonary connection. , 2004, Journal of biomechanical engineering.

[7]  K. Vaesen,et al.  Robustness Analysis , 2006, Philosophy of Science.

[8]  C. Brizard,et al.  The Fontan Procedure: Contemporary Techniques Have Improved Long-Term Outcomes , 2007, Circulation.

[9]  A. Yoganathan,et al.  Blood flow distribution in a large series of patients having the Fontan operation: a cardiac magnetic resonance velocity mapping study. , 2009, The Journal of thoracic and cardiovascular surgery.

[10]  Brandon W. Coats,et al.  Cavopulmonary assist for the univentricular Fontan circulation: von Kármán viscous impeller pump. , 2010, The Journal of thoracic and cardiovascular surgery.

[11]  A. Yoganathan,et al.  Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac. , 2011, Journal of Thoracic and Cardiovascular Surgery.

[12]  A. Marsden,et al.  Hepatic blood flow distribution and performance in conventional and novel Y-graft Fontan geometries: a case series computational fluid dynamics study. , 2012, The Journal of thoracic and cardiovascular surgery.

[13]  James P. Carr,et al.  Uniquely shaped cardiovascular stents enhance the pressure generation of intravascular blood pumps. , 2012, The Journal of thoracic and cardiovascular surgery.

[14]  Jinfen Liu,et al.  Extracardiac Fontan With Direct Cavopulmonary Connections: Midterm Results , 2012, World journal for pediatric & congenital heart surgery.

[15]  E. Bacha,et al.  Effects of lack of pulsatility on pulmonary endothelial function in the Fontan circulation. , 2013, The Journal of thoracic and cardiovascular surgery.

[16]  Yingzheng Liu,et al.  Extracardiac Fontan with direct cavopulmonary connections: midterm results. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  Jarek Rossignac,et al.  Surgical Planning of the Total Cavopulmonary Connection: Robustness Analysis , 2014, Annals of Biomedical Engineering.

[18]  Shu Takagi,et al.  Patient‐specific assessment of cardiovascular function by combination of clinical data and computational model with applications to patients undergoing Fontan operation , 2014, International journal for numerical methods in biomedical engineering.

[19]  F. Liang,et al.  Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. , 2014, American journal of physiology. Heart and circulatory physiology.

[20]  J. Galati,et al.  Redefining Expectations of Long-Term Survival After the Fontan Procedure: Twenty-Five Years of Follow-Up From the Entire Population of Australia and New Zealand , 2014, Circulation.

[21]  A. Marsden,et al.  The assisted bidirectional Glenn: a novel surgical approach for first-stage single-ventricle heart palliation. , 2015, The Journal of thoracic and cardiovascular surgery.

[22]  R. Weisel,et al.  Cavopulmonary Support with a Microaxial Pump for the Failing Fontan Physiology , 2015, ASAIO journal.

[23]  H. Reichenspurner,et al.  Towards a Tissue-Engineered Contractile Fontan-Conduit: The Fate of Cardiac Myocytes in the Subpulmonary Circulation , 2016, PloS one.

[24]  Y. D'udekem,et al.  Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation , 2017, Journal of the American Heart Association.

[25]  A. Marelli,et al.  Fontan-associated liver disease: proceedings form the American College of Cardiology stakeholders meeting , 2017 .

[26]  S. Colan,et al.  Longitudinal Outcomes of Patients With Single Ventricle After the Fontan Procedure. , 2017, Journal of the American College of Cardiology.

[27]  S. Gent,et al.  Shear accumulation as a means for evaluating risk of thromboembolic events in novel endovascular stent graft designs , 2017, Journal of vascular surgery.

[28]  D. Morales,et al.  Ventricular assist device use in single ventricle congenital heart disease , 2017, Pediatric transplantation.

[29]  M. Fogel,et al.  Hepatic Fibrosis Is Universal Following Fontan Operation, and Severity is Associated With Time From Surgery: A Liver Biopsy and Hemodynamic Study , 2017, Journal of the American Heart Association.

[30]  A. Marsden,et al.  Optimization of the Assisted Bidirectional Glenn Procedure for First Stage Single Ventricle Repair , 2018, World journal for pediatric & congenital heart surgery.

[31]  M. Jongbloed,et al.  Energetics of Blood Flow in Cardiovascular Disease: Concept and Clinical Implications of Adverse Energetics in Patients With a Fontan Circulation , 2018, Circulation.

[32]  Marcus W. Ni,et al.  Computational Investigation of a Self-Powered Fontan Circulation , 2018, Cardiovascular engineering and technology.