Patient-Specific Surgery Planning for the Fontan Procedure

Objectives: Patient-specific multiscale modeling simulates virtual surgeries of the Fontan procedure using three different graft options. Predictive modeling details post-operative outcomes that can help inform clinical decision support. Methods: Six patients underwent preoperative cardiac magnetic resonance imaging and catheterization. Virtual surgery is carried out for each patient to test the resulting hemodynamics of three Fontan graft options: ECC, 9mm Y-graft, and 12mm Y-graft. Results: 1) one-way ANOVA p>0.998 in all systemic pressures and flows between graft options, 2) p=0.706 for hepatic flow distribution between graft options, 3) local power loss differences do not affect the systemic circulation, 4) anastomosis positioning modification of the same Y-graft in the same patient changed left PA hepatic distribution from 0.66 to 0.49 Conclusions: Systemic pressures and blood flow after the Fontan procedure are not affected by graft selection but are well influenced by patient pulmonary vascular impedance. The hepatic distribution can be affected by anastomosis placement.

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High-Order Large Eddy Simulation of Flow in Idealized and Patient-Specific Total Cavopulmonary Connections

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53549 ◽

2011 ◽

Author(s):

Kameswararao Anupindi ◽

Steven Frankel ◽

Jun Chen ◽

Dinesh Shetty ◽

Jeffrey Kennington ◽

...

Keyword(s):

Inferior Vena ◽

Fontan Procedure ◽

Pulmonary Arteries ◽

Patient Specific ◽

Complex Congenital Heart Disease ◽

Eddy Simulation ◽

Large Eddy ◽

Left And Right ◽

Viscous Impeller Pump ◽

Cavopulmonary Connection

The Fontan procedure is used in pediatric situations in which infants have complex congenital heart disease or a single effective ventricle. This procedure by-passes right heart by connecting the left and right pulmonary arteries (LPA/RPA) to the superior and inferior vena cavae (SVC/IVC). The resulting reconstructed anatomy is called total cavopulmonary connection or TCPC. Knowledge of fluid dynamics in TCPC helps in optimizing the connection itself for reduced resistance as well as aids in designing cavopulmonary assist devices like viscous impeller pump (VIP) [1].

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Hemodynamics Characteristics of a Four-Way Right-Atrium Bypass Connector

Journal of Fluids Engineering ◽

10.1115/1.4040214 ◽

2018 ◽

Vol 140 (12) ◽

Cited By ~ 1

Author(s):

Elizabeth Mack ◽

Alexandrina Untaroiu

Keyword(s):

Superior Vena Cava ◽

Right Atrium ◽

Superior Vena ◽

Fontan Procedure ◽

Pulmonary Arteries ◽

Vena Cava ◽

Right Ventricular Dysfunction ◽

Patient Specific ◽

Optimal Size ◽

Size Change

Currently, the surgical procedure followed by the majority of cardiac surgeons to address right ventricular dysfunction is the Fontan procedure, which connects the superior vena cava and inferior vena cava (IVC) directly to the left and right pulmonary arteries (LPA and RPA, respectively) bypassing the right atrium. The goal of this study is to develop a patient-specific four-way connector to bypass the dysfunctional right ventricle and augment the pulmonary circulation. The four-way connector was intended to channel the blood flow from the inferior and superior vena cava directly to the RPA and LPA. By creating a connector with proper hemodynamic characteristics, one can control the jet flow interactions between the inferior and superior vena cava and streamline the flow toward the RPA and LPA. The focus for this study was on creating a system that could identify the optimal configuration for the four-way connector for patients from 0 to 20 years of age. A platform was created in ANSYS that utilized the design of experiments (DOE) function to minimize power-loss and blood damage propensity in the connector based on junction geometries. It was confirmed that as the patient's age and artery size change, the optimal size and shape of the connector also changes. However, the corner radius did not decrease at the same rate as the opening diameters. However, it was found that power losses within the connector decrease, and average and maximum blood traversal time through the connector increased for increasing opening radius.

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Patient-Specific Polyvinyl Alcohol Phantom Fabrication with Ultrasound and X-Ray Contrast for Brain Tumor Surgery Planning

Journal of Visualized Experiments ◽

10.3791/61344 ◽

2020 ◽

Author(s):

Eleanor C. Mackle ◽

Jonathan Shapey ◽

Efthymios Maneas ◽

Shakeel R. Saeed ◽

Robert Bradford ◽

...

Keyword(s):

Brain Tumor ◽

Polyvinyl Alcohol ◽

Patient Specific ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Surgery Planning ◽

X Ray

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A Method for In Vitro TCPC Compliance Verification

Journal of Biomechanical Engineering ◽

10.1115/1.4036474 ◽

2017 ◽

Vol 139 (6) ◽

Cited By ~ 7

Author(s):

Mike Tree ◽

Zhenglun Alan Wei ◽

Brady Munz ◽

Kevin Maher ◽

Shriprasad Deshpande ◽

...

Keyword(s):

Material Properties ◽

Heart Defects ◽

Fontan Procedure ◽

Magnetic Resonance Images ◽

Model Material ◽

Patient Specific ◽

Pressure Data ◽

Specific Flow ◽

Compliance Testing

The Fontan procedure is a common palliative intervention for sufferers of single ventricle congenital heart defects that results in an anastomosis of the venous return to the pulmonary arteries called the total cavopulmonary connection (TCPC). Local TCPC and global Fontan circulation hemodynamics are studied with in vitro circulatory models because of hemodynamic ties to Fontan patient long-term complications. The majority of in vitro studies, to date, employ a rigid TCPC model. Recently, a few studies have incorporated flexible TCPC models, but provide no justification for the model material properties. The method set forth in this study successfully utilizes patient-specific flow and pressure data from phase contrast magnetic resonance images (PCMRI) (n = 1) and retrospective pulse-pressure data from an age-matched patient cohort (n = 10) to verify the compliance of an in vitro TCPC model. These data were analyzed, and the target compliance was determined as 1.36 ± 0.78 mL/mm Hg. A method of in vitro compliance testing and computational simulations was employed to determine the in vitro flexible TCPC model material properties and then use those material properties to estimate the wall thickness necessary to match the patient-specific target compliance. The resulting in vitro TCPC model compliance was 1.37 ± 0.1 mL/mm Hg—a value within 1% of the patient-specific compliance. The presented method is useful to verify in vitro model accuracy of patient-specific TCPC compliance and thus improve patient-specific hemodynamic modeling.

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Modeling of Patient-Specific Fontan Physiology From MRI Images for CFD Testing of a Cavopulmonary Assist Device

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53339 ◽

2011 ◽

Author(s):

Jonathan DeGan ◽

Jeffrey Kennington ◽

Kameswararao Anupindi ◽

Dinesh Shetty ◽

Jun Chen ◽

...

Keyword(s):

Inferior Vena ◽

Fontan Procedure ◽

Pulmonary Arteries ◽

Patient Specific ◽

Systemic Blood Flow ◽

Congenital Condition ◽

Left And Right ◽

Fontan Physiology ◽

Cavopulmonary Connection ◽

Cavopulmonary Assist Device

Single ventricle heart disease is a congenital condition characterized by the inoperability of one ventricle of an infant’s heart. Those suffering from this condition face a series of palliative surgeries called the Fontan procedure, which bypasses the non-functional ventricle by creating a total cavopulmonary connection, or TCPC. This TCPC forms from the anastomosis of the superior and inferior vena cavae (SVC, IVC) to the left and right pulmonary arteries (LPA, RPA), thus allowing systemic blood flow to bypass the heart and flow passively to the lungs. The Fontan procedure creates this junction with three surgeries separated by months or years.

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Magnetic resonance imaging-guided surgical design: can we optimise the Fontan operation?

Cardiology in the Young ◽

10.1017/s1047951113001637 ◽

2013 ◽

Vol 23 (6) ◽

pp. 818-823 ◽

Cited By ~ 1

Author(s):

Christopher M. Haggerty ◽

Ajit P. Yoganathan ◽

Mark A. Fogel

Keyword(s):

Planning Process ◽

Fontan Procedure ◽

Fontan Operation ◽

Patient Specific ◽

Modern Approach ◽

Technological Advances ◽

Operative Planning ◽

Fontan Surgery ◽

Improve Patient

AbstractThe Fontan procedure, although an imperfect solution for children born with a single functional ventricle, is the only reconstruction at present short of transplantation. The haemodynamics associated with the total cavopulmonary connection, the modern approach to Fontan, are severely altered from the normal biventricular circulation and may contribute to the long-term complications that are frequently noted. Through recent technological advances, spear-headed by advances in medical imaging, it is now possible to virtually model these surgical procedures and evaluate the patient-specific haemodynamics as part of the pre-operative planning process. This is a novel paradigm with the potential to revolutionise the approach to Fontan surgery, help to optimise the haemodynamic results, and improve patient outcomes. This review provides a brief overview of these methods, presents preliminary results of their clinical usage, and offers insights into its potential future directions.

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