scholarly journals The right auricle tunnel as intercaval tunnel in total cavopulmonary connection may prevent atrial flutter1

1998 ◽  
Vol 14 (6) ◽  
pp. 590-595 ◽  
Author(s):  
Tjalling W. Waterbolk ◽  
Margreet Th.E. Bink-Boelkens ◽  
Nynke J. Elzenga ◽  
Gertie C.M. Beaufort-Krol ◽  
Tjark Ebels
Keyword(s):  
Total Cavopulmonary Connection ◽  
The Right ◽  
Cavopulmonary Connection

The Effect of Incorporating Vessel Compliance in a Computational Model of Blood Flow in a Total Cavopulmonary Connection (TCPC) with Caval Centerline Offset

2004 ◽  
Vol 126 (6) ◽  
pp. 709-713 ◽  
Author(s):  
J. C. Masters ◽  
M. Ketner ◽  
M. S. Bleiweis ◽  
M. Mill ◽  
A. Yoganathan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Power Loss ◽  
Fluid Dynamic ◽  
Reducing Power ◽  
Pressure Head ◽  
Congenital Defects ◽  
Total Cavopulmonary Connection ◽  
Flow Mixing ◽  
The Right ◽  
Cavopulmonary Connection

Background—The total cavopulmonary connection (TCPC), a palliative correction for congenital defects of the right heart, is based on the corrective technique developed by Fontan and Baudet. Research into the TCPC has primarily focused on reducing power loss through the connection as a means to improve patient longevity and quality of life. The goal of our study is to investigate the efficacy of including a caval offset on the hemodynamics and, ultimately, power loss of a connection. As well, we will quantify the effect of vessel wall compliance on these factors and, in addition, the distribution of hepatic blood to the lungs. Methods—We employed a computational fluid dynamic model of blood flow in the TCPC that includes both the non-Newtonian shear thinning characteristics of blood and the nonlinear compliance of vessel tissue. Results—Power loss in the rigid-walled simulations decayed exponentially as caval offset increased. The compliant-walled results, however, showed that after an initial substantial decrease in power loss for offsets up to half the caval diameter, power loss increased slightly again. We also found only minimal mixing in both simulations of all offset models. Conclusions—The increase in power loss beyond an offset of half the caval diameter was due to an increase in the kinetic contribution. Reduced caval flow mixing, on the other hand, was due to the formation of a pressure head in the offset region which acts as a barrier to flow.

Successful surgical repair of Uhl's anomaly

2002 ◽  
Vol 12 (2) ◽  
pp. 192-195 ◽  
Author(s):  
Nawal Azhari ◽  
Mervat Assaqqat ◽  
Ziad Bulbul
Keyword(s):  
Right Ventricle ◽  
Surgical Repair ◽  
Total Cavopulmonary Connection ◽  
Thromboembolic Stroke ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
Patch Closure ◽  
The Right ◽  
Cavopulmonary Connection

We report a case of Uhl's anomaly in a 5-month-old cyanotic infant who presented with thromboembolic stroke and acute hemiparesis. The patient underwent successfully an initial surgical repair, which included exclusion of the right ventricle by patch closure of the tricuspid valve, atrial septectomy and construction of a bidirectional Glenn shunt. This was followed by successful construction of a total cavopulmonary connection.

Investigation of Vessel Growth and its Impact on Hemodynamics in Patients With Lateral Tunnel Total Cavopulmonary Connection

2012 ◽  
Author(s):  
Maria Restrepo ◽  
Lucia Mirabella ◽  
Elaine Tang ◽  
Chris Haggerty ◽  
Mark A. Fogel ◽  
...  
Keyword(s):  
Heart Defects ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Lateral Tunnel ◽  
Vessel Growth ◽  
Original Size ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle heart defects affect 2 per 1000 live births in the US and are lethal if left untreated. The Fontan procedure used to treat these defects consists of a series of palliative surgeries to create the total cavopulmonary connection (TCPC), which bypasses the right heart. In the last stage of this procedure, the inferior vena cava (IVC) is connected to the pulmonary arteries (PA) using one of the two approaches: the extra-cardiac (EC), where a synthetic graft is used as the conduit; and the lateral tunnel (LT) where part of the atrial wall is used along with a synthetic patch to create the conduit. The LT conduit is thought to grow in size in the long term because it is formed partially with biological tissue, as opposed to the EC conduit that retains its original size because it contains only synthetic material. The growth of the LT has not been yet quantified, especially in respect to the growth of other vessels forming the TCPC. Furthermore, the effect of this growth on the hemodynamics has not been elucidated. The objective of this study is to quantify the TCPC vessels growth in LT patients from serial magnetic resonance (MR) images, and to understand its effect on the connection hemodynamics using computational fluid dynamics (CFD).

scholarly journals Analysis and regulation of the cardiovascular system of univentricular heart with different configurations of the total cavopulmonary connection

2021 ◽  
Vol 2091 (1) ◽  
pp. 012023
Author(s):  
A A Galiastov ◽  
D V Telyshev
Keyword(s):  
Cardiovascular System ◽  
Artificial Heart ◽  
Total Artificial Heart ◽  
Univentricular Heart ◽  
Total Cavopulmonary Connection ◽  
Assist Device ◽  
Ventricular Assist ◽  
Internal Parameters ◽  
The Right ◽  
Cavopulmonary Connection

Abstract The cardiovascular system (CVS) is a complex mechanism capable of reacting and regulating various changes in external and internal parameters. A particular problem is the study of CVS with univentricular heart. We studied the hemodynamic response of the CVS to the use of various configurations of bypassing the right side of the heart. During our research, we selected three different configurations of the total cavopulmonary connection. All configurations were made from Clear Flex 50 and tested in an experimental workbench. According to the research results, the TCPC-3 configuration is the most optimal. It has symmetrical output values of flows and pressures and there is no significant increase in inlet pressure. The results of this study can be used to optimize the control of the parameters of the ventricular assist device and the total artificial heart.

scholarly journals Case Report: An Anomalous Left Hepatic Venous Connection in a Patient With Unexpected Cyanosis

2021 ◽  
Vol 9 ◽  
Author(s):  
Fanyan Luo ◽  
Haisong Bu
Keyword(s):  
Rural Areas ◽  
Treatment Time ◽  
Superior Vena ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Blood Oxygen Saturation ◽  
Tunnel Technique ◽  
Cardiac Lesions ◽  
The Right ◽  
Cavopulmonary Connection

An anomalous left hepatic venous (LHV) connection is an extremely rare cardiac malformation, and left hepatic venous route abnormalities not associated with other cardiac lesions do not require surgical treatment because they are physiologically benign. However, when venous route abnormalities exist with associated cardiac lesions, the conduct of the cardiac surgical repair must accommodate the abnormal venous anatomy, especially in total cavopulmonary connection patients. Herein, we present a rare case of a 7-year-old Chinese boy about 1 year post bilateral superior vena cava pulmonary anastomosis who presented with severe cyanosis and was referred to our department. However, the patient showed an unexpected gradual decrease in blood oxygen saturation to 60–70% after the extracardiac total cavopulmonary connection (ETCPC) operation. Emergency echocardiography and computed tomography confirmed that the LHV entered the right atrium. Subsequently, the patient undergone completion of a staged TCPC with intra-atrial tunnel technique. This illustrative report highlights the essence of improving the preoperative accurate diagnosis to avoid unplanned reoperation in China, especially for the remote rural areas of eastern countries where the level of health care and services is relatively backward. Failure to identify anomalous LHV connection, in this case, will delay effective treatment past the optimal treatment time.

Effect of Flow Pulsatility and Wall Compliance on the Energy Loss in the Total Cavopulmonary Connection

2013 ◽  
Author(s):  
Reza H. Khiabani ◽  
Sulisay Phonekeo ◽  
Harish Srinimukesh ◽  
Elaine Tang ◽  
Mark Fogel ◽  
...  
Keyword(s):  
Energy Loss ◽  
Wall Motion ◽  
Heart Defects ◽  
Superior Vena ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Venous Flow ◽  
The Right ◽  
Cavopulmonary Connection

Single Ventricle Heart Defects (SVHD) are present in 2 per 1000 live births in the US. SVHD are characterized by cyanotic mixing between the de-oxygenated blood from the systemic circulation return and the oxygenated blood from the pulmonary arteries. In the current practice, surgical interventions on SVHD patients commonly result in the total cavopulmonary connection (TCPC) [1]. In this configuration the systemic venous returns (inferior vena cava, IVC, and superior vena cava, SVC) are directly routed to the right and left pulmonary arteries (RPA and LPA), bypassing the right heart. The resulting anatomy has complex and unsteady hemodynamics characterized by flow mixing and flow separation. Pulsation of the inlet venous flow during a cardiac cycle and wall motion may result in complex and unsteady flow patterns in the TCPC. Although vessel wall motion and different degrees of pulsatility have been observed in vivo, non-pulsatile (time-averaged) flow boundary conditions and rigid walls have traditionally been assumed in estimating the TCPC hemodynamic parameters (such as energy loss). Recent studies have shown that these assumptions may result in significant inaccuracies in modeling TCPC hemodynamics [2, 3].

Theoretical analysis of rest and exercise hemodynamics in patients with total cavopulmonary connection

2002 ◽  
Vol 282 (3) ◽  
pp. H1018-H1034 ◽  
Author(s):  
Elisa Magosso ◽  
Silvio Cavalcanti ◽  
Mauro Ursino
Keyword(s):  
Cardiac Output ◽  
Venous Return ◽  
Poor Response ◽  
Intrathoracic Pressure ◽  
Systemic Arterial Pressure ◽  
Regulatory Mechanisms ◽  
Total Cavopulmonary Connection ◽  
The Right ◽  
The Impact ◽  
Cavopulmonary Connection

The objective of this study was to determine the impact of a total cavopulmonary connection on the main hemodynamic quantities, both at rest and during exercise, when compared with normal biventricular circulation. The analysis was performed by means of a mathematical model of the cardiovascular system. The model incorporates the main parameters of systemic and pulmonary circulation, the pulsating heart, and the action of arterial and cardiopulmonary baroreflex mechanisms. Furthermore, the effect of changes in intrathoracic pressure on venous return is also incorporated. Finally, the response to moderate dynamic exercise is simulated, including the effect of a central command, local metabolic vasodilation, and the “muscle pump” mechanism. Simulations of resting conditions indicate that the action of baroreflex regulatory mechanisms alone can only partially compensate for the absence of the right heart. Cardiac output and mean systemic arterial pressure at rest show a large decrease compared with the normal subject. More acceptable hemodynamic quantity values are obtained by combining the action of regulatory mechanisms with a chronic change in parameters affecting mean filling pressure. With such changes assumed, simulations of the response to moderate exercise show that univentricular circulation exhibits a poor capacity to increase cardiac output and to sustain aerobic metabolism, especially when the oxygen consumption rate is increased above 1.2–1.3 l/min. The model ascribes the poor response to exercise in these patients to the incapacity to sustain venous return caused by the high resistance to venous return and/or to exhaustion of volume compensation reserve.

the patterns of flow in the total extracardiac cavopulmonary connection

2004 ◽  
Vol 14 (S3) ◽  
pp. 53-56 ◽  
Author(s):  
antonio amodeo ◽  
mauro grigioni ◽  
giuseppe d'avenio ◽  
carla daniele ◽  
roberto m. di donato
Keyword(s):  
Right Ventricle ◽  
Clinical Outcomes ◽  
Right Atrium ◽  
Pulmonary Arteries ◽  
Total Cavopulmonary Connection ◽  
Remarkable Improvement ◽  
Dissipation Of Energy ◽  
Intracardiac Extension ◽  
The Right ◽  
Cavopulmonary Connection

more than 30 years ago, fontan and baudet proposed bypass of a dysfunctional right ventricle by connecting the pulmonary arteries directly to the right atrium, the so-called atriopulmonary anastomosis. since then, much experience has been accrued in the field of the functionally univentricular circulation. the proposed connections have been subjected to several modifications, aiming towards minimizing the losses of energy in the cavopulmonary system, and thereby improving the clinical outcomes. a remarkable improvement was achieved with the introduction of the concept of the total cavopulmonary connection, specifically the combination of a bi-directional glenn anastomosis with a tubular intracardiac extension from the inferior caval venous to the pulmonary arteries. this design was shown to avoid the dissipation of energy associated with the swirling patterns seen in the traditional atrio-pulmonary anastomosis.

Hemodynamic Impact of Stenting in the Total Cavopulmonary Connection With Lateral Tunnel Stenosis

2012 ◽  
Author(s):  
Elaine Tang ◽  
Doff B. McElhinney ◽  
Ajit P. Yoganathan
Keyword(s):  
Heart Defects ◽  
Superior Vena ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Lateral Tunnel ◽  
The Us ◽  
Intravascular Stent ◽  
The Right ◽  
Cavopulmonary Connection

2 per 1000 children in the US are born with functionally single ventricle (SV) heart defects. To restore the separate systemic and pulmonary circulations, a Total Cavopulmonary Connection (TCPC) is carried out through a series of surgical steps, which result in the direct connection of the superior vena cava (SVC) and inferior vena cava (IVC) to the pulmonary arteries without an intervening pulmonary ventricle. One way to complete the TCPC is by placing a synthetic patch in the right atrium, forming an intracardiac lateral tunnel (LT) as the final step. As patients grow, some LT pathways become stenosed. The stenosis can impose extra resistance to flow in addition to the TCPC in the SV circulation. One method of treating LT stenosis is by placement of an intravascular stent.

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