a study of the fontan circulation and ventricular energetics based on a model

2004 ◽  
Vol 14 (S3) ◽  
pp. 11-19 ◽  
Author(s):  
andrea ripoli ◽  
sergio berti ◽  
mattia glauber ◽  
vittorio vanini ◽  
vincenzo stefano luisi ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Volume Overload ◽  
Systemic Circulation ◽  
Fontan Circulation ◽  
Total Cavopulmonary Connection ◽  
Right Heart ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
The Right ◽  
Cavopulmonary Connection

patients with congenitally malformed hearts characterised by a functionally single ventricle are currently treated using several procedures that bypass the right heart, such as the fontan and hemi-fontan operations, the bidirectional cavopulmonary anastomosis, and the total cavopulmonary connection. all these options are based on the procedures introduced for palliative correction of tricuspid atresia by fontan and baudet in 1971. introduced with the purpose of reducing the pre-operative volume overload, the surgical task mainly consists of separating the pulmonary from the systemic circulation. irrespective of the specific operation performed, we can call the resulting circulation the fontan circulation.

A Skeletalized Representation of the Total Cavopulmonary Connection

2007 ◽  
Author(s):  
Resmi Krishnankuttyrema ◽  
Lakshmi Prasad Dasi ◽  
Kerem Pekkan ◽  
Kartik Sundareswaran ◽  
Hiroumi D. Kitajima ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Single Ventricle ◽  
Venous Return ◽  
Right Heart ◽  
Live Births ◽  
Correction Technique ◽  
The Usa ◽  
Systemic Venous Return ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle congenital heart problems are reported for 2 out of every 1000 live births in the USA. In these cases, mixing of oxygenated and deoxygenated blood occurs in the heart causing severe cyanosis. The Fontan repair is a 3-stage palliative surgical correction technique performed during infancy. Its aim is to restore normal oxygen saturation by directly connecting the systemic venous return to the lungs and bypassing the right heart [1].

Impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after Fontan operation

2018 ◽  
Vol 28 (12) ◽  
pp. 1436-1443 ◽  
Author(s):  
Shuichi Shiraishi ◽  
Toshihide Nakano ◽  
Shinichiro Oda ◽  
Hideaki Kado
Keyword(s):  
Pulmonary Artery ◽  
Hypoplastic Left Heart Syndrome ◽  
Chest Tube ◽  
Total Cavopulmonary Connection ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Left Heart Syndrome ◽  
Cavopulmonary Connection

AbstractBackgroundsThe aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection.MethodsWe conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, <6 months (n=33), and older group, >6 months (n=67).ResultsThe proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044).ConclusionsEarly bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.

Can we do without routine fenestration in extracardiac total cavopulmonary connections? Report on 84 consecutive patients

2006 ◽  
Vol 16 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Christian Schreiber ◽  
Martin Kostolny ◽  
Jürgen Hörer ◽  
Julie Cleuziou ◽  
Klaus Holper ◽  
...  
Keyword(s):  
High Risk ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Total Cavopulmonary Connection ◽  
Mean Pulmonary Arterial Pressure ◽  
Increased Risk ◽  
Cavopulmonary Anastomosis ◽  
Pulmonary Arterial ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Cavopulmonary Connection

Fenestration is still widely used in right heart bypass operations. Our study was conducted to assess its need in the most recent modification, the completion of a total cavopulmonary connection with an extracardiac tube.The extracardiac approach was introduced at our institution in January, 1999. Since June of 2000, no patient had a fenestration. If more than 1 risk factor amongst ventricular function being more than moderately impaired, atrioventricular valvar regurgitation more than moderate, mean pulmonary arterial pressure more than 15 millimetres of mercury, mean atrial pressure higher than 12 millimetres of mercury, pulmonary arterial distortion, or other than sinus rhythm was present preoperatively, the patient was considered a “high risk” candidate. Postoperatively elevated pulmonary arterial pressure higher than 16 millimetres of mercury, prolonged effusions and requirement for drainage longer than 7 days, and death were considered endpoints in the statistical analysis.Our study group included 84 patients who underwent surgery up to August, 2004. A previous bidirectional cavopulmonary anastomosis had been accomplished in 73 patients at a mean age of 27.01 plus or minus 32.60 months, with a median of 11.5 months, without creating an additional source of flow of blood to the lungs.At the time of the total cavopulmonary connection, the mean age was 66.4 plus or minus 60.1 months, with a median of 37.1 months, and a range from 17.3 to 251.2 months, with 50 patients being younger than 48 months.We deemed 16 patients to be at “high risk”. These patients were older at the time of bidirectional cavopulmonary anstomosis (p smaller than 0.016), at the time of completion (p smaller than 0.019), and also differed in size at time of completion (p smaller than 0.020). They required a longer time on cardiopulmonary bypass (p smaller than 0.015), and reached higher early postoperative pulmonary arterial pressures after completion (p smaller than 0.025). There were no differences between groups of patients having up to 1 or more risk factors in regard to need for intubation (p smaller than 0.511), pulmonary arterial pressures after extubation (p smaller than 0.817), and duration of chest drainage (p smaller than 0.650). Three patients died, one in the group deemed at high risk. There was no death in the last 38 patients.We conclude that a total cavopulmonary connection with an extracardiac tube can be performed without fenestration, even if the patients are deemed to be at increased risk. Early staging of patients with functionally univentricular physiology might be one of the keys for these findings.

Mechanical support of the functionally single ventricle

2006 ◽  
Vol 16 (S1) ◽  
pp. 55-60 ◽  
Author(s):  
Chitra Ravishankar ◽  
J. William Gaynor
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Pulmonary Arteries ◽  
Fontan Circulation ◽  
Ventricular Assist Devices ◽  
Mechanical Support ◽  
Membrane Oxygenation ◽  
Lateral Tunnel ◽  
Cavopulmonary Anastomosis ◽  
The Right

Children with a functionally single ventricle constitute just over 1% of congenital cardiac defects.1A majority of children with the functionally univentricular circulation undergo a three-staged reconstruction to achieve completion of the Fontan circulation. The first stage is usually performed in the neonatal period, and is either banding of the pulmonary trunk, an aorto-pulmonary shunt alone, or the shunt included as part of the first stage of reconstruction. In recent years, a conduit placed from the right ventricle to the pulmonary arteries is being used as an alternate source of flow of blood to the lungs. The second stage is the bidirectional cavopulmonary anastomosis, the two surgical variations being the so-called “hemifontan”, and “bidirectional Glenn” procedures, while the third stage is the completion of the Fontan circulation, the two surgical variations being either construction of a lateral tunnel, or placement of an extra-cardiac conduit, each being possible with or without a fenestration. In many centres, patients with the functionally univentricular circulation make up one-fifth of the total surgical volume. The syndrome of low cardiac output is quite common in this population through all three stages of reconstruction, and some of these patients will eventually require cardiac transplantation. While conventional therapy, with inotropic support and afterload reduction, remains the mainstay of therapy for the failing heart in children, mechanical support is being increasingly used.3Most of this experience is limited to extracorporeal membrane oxygenation.2–5In this review, we discuss the current experiences with extracorporeal membrane oxygenation in patients with a functionally univentricular circulation, and describes some of their unique features. We also focus on the pulsatile ventricular assist devices capable of providing support over the longer term, and other new devices that may have a role in the future in these patients.6

Experimental Study of Powered Fontan Hemodynamics in an Idealized Total Cavopulmonary Connection Model

2011 ◽  
Author(s):  
Jeffrey R. Kennington ◽  
Mark D. Rodefeld ◽  
Steven H. Frankel ◽  
Jun Chen ◽  
Anna-Elodie M. Kerlo ◽  
...  
Keyword(s):  
Birth Defects ◽  
Single Ventricle ◽  
Fontan Circulation ◽  
Total Cavopulmonary Connection ◽  
Cfd Simulations ◽  
Percutaneous Catheter ◽  
Number Of Patients ◽  
Fontan Failure ◽  
Computational Fluid Dynamics Cfd ◽  
Cavopulmonary Connection

Cardiac single ventricle birth defects are a leading cause of death among birth defects for children under one years of age. Fontan palliation is the current clinical treatment for patients with these birth defects and result in a single working ventricle to power the entire system by forming a total cavopulmonary connection (TCPC). A significant number of patients with univentricle Fontan circulation develop Fontan failure caused by the inability of the single ventricle to power the Fontan circulation. The use of mechanical cavopulmonary assist device has been proposed as a treatment for these patients. Particularly, the application of a percutaneous, catheter driven, viscous impeller pump (VIP) has been identified to provide promising cavopulmonary support [1]. Computational Fluid Dynamics (CFD) simulations have demonstrated that this VIP pump can satisfactorily augment cavopulmonary blood flow at pressures sufficient to overcome increased downstream resistance. Experimental characterization of flow induced by the VIP in the TCPC, including detailed flow structures and hemodynamic performances, needs to be conducted for minimizing risk of hemolysis and thrombosis while maximizing the pump performance, and for validating the results from high-fidelity CFD simulations.

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.

Sign in / Sign up

Export Citation Format

Share Document