Impact of the location of the fenestration on Fontan circulation haemodynamics: a three-dimensional, computational model study

2017 ◽  
Vol 27 (7) ◽  
pp. 1289-1294 ◽  
Author(s):  
Koichi Sughimoto ◽  
Yuta Asakura ◽  
Christian P. Brizard ◽  
Fuyou Liang ◽  
Takashi Fujiwara ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Energy Loss ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Three Dimensional ◽  
Middle Part ◽  
Central Venous ◽  
Physiological Conditions ◽  
Loss Index

AbstractObjectivesThere is no consensus or theoretical explanation regarding the optimal location for the fenestration during the Fontan operation. We investigated the impact of the location of the fenestration on Fontan haemodynamics using a three-dimensional Fontan model in various physiological conditions.MethodsA three-dimensional Fontan model was constructed on the basis of CT images, and a 4-mm-diameter fenestration was located between the extracardiac Fontan conduit and the right atrium at three positions: superior, middle, and inferior part of the conduit. Haemodynamics in the Fontan route were analysed using a three-dimensional computational fluid dynamic model in realistic physiological conditions, which were predicted using a lumped parameter model of the cardiovascular system. The respiratory effect of the caval flow was taken into account. The flow rate through the fenestration, the effect of lowering the central venous pressure, and wall shear stress in the Fontan circuit were evaluated under central venous pressures of 10, 15, and 20 mmHg. The pulse power index and pulsatile energy loss index were calculated as energy loss indices.ResultsUnder all central venous pressures, the middle-part fenestration demonstrated the most significant effect on enhancing the flow rate through the fenestration while lowering the central venous pressure. The middle-part fenestration produced the highest time-averaged wall shear stress, pressure pulse index, and pulsatile energy loss index.ConclusionsDespite slightly elevated energy loss, the middle-part fenestration most significantly increased cardiac output and lowered central venous pressure under respiration in the Fontan circulation.

scholarly journals Computational Fluid Dynamics Characterization of Two Patient-Specific Systemic-to-Pulmonary Shunts before and after Operation

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Neichuan Zhang ◽  
Haiyun Yuan ◽  
Xiangyu Chen ◽  
Jiawei Liu ◽  
Qifei Jian ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Pulmonary Artery ◽  
Energy Loss ◽  
Three Dimensional ◽  
Left Pulmonary Artery ◽  
Postoperative Recovery ◽  
Patient Specific ◽  
Wall Shear ◽  
Ct Data

Studying the haemodynamics of the central shunt (CS) and modified Blalock–Taussig shunt (MBTS) benefits the improvement of postoperative recovery for patients with an aorta-pulmonary shunt. Shunt configurations, including CS and MBTS, are virtually reconstructed for infants A and B based on preoperative CT data, and three-dimensional models of A, 11 months after CS, and B, 8 months after MBTS, are reconstructed based on postoperative CT data. A series of parameters including energy loss, wall shear stress, and shunt ratio are computed from simulation to analyse the haemodynamics of CS and MBTS. Our results showed that the shunt ratio of the CS is approximately 30% higher than the MBTS and velocity distribution in the left pulmonary artery (LPA) and right pulmonary artery (RPA) was closer to a natural development in the CS than the MBTS. However, energy loss of the MBTS is lower, and the MBTS can provide more symmetric pulmonary artery (PA) flow than the CS. With the growth of infants A and B, the shunt ratio of infants was decreased, but maximum wall shear stress and the distribution region of high wall shear stress (WSS) were increased, which raises the probability of thrombosis. For infant A, the preoperative abnormal PA structure directly resulted in asymmetric growth of PA after operation, and the LPA/RPA ratio decreased from 0.49 to 0.25. Insufficient reserved length of the MBTS led to traction phenomena with the growth of infant B; on the one hand, it increased the eddy current, and on the other hand, it increased the flow resistance of anastomosis, promoting asymmetric PA flow.

scholarly journals Three-Dimensional inferior vena cava for assessing central venous pressure in patients with cardiogenic shock

2019 ◽  
Vol 11 (1) ◽  
pp. e291-e292
Author(s):  
R. Huguet ◽  
Damien. Fard ◽  
Thomas. D’humières ◽  
O. Brault-Meslin ◽  
Louis. Nahory ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cardiogenic Shock ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Three Dimensional ◽  
Vena Cava ◽  
Central Venous

Three-Dimensional Inferior Vena Cava for Assessing Central Venous Pressure in Patients with Cardiogenic Shock

2018 ◽  
Vol 31 (9) ◽  
pp. 1034-1043 ◽  
Author(s):  
Raphaëlle Huguet ◽  
Damien Fard ◽  
Thomas d’Humieres ◽  
Ophelie Brault-Meslin ◽  
Laureline Faivre ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cardiogenic Shock ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Three Dimensional ◽  
Vena Cava ◽  
Central Venous

Variability in the establishment of an external reference point for central venous pressure measurement in children

2006 ◽  
Vol 0 (0) ◽  
Author(s):  
Aline S. C. Belela ◽  
Mavilde L. G. Pedreira ◽  
Maria Angélica S. Peterlini ◽  
Denise M. Kusahara ◽  
Werther B. Carvalho ◽  
...  
Keyword(s):  
Central Venous Pressure ◽  
Pressure Measurement ◽  
Reference Point ◽  
Venous Pressure ◽  
Central Venous ◽  
External Reference

Central venous pressure monitoring in critical care settings

2021 ◽  
Vol 30 (4) ◽  
pp. 230-236
Author(s):  
Barry Hill ◽  
Catherine Smith
Keyword(s):  
Critical Care ◽  
Central Venous Pressure ◽  
Right Atrium ◽  
Venous Pressure ◽  
Vena Cava ◽  
Alternative Methods ◽  
Haemodynamic Monitoring ◽  
Haemodynamic Instability ◽  
Central Venous ◽  
The Right

Patients who present with acute cardiovascular compromise require haemodynamic monitoring in a critical care unit. Central venous pressure (CVP) is the most frequently used measure to guide fluid resuscitation in critically ill patients. It is most often done via a central venous catheter (CVC) positioned in the right atrium or superior or inferior vena cava as close to the right atrium as possible. The CVC is inserted via the internal jugular vein, subclavian vein or via the femoral vein, depending on the patient and their condition. Complications of CVC placement can be serious, so its risks and benefits need to be considered. Alternative methods to CVC use include transpulmonary thermodilution and transoesophageal Doppler ultrasound. Despite its widespread use, CVP has been challenged in many studies, which have reported it to be a poor predictor of haemodynamic responsiveness. However, it is argued that CVP monitoring provides important physiologic information for the evaluation of haemodynamic instability. Nurses have central roles during catheter insertion and in CVP monitoring, as well as in managing these patients and assessing risks.

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