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.

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.

Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients with Failing Fontan Circulation

2015 ◽  
Vol 63 (05) ◽  
pp. 380-387 ◽  
Author(s):  
Julie Cleuziou ◽  
Jelena Kasnar-Samprec ◽  
Melchior Burri ◽  
Vanessa Hepp ◽  
Manfred Vogt ◽  
...  
Keyword(s):  
Functional Status ◽  
Older Patients ◽  
Fontan Circulation ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection ◽  
Failing Fontan

scholarly journals Results of total cavopulmonary connection in the treatment of patients with a functional single ventricle

1991 ◽  
Vol 102 (2) ◽  
pp. 280-287 ◽  
Author(s):  
Darryl G. Stein ◽  
Hillel Laks ◽  
Davis C. Drinkwater ◽  
Lester C. Permut ◽  
Henry W. Louie ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

scholarly journals The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

2008 ◽  
Vol 295 (6) ◽  
pp. H2427-H2435 ◽  
Author(s):  
Kartik S. Sundareswaran ◽  
Kerem Pekkan ◽  
Lakshmi P. Dasi ◽  
Kevin Whitehead ◽  
Shiva Sharma ◽  
...  
Keyword(s):  
Heart Rate ◽  
Single Ventricle ◽  
Fluid Dynamic ◽  
Three Dimensional ◽  
Lumped Parameter Model ◽  
Total Cavopulmonary Connection ◽  
Dynamic Simulations ◽  
Lumped Parameter ◽  
The Impact ◽  
Cavopulmonary Connection

Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96 ± 0.80 WU) and systemic vascular resistances (18.4 ± 7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39 ± 0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI ( n = 16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output (CO) dependence on TCPC resistance was negligible (sensitivity = −0.064 l·min−1·WU−1) but not for the SV circulation (sensitivity = −0.88 l·min−1·WU−1). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (+35%) and decreased preload (−12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology.

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