In Vitro Investigation of the Effect of Flow Pulsatility on Power Loss in the Total Cavopulmonary Connection

Unique Challenge ◽

Venae Cavae ◽

In Vitro Investigation ◽

The Right ◽

Total Cavopulmonary Connection (TCPC) is the most common surgical palliation for single ventricle heart defects. In such connections, venae cavae are connected to the pulmonary arteries, bypassing the right ventricle. The patient-specific anatomical complexity makes characterization and optimization of the fluid mechanics a unique challenge.

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

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80329 ◽

2012 ◽

Author(s):

Maria Restrepo ◽

Lucia Mirabella ◽

Elaine Tang ◽

Chris Haggerty ◽

Mark A. Fogel ◽

...

Keyword(s):

Heart Defects ◽

Fontan Procedure ◽

Pulmonary Arteries ◽

Vena Cava ◽

Lateral Tunnel ◽

Vessel Growth ◽

Original Size ◽

The Right ◽

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).

Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions ◽

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

10.1115/sbc2013-14811 ◽

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 ◽

Venous Flow ◽

The Right ◽

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].

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

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80252 ◽

2012 ◽

Author(s):

Elaine Tang ◽

Doff B. McElhinney ◽

Ajit P. Yoganathan

Keyword(s):

Heart Defects ◽

Superior Vena ◽

Pulmonary Arteries ◽

Vena Cava ◽

Lateral Tunnel ◽

The Us ◽

Intravascular Stent ◽

The Right ◽

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.

In Vitro Flow Analysis of a Patient-Specific Intraatrial Total Cavopulmonary Connection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2004.12.052 ◽

2005 ◽

Vol 79 (6) ◽

pp. 2094-2102 ◽

Cited By ~ 52

Author(s):

Diane A. de Zélicourt ◽

Kerem Pekkan ◽

Lisa Wills ◽

Kirk Kanter ◽

Joseph Forbess ◽

...

Keyword(s):

Flow Analysis ◽

Patient Specific ◽

Computational haemodynamic analysis of patient-specific virtual operations for total cavopulmonary connection with dual superior venae cavae

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezt394 ◽

2013 ◽

Vol 45 (3) ◽

pp. 564-569 ◽

Cited By ~ 9

Author(s):

Qi Sun ◽

Jinlong Liu ◽

Yi Qian ◽

Haibo Zhang ◽

Qian Wang ◽

...

Keyword(s):

Patient Specific ◽

Venae Cavae ◽

the patterns of flow in the total extracardiac cavopulmonary connection

Cardiology in the Young ◽

10.1017/s1047951104006572 ◽

2004 ◽

Vol 14 (S3) ◽

pp. 53-56 ◽

Cited By ~ 6

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 ◽

Remarkable Improvement ◽

Dissipation Of Energy ◽

Intracardiac Extension ◽

The Right ◽

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.

Effect of Flow Pulsatility on 2nd Stage Fontan Hemodynamics: An In Vitro Investigation

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-204573 ◽

2009 ◽

Author(s):

Christopher M. Haggerty ◽

Lakshmi P. Dasi ◽

Jessica Kanter ◽

Ajit P. Yoganathan

Keyword(s):

Congenital Heart ◽

Single Ventricle ◽

Heart Defects ◽

Superior Vena ◽

Fontan Procedure ◽

Pulmonary Arteries ◽

Vena Cava ◽

Second Stage ◽

In Vitro Investigation

The Fontan procedure [1] is the staged, palliative surgical approach used to treat patients suffering from single ventricle congenital heart defects. The second stage of this procedure involves the connection of the superior vena cava (SVC) to the pulmonary arteries (PAs) in either an end-to-side (known as the Bi-Directional Glenn (BDG)) or side-to-side (or Hemi-Fontan (HF)) fashion. Because of obvious disparities at the connection site, there are understandable differences in the fluid dynamics between the two geometries.

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

Journal of Biomechanical Engineering ◽

10.1115/1.1824126 ◽

2004 ◽

Vol 126 (6) ◽

pp. 709-713 ◽

Cited By ~ 21

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 ◽

Flow Mixing ◽

The Right ◽

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

Cardiology in the Young ◽

10.1017/s1047951102000410 ◽

2002 ◽

Vol 12 (2) ◽

pp. 192-195 ◽

Cited By ~ 15

Author(s):

Nawal Azhari ◽

Mervat Assaqqat ◽

Ziad Bulbul

Keyword(s):

Right Ventricle ◽

Surgical Repair ◽

Thromboembolic Stroke ◽

Glenn Shunt ◽

Bidirectional Glenn ◽

Bidirectional Glenn Shunt ◽

Patch Closure ◽

The Right ◽

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.