A Hemi Fontan Operation Performed by an Engineer: Considerations on Virtual Surgery

2013 ◽  
Author(s):  
Giovanni Biglino ◽  
Ethan Kung ◽  
Adam Dorfman ◽  
Andrew M. Taylor ◽  
Edward Bove ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Fontan Operation ◽  
Hybrid Approach ◽  
Pulmonary Arteries ◽  
Virtual Surgery ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle circulation, characterized at birth by a rudimentary or absent left or right ventricle, presents a challenging and life-threatening physiological scenario. Surgical palliation aims to restore the balance between systemic and pulmonary blood flow and is staged, each of the three stages presenting the surgeon with different options: - Stage 1 (Norwood procedure) involves different types of shunting to source pulmonary blood flow, or recently a hybrid approach [1]; - Stage 2 can involve a superior cavopulmonary connection (Glenn operation) or patching between the right atrium and the pulmonary arteries (Hemi Fontan operation [2]); - Stage 3 involves a total cavopulmonary connection with extracardiac conduit or lateral tunnel, or with novel alternatives such as the Y-graft [3].

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 Augmentation of pulmonary blood flow and cardiac output by non-invasive external ventilation late after Fontan palliation

Heart ◽  
2020 ◽  
Vol 107 (2) ◽  
pp. 142-149
Author(s):  
Pradeepkumar Charla ◽  
Gauri Rani Karur ◽  
Kenichiro Yamamura ◽  
Shi-Joon Yoo ◽  
John T Granton ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Pulmonary Blood Flow ◽  
Pulmonary Arteries ◽  
Primary Objective ◽  
Non Invasive ◽  
Lateral Tunnel ◽  
The Impact ◽  
Fontan Palliation ◽  
Cmr Imaging

ObjectivesAlthough a life-preserving surgery for children with single ventricle physiology, the Fontan palliation is associated with striking morbidity and mortality with advancing age. Our primary objective was to evaluate the impact of non-invasive, external, thoraco-abdominal ventilation on pulmonary blood flow (PBF) and cardiac output (CO) as measured by cardiovascular magnetic resonance (CMR) imaging in adult Fontan subjects.MethodsAdults with a dominant left ventricle post-Fontan palliation (lateral tunnel or extracardiac connections) and healthy controls matched by sex and age were studied. We evaluated vascular flows using phase-contrast CMR imaging during unassisted breathing, negative pressure ventilation (NPV) and biphasic ventilation (BPV). Measurements were made within target vessels (aorta, pulmonary arteries, vena cavae and Fontan circuit) at baseline and during each ventilation mode.ResultsTen Fontan subjects (50% male, 24.5 years (IQR 20.8–34.0)) and 10 matched controls were studied. Changes in PBF and CO, respectively, were greater following BPV as compared with NPV. In subjects during NPV, PBF increased by 8% (Δ0.20 L/min/m2 (0.10–0.53), p=0.011) while CO did not change significantly (Δ0.17 L/min/m2 (−0.11–0.23), p=0.432); during BPV, PBF increased by 25% (Δ0.61 L/min/m2 (0.20–0.84), p=0.002) and CO increased by 16% (Δ0.47 L/min/m2 (0.21–0.71), p=0.010). Following BPV, change in PBF and CO were both significantly higher in subjects versus controls (0.61 L/min/m2 (0.2–0.84) vs −0.27 L/min/m2 (−0.55–0.13), p=0.001; and 0.47 L/min/m2 (0.21–0.71) vs 0.07 L/min/m2 (−0.47–0.33), p=0.034, respectively).ConclusionExternal ventilation acutely augments PBF and CO in adult Fontan subjects. Confirmation of these findings in larger populations with longer duration of ventilation and extended follow-up will be required to determine sustainability of haemodynamic effects.

Transposition of the great arteries {S,D,D} and absent proximal left pulmonary artery

1995 ◽  
Vol 5 (2) ◽  
pp. 199-201
Author(s):  
Dipak Kholwadwala ◽  
Vincent A. Parnell ◽  
Rubin S. Cooper
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Left Ventricular Outflow Tract ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Left Ventricular Outflow ◽  
The Right

while preferential blood flow to the rightpulmonary artery has been described in transposition of the great arteries with or without obstruction of the left ventricular outflow tract, this disparity of pulmonary blood flow is not present in newborns.1We report a newborn with transposition in whom there was discontinuity of the pulmonary arteries and ductal blood supply to the left pulmonary artery. To our knowledge, this entity has not been described in newborns with transposition of the great arteries {S,D,D}.

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.

scholarly journals CLOSING OF INTERVENTRICULAR SEPTUM DEFECT IN ONE-STEP AND STEPWISE SURGICAL TREATMENT IN PATIENTS WITH PULMONARY ATRESIA AND AORTO-PULMONARY COLLATERALS

2015 ◽  
Vol 174 (4) ◽  
pp. 9-12
Author(s):  
A. A. Morozov ◽  
R. R. Movsesyan ◽  
V. G. Lyubomudrov
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Pulmonary Blood Flow ◽  
Interventricular Septum ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Definitive Repair ◽  
One Step ◽  
Pulmonary Arterial ◽  
The Right

Pulmonary atresia with defect of interventricular septum and collateral pulmonary blood flow refers to complicated congenital malformation of the heart. Surgical treatment represents itself as very difficult task because of anatomical variability of this abnormality. The main problem of surgery is a definitive repair of the defect including correction of maldistributions of pulmonary arterial bed (unifocalization of pulmonary blood flow), reconstruction of outflow tract of the right ventricle and closing of interventricular septum defect. The performance of closing interventricular septum defect could be successful in patients with pulmonary atresia and collateral pulmonary blood flow in case of stepwise and one-step surgical treatment. The combination of maximal number of pulmonary segments and sufficient development of central pulmonary arteries facilitates to progress of assigned task. Patients with the level of pulmonary-arterial index more than 170 mm/m² and integrity of pulmonary arterial bed, centralization of pulmonary segments (minimum 15) could be considered as a candidate for definite repair of the defect.

Abstract 11582: Catheter Ablation of Supraventricular Tachycardia in Patients With Total Cavopulmonary Connection

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Keiko Toyohara ◽  
Tomomi Nishimura ◽  
Morio Shoda ◽  
Toshio Nakanishi
Keyword(s):  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Fontan Operation ◽  
Accessory Pathway ◽  
Total Cavopulmonary Connection ◽  
Transseptal Puncture ◽  
Atrioventricular Reentrant Tachycardia ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

Introduction: Management of arrhythmias after the Fontan operation is difficult. Total cavopulmonary connection (TCPC), rather than atriopulmonary connection, is considered the optimal method to minimize the risk of arrhythmias, although they are sometimes still observed after TCPC. Catheter ablation (CA) for supraventricular tachycardia (SVT) is extremely difficult after TCPC because the systemic venous route is excluded from the atria. The purpose of this study was to evaluate the efficacy of CA in treating SVT after TCPC. Results: CA was attempted after TCPC in 14 patients aged 8-37 years (median: 23 years). TCPC was performed using the lateral tunnel approach in 5 patients, the intra-atrial conduit procedure in 2, and the extracardiac polytetrafluoroethylene conduit procedure in 7. During CA, the atrium was approached either by a transseptal puncture (12 patients), a fenestration in the patch (1 patient), or suture leakage (1 patient). Transseptal puncture was performed using a conventional Brockenbrough needle in all 12 patients. There were no clinically significant complications and only one unsuccessful puncture. SVT included atrial flutter in 4 patients, atrial tachycardia in 7, atrioventricular reentrant tachycardia (AVRT) via the accessory pathway in 1, and AVRT involving twin atrioventricular nodes in 2. Acute treatment of SVT with CA was achieved in 10 patients (71%), but tachycardia recurred in 3 during follow-up. Deterioration of cyanosis was not observed after transseptal puncture, and closure of the puncture site was confirmed in all 12 patients. Overall, SVT was successfully managed using CA in 7 out of 14 patients (50%), and with medication in the remaining patients. Conclusions: SVT may arise after the TCPC procedure. Puncture of the extracardiac conduit is feasible, and CA can be an effective treatment option for refractory SVT after TCPC.

Pulmonary blood flow distribution after the total cavopulmonary connection for complex cardiac anomalies

1999 ◽  
Vol 14 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Masao Tayama ◽  
Nobuaki Hirata ◽  
Tohru Matsushita ◽  
Tetsuya Sano ◽  
Norihide Fukushima ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Total Cavopulmonary Connection ◽  
Blood Flow Distribution ◽  
Cardiac Anomalies ◽  
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.

scholarly journals Mechanisms of calcitonin gene-related peptide-induced increases of pulmonary blood flow in fetal sheep

2000 ◽  
Vol 279 (4) ◽  
pp. H1654-H1660 ◽  
Author(s):  
Yasushi Takahashi ◽  
Maartje De Vroomen ◽  
Christine Roman ◽  
Michael A. Heymann
Keyword(s):  
Nitric Oxide ◽  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Pulmonary Arteries ◽  
Calcitonin Gene Related Peptide ◽  
Fetal Sheep ◽  
Nitric Oxide Synthase Inhibitor ◽  
Flow Transducer ◽  
Related Peptide ◽  
Calcitonin Gene

Fetal pulmonary blood flow is regulated by various vasoactive substances. One, calcitonin gene-related peptide (CGRP), increases pulmonary blood flow. We examined four key physiological mechanisms underlying this response using the blocker drugs CGRP receptor blocker (CGRP8–37), nitric oxide synthase inhibitor [ N ω-nitro-l-arginine (l-NNA)], adenosine triphosphate-dependent potassium (KATP) channel blocker (glibenclamide), and cyclooxygenase inhibitor (indomethacin) in 17 near-term fetal sheep. Catheters were placed in the left (LPA) and main pulmonary arteries, and an ultrasonic flow transducer was placed around the LPA to measure flow continuously. CGRP was injected directly into the LPA (mean 1.02 μg/kg) before and after blockade, and responses to CGRP were statistically compared. Before blockade, CGRP increased LPA blood flow from 23 ± 25 to 145 ± 77 ml/min (means ± SD), and these increases were significantly attenuated by CGRP8–37( n = 6; 91% inhibition), l-NNA ( n = 6; 86% inhibition), and glibenclamide ( n = 6; 69% inhibition). No significant changes were found with indomethacin ( n = 6; 4% inhibition). Thus, in the fetal pulmonary circulation, CGRP increases pulmonary blood flow not only through its specific receptor but also, in part, through nitric oxide release and KATP channel activation.

Effect of a regional increase in alveolar pressure on pulmonary blood flow

1992 ◽  
Vol 73 (4) ◽  
pp. 1291-1296 ◽  
Author(s):  
L. E. Olson ◽  
R. L. Wardle
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Left Lung ◽  
Dry Weight ◽  
Test Lung ◽  
Test Segment ◽  
Control Segment ◽  
Lung Segment ◽  
Lung Blood Flow ◽  
The Right

We examined whether wedging a catheter (0.5 cm OD) into a subsegmental airway in dog (n = 6) or pig lungs (n = 5) and increasing pressure in the distal lung segment affected pulmonary blood flow. Dogs and pigs were anesthetized and studied in the prone position. Pulmonary blood flow was measured by injecting radiolabeled microspheres (15 microns diam) into the right atrium when airway pressure (Pao) was 0 cmH2O and pressure in the segment distal to the wedged catheter (Ps) was 0, 5, or 15 cmH2O and when Pao = Ps = 15 cmH2O. The lungs were excised, air-dried, and sectioned. Blood flow per gram dry weight normalized to cardiac output to the right or left lung, as appropriate, was calculated for the test segment, a control segment in the opposite lung corresponding anatomically to the test segment, the remainder of the lung containing the test segment (test lung), and the remainder of the lung containing the control segment (control lung). The presence of the catheter reduced blood flow in the test segment compared with that in the control segment and in the test lung. Blood flow was not affected by increasing pressure in the test segment. We conclude that, in studies designed to measure collateral ventilation in dog lungs, the presence of the wedged catheter is likely to have a greater effect on blood flow than the increase in pressure associated with measuring collateral airway resistance.

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