Document Detail


Cavopulmonary assist for the univentricular Fontan circulation: von Kármán viscous impeller pump.
MedLine Citation:
PMID:  20561640     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In a univentricular Fontan circulation, modest augmentation of existing cavopulmonary pressure head (2-5 mm Hg) would reduce systemic venous pressure, increase ventricular filling, and thus substantially improve circulatory status. An ideal means of providing mechanical cavopulmonary support does not exist. We hypothesized that a viscous impeller pump, based on the von Kármán viscous pump principle, is optimal for this role.
METHODS: A 3-dimensional computational model of the total cavopulmonary connection was created. The impeller was represented as a smooth 2-sided conical actuator disk with rotation in the vena caval axis. Flow was modeled under 3 conditions: (1) passive flow with no disc; (2) passive flow with a nonrotating disk, and (3) induced flow with disc rotation (0-5K rpm). Flow patterns and hydraulic performance were examined for each case. Hydraulic performance for a vaned impeller was assessed by measuring pressure increase and induced flow over 0 to 7K rpm in a laboratory mock loop.
RESULTS: A nonrotating actuator disc stabilized cavopulmonary flow, reducing power loss by 88%. Disk rotation (from baseline dynamic flow of 4.4 L/min) resulted in a pressure increase of 0.03 mm Hg. A further increase in pressure of 5 to 20 mm Hg and 0 to 5 L/min flow was obtained with a vaned impeller at 0 to 7K rpm in a laboratory mock loop.
CONCLUSIONS: A single viscous impeller pump stabilizes and augments cavopulmonary flow in 4 directions, in the desired pressure range, without venous pathway obstruction. A viscous impeller pump applies to the existing staged protocol as a temporary bridge-to-recovery or -transplant in established univentricular Fontan circulations and may enable compressed palliation of single ventricle without the need for intermediary surgical staging or use of a systemic-to-pulmonary arterial shunt.
Authors:
Mark D Rodefeld; Brandon Coats; Travis Fisher; Guruprasad A Giridharan; Jun Chen; John W Brown; Steven H Frankel
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-06-18
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-09-20     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  529-36     Citation Subset:  AIM; IM    
Copyright Information:
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine and James Whitcomb Riley Hospital for Children, Indianapolis, Ind 46202, USA. rodefeld@iupui.edu
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure
Computer Simulation
Fontan Procedure / adverse effects,  instrumentation*
Heart Bypass, Right / adverse effects,  instrumentation*
Heart Defects, Congenital / physiopathology,  surgery*
Heart-Assist Devices*
Hemodynamics*
Hemorheology
Humans
Models, Cardiovascular
Prosthesis Design
Regional Blood Flow
Stress, Mechanical
Grant Support
ID/Acronym/Agency:
HL080089/HL/NHLBI NIH HHS; R01 HL098353-01A1/HL/NHLBI NIH HHS; R21 HL080089-02/HL/NHLBI NIH HHS
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