Document Detail


Flow study of an extracardiac connection with persistent left superior vena cava.
MedLine Citation:
PMID:  16580435     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Numerous studies have sought to optimize the design of total cavopulmonary connections with a single superior vena cava. This study was directed to the 2% to 4.5% of the population with dual superior venae cavae, investigating the flow fields associated with such total cavopulmonary connection anatomies. Additionally, it demonstrates the potential use of computational designs and simulations as surgical planning tools. METHODS: A 3-dimensional model of a total cavopulmonary connection with bilateral superior venae cavae was reconstructed from a patient's magnetic resonance images and investigated experimentally and numerically to assess the power losses and flow structures within the connection. On the basis of these results, a virtual operation was performed in the computer to improve the original connection design. The modified anatomy was studied numerically. RESULTS: Because of a smooth connection with an extracardiac conduit and no major dimension mismatch between the baffle and the connecting vessels, the original anatomy yielded smooth flow fields, low power losses, and few disturbances. However, a large offset between the inferior vena cava and the left superior vena cava resulted in flow stasis and unbalanced hepatic flow distribution. Shifting the inferior vena cava and positioning it between the 2 superior venae cavae resulted in a 7% decrease in power losses and eliminated the associated flow stasis regions in the main pulmonary artery segment. CONCLUSIONS: This study demonstrates the potential use of computer-aided design and numeric simulations for surgical planning. It shows that locating the inferior vena cava between the superior venae cavae may lead to better-balanced lung perfusion. This may require suturing the right and left superior venae cavae closer to each other during the hemi-Fontan or Glenn stage.
Authors:
Diane A de Zélicourt; Kerem Pekkan; James Parks; Kirk Kanter; Mark Fogel; Ajit P Yoganathan
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  131     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-03     Completed Date:  2006-06-06     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  785-91     Citation Subset:  AIM; IM    
Affiliation:
Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga 30332-0535, USA.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical
Child
Computer-Aided Design
Fontan Procedure* / methods
Humans
Liver / blood supply
Lung / blood supply
Magnetic Resonance Imaging
Male
Regional Blood Flow
Vascular Resistance
Vena Cava, Inferior / surgery*
Vena Cava, Superior / abnormalities*
Grant Support
ID/Acronym/Agency:
HL67622/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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