Document Detail

Nonlinear power loss during exercise in single-ventricle patients after the Fontan: insights from computational fluid dynamics.
MedLine Citation:
PMID:  17846299     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We previously demonstrated that power loss (PL) through the total cavopulmonary connection (TCPC) in single-ventricle patients undergoing Fontan can be calculated by computational fluid dynamic analysis using 3-dimensional MRI anatomic reconstructions. PL through the TCPC may play a role in single-ventricle physiology and is a function of cardiac output. We hypothesized that PL through the TCPC increases significantly under exercise flow conditions. METHODS AND RESULTS: MRI data of 10 patients with a TCPC were analyzed to obtain 3-dimensional geometry and flow rates through the superior vena cava, inferior vena cava, left pulmonary artery, and right pulmonary artery. Steady computational fluid dynamic simulations were performed at baseline conditions using MRI-derived flows. Simulated exercise conditions of twice (2x) and three times (3x) baseline flow were performed by increasing inferior vena cava flow. PL, head loss, and effective resistance through the TCPC were calculated for each condition. Each condition was repeated at left pulmonary artery/right pulmonary artery ratios of 30/70 and 70/30 to determine the effects of pulmonary flow splits on exercise PL. For each patient, PL increases dramatically in a nonlinear fashion with increasing cardiac output, even when normalized to calculate head loss or resistance. Flow splits had a significant effect on PL at exercise, with most geometries favoring right pulmonary artery flow. CONCLUSIONS: The relationship between cardiac output and PL is nonlinear and highly dependent on TCPC geometry and pulmonary flow splits. This study demonstrates the importance of studying the TCPC under exercise conditions, because baseline conditions may not adequately characterize TCPC efficiency.
Kevin K Whitehead; Kerem Pekkan; Hiroumi D Kitajima; Stephen M Paridon; Ajit P Yoganathan; Mark A Fogel
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Circulation     Volume:  116     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-11     Completed Date:  2007-10-11     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I165-71     Citation Subset:  AIM; IM    
Children's Hospital of Philadelphia, Division of Cardiology, Main Hospital, 2 Floor, 34 and Civic Center Blvd, Philadelphia, PA 19104, USA.
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MeSH Terms
Cardiac Output / physiology
Computational Biology / methods
Computer Simulation*
Exercise / physiology*
Fontan Procedure*
Nonlinear Dynamics*
Pulsatile Flow / physiology*
Ventricular Function*
Grant Support

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