| Nonlinear power loss during exercise in single-ventricle patients after the Fontan: insights from computational fluid dynamics. | |
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MedLine Citation:
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PMID: 17846299 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kevin K Whitehead; Kerem Pekkan; Hiroumi D Kitajima; Stephen M Paridon; Ajit P Yoganathan; Mark A Fogel |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Circulation Volume: 116 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-09-11 Completed Date: 2007-10-11 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: I165-71 Citation Subset: AIM; IM |
Affiliation:
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Children's Hospital of Philadelphia, Division of Cardiology, Main Hospital, 2 Floor, 34 and Civic Center Blvd, Philadelphia, PA 19104, USA. whiteheadk@email.chop.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Cardiac Output / physiology Child Computational Biology / methods Computer Simulation* Exercise / physiology* Fontan Procedure* Humans Nonlinear Dynamics* Pulsatile Flow / physiology* Ventricular Function* |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL 67622/HL/NHLBI NIH HHS; T32 HL007915-08/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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