Document Detail

Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac.
MedLine Citation:
PMID:  20621314     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Pulmonary arteriovenous malformations can occur after the Fontan procedure and are believed to be associated with disproportionate pulmonary distribution of hepatic venous effluent. We studied the effect of total cavopulmonary connection geometry and the effect of increased cardiac output on distribution of inferior vena caval return to the lungs.
METHODS: Ten patients undergoing the Fontan procedure, 5 with extracardiac and 5 with intracardiac configurations of the total cavopulmonary connection, previously analyzed for power loss were processed for calculating the distribution of inferior vena caval return to the lungs (second-order accuracy). One idealized total cavopulmonary connection was similarly analyzed under parametric variation of inferior vena caval offset and cardiac output flow split.
RESULTS: Streaming of the inferior vena caval return in the idealized total cavopulmonary connection model was dependent on both inferior vena caval offset magnitude and cardiac output flow-split ratio. For patient-specific total cavopulmonary connections, preferential streaming of the inferior vena caval return was directly proportional to the cardiac output flow-split ratio in the intracardiac total cavopulmonary connections (P < .0001). Preferential streaming in extracardiac total cavopulmonary connections correlated to the inferior vena caval offset (P < .05) and did not correlate to cardiac output flow split. Enhanced mixing in intracardiac total cavopulmonary connections is speculated to explain the contrasting results. Exercising tends to reduce streaming toward the left pulmonary artery in intracardiac total cavopulmonary connections, whereas for extracardiac total cavopulmonary connections, exercising tends to equalize the streaming.
CONCLUSIONS: Extracardiac and intracardiac total cavopulmonary connections have inherently different streaming characteristics because of contrasting mixing characteristics caused by their geometric differences. Pulmonary artery diameters and inferior vena caval offsets might together determine hepatic flow streaming.
Lakshmi P Dasi; Kevin Whitehead; Kerem Pekkan; Diane de Zelicourt; Kartik Sundareswaran; Kirk Kanter; Mark A Fogel; Ajit P Yoganathan
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-20     Completed Date:  2011-01-13     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:  207-14     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Department of Mechanical Engineering & School of Biomedical Engineering, Colorado State University, Fort Collins, Colo, USA.
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MeSH Terms
Arteriovenous Fistula / etiology,  pathology,  physiopathology*
Cardiac Output
Computer Simulation
Fontan Procedure / adverse effects
Liver Circulation*
Lung / blood supply*
Magnetic Resonance Imaging
Models, Cardiovascular
Pulmonary Circulation*
Treatment Outcome
Vena Cava, Inferior / pathology,  physiopathology,  surgery*
Grant Support
HL67622/HL/NHLBI NIH HHS; K23 HL089647/HL/NHLBI NIH HHS; K23 HL089647-03/HL/NHLBI NIH HHS; R01 HL067622-05/HL/NHLBI NIH HHS; R01 HL098252-02/HL/NHLBI NIH HHS; T32 HL007915-08/HL/NHLBI NIH HHS

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