Document Detail


Simulating hemodynamics of the Fontan Y-graft based on patient-specific in vivo connections.
MedLine Citation:
PMID:  22560957     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Using a bifurcated Y-graft as the Fontan baffle is hypothesized to streamline and improve flow dynamics through the total cavopulmonary connection (TCPC). This study conducted numerical simulations to evaluate this hypothesis using postoperative data from 5 patients.
METHODS: Patients were imaged with cardiac magnetic resonance or computed tomography after receiving a bifurcated aorto-iliac Y-graft as their Fontan conduit. Numerical simulations were performed using in vivo flow rates, as well as 2 levels of simulated exercise. Two TCPC models were virtually created for each patient to serve as the basis for hemodynamic comparison. Comparative metrics included connection flow resistance and inferior vena caval flow distribution.
RESULTS: Results demonstrate good hemodynamic outcomes for the Y-graft options. The consistency of inferior vena caval flow distribution was improved over TCPC controls, whereas the connection resistances were generally no different from the TCPC values, except for 1 case in which there was a marked improvement under both resting and exercise conditions. Examination of the connection hemodynamics as they relate to surgical Y-graft implementation identified critical strategies and modifications that are needed to potentially realize the theoretical efficiency of such bifurcated connection designs.
CONCLUSIONS: Five consecutive patients received a Y-graft connection to complete their Fontan procedure with positive hemodynamic results. Refining the surgical technique for implementation should result in further energetic improvements that may help improve long-term outcomes.
Authors:
Christopher M Haggerty; Kirk R Kanter; Maria Restrepo; Diane A de Zélicourt; W James Parks; Jarek Rossignac; Mark A Fogel; Ajit P Yoganathan
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-05-04
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  145     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-18     Completed Date:  2013-05-16     Revised Date:  2014-03-12    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  663-70     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Blood Vessel Prosthesis*
Child
Child, Preschool
Computer Simulation
Female
Fontan Procedure / instrumentation,  methods*
Heart Defects, Congenital / surgery*
Hemodynamics / physiology*
Humans
Hydrodynamics
Magnetic Resonance Imaging
Male
Models, Cardiovascular
Polytetrafluoroethylene
Prosthesis Design
Regional Blood Flow
Tomography, X-Ray Computed
Treatment Outcome
Grant Support
ID/Acronym/Agency:
HL67622/HL/NHLBI NIH HHS; R01 HL067622/HL/NHLBI NIH HHS; R01 HL098252/HL/NHLBI NIH HHS; R01HL098252/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene
Comments/Corrections

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


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