Document Detail


Total cavopulmonary connection flow with functional left pulmonary artery stenosis: angioplasty and fenestration in vitro.
MedLine Citation:
PMID:  16286590     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In our multicenter study of the total cavopulmonary connection (TCPC), a cohort of patients with long-segment left pulmonary artery (LPA) stenosis was observed (35%). The clinically recognized detrimental effects of LPA stenosis motivated a computational fluid dynamic simulation study within 3-dimensional patient-specific and idealized TCPC pathways. The goal of this study was to quantify and evaluate the hemodynamic impact of LPA stenosis and to judge interventional strategies aimed at treating it. METHODS AND RESULTS: Simulations were conducted at equal vascular lung resistance, modeling both discrete stenosis (DS) and diffuse long-segment hypoplasia with varying degrees of obstruction (0% to 80%). Models having fenestrations of 2 to 6 mm and atrium pressures of 4 to 14 mm Hg were explored. A patient-specific, extracardiac TCPC with 85% DS was studied in its original configuration and after virtual surgery that dilated the LPA to 0% stenosis in the computer medium. Performance indices improved exponentially (R2>0.99) with decreasing obstruction. Diffuse long-segment hypoplasia was approximately 50% more severe with regard to lung perfusion and cardiac energy loss than DS. Virtual angioplasty performed on the 3-dimensional Fontan anatomy exhibiting an 85% DS stenosis produced a 61% increase in left lung perfusion and a 50% decrease in cardiac energy dissipation. After 4-mm fenestration, TCPC baffle pressure dropped by approximately 10% and left lung perfusion decreased by approximately 8% compared with the 80% DS case. CONCLUSIONS: DS <60% and diffuse long-segment hypoplasia <40% could be considered tolerable because both resulted in only a 12% decrease in left lung perfusion. In contrast to angioplasty, a fenestration (right-to-left shunt) reduced TCPC pressure at the cost of decreased left and right lung perfusion. These results suggest that pre-Fontan computational fluid dynamic simulation may be valuable for determining both the hemodynamic significance of LPA stenosis and the potential benefits of intervention.
Authors:
Kerem Pekkan; Hiroumi D Kitajima; Diane de Zelicourt; Joseph M Forbess; W James Parks; Mark A Fogel; Shiva Sharma; Kirk R Kanter; David Frakes; Ajit P Yoganathan
Publication Detail:
Type:  In Vitro; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2005-11-14
Journal Detail:
Title:  Circulation     Volume:  112     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-22     Completed Date:  2006-02-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3264-71     Citation Subset:  AIM; IM    
Affiliation:
Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0535, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty
Computer Simulation
Constriction, Pathologic
Databases, Factual
Fontan Procedure*
Heart Bypass, Right*
Humans
Imaging, Three-Dimensional
Lung / blood supply,  physiology
Models, Cardiovascular*
Pulmonary Artery / pathology*,  physiology,  surgery*
Pulmonary Circulation
User-Computer Interface
Vascular Resistance
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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