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Author Notes:

Ajit P. Yoganathan, Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA. ajit.yoganathan@bme.gatech.edu.

We also acknowledge Dr. Dave Frakes for providing the ACGI technology and Dr. Hiroumi Kitajima for processing the patient MRI datasets.

Experimental and computational studies were made possible by the help of our brilliant undergraduate students: Vasu Yernini, Maria Restrepo, Kiyu Kim, and Quantez Freeman.

Subjects:

Research Funding:

This work was supported by a grant from the National Heart, Lung, and Blood Institute, HL67622.

Keywords:

  • Science & Technology
  • Technology
  • Engineering, Biomedical
  • Engineering
  • CFD
  • Patient-specific
  • Fontan
  • Congenital
  • Univentricular
  • PIV
  • Hemodynamics
  • TOTAL CAVOPULMONARY CONNECTION
  • LEFT-HEART SYNDROME
  • LATERAL TUNNEL
  • EXTRACARDIAC CONDUIT
  • IN-VITRO
  • COMPUTATIONAL SIMULATIONS
  • CARDIAC OUTPUT
  • VENOUS RETURN
  • CURRENT ERA
  • OPERATION

Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates

Tools:

Journal Title:

Annals of Biomedical Engineering

Volume:

Volume 37, Number 1

Publisher:

, Pages 50-63

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Flow structures, hemodynamics and the hydrodynamic surgical pathway resistances of the final stage functional single ventricle reconstruction, namely the total cavopulmonary connection (TCPC) anatomy, have been investigated extensively. However, the second stage surgical anatomy (i.e., bi-directional Glenn or hemi-Fontan template) has received little attention. We thus initiated a multi-faceted study, involving magnetic resonance imaging (MRI), phase contrast MRI, computational and experimental fluid dynamics methodologies, focused on the second stage of the procedure. Twenty three-dimensional computer and rapid prototype models of 2nd stage TCPC anatomies were created, including idealized parametric geometries (n = 6), patient-specific anatomies (n = 7), and their virtual surgery variant (n = 7). Results in patient-specific and idealized models showed that the Glenn connection template is hemodynamically more efficient with (83% p = 0.08 in patient-specific models and 66% in idealized models) lower power losses compared to hemi-Fontan template, respectively, due to its direct end-to-side anastomosis. Among the several secondary surgical geometrical features, stenosis at the SVC anastomosis or in pulmonary branches was found to be the most critical parameter in increasing the power loss. The pouch size and flare shape were found to be less significant. Compared to the third stage surgery the hydrodynamic resistance of the 2nd stage is considerably lower (both in idealized models and in anatomical models at MRI resting conditions) for both hemi- and Glenn templates. These results can impact the surgical design and planning of the staged TCPC reconstruction.

Copyright information:

© 2008 Biomedical Engineering Society.

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