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Author Notes:

Ajit P. Yoganathan, PhD, The Wallace H. Coulter Distinguished Faculty Chair in Biomedical Engineering & Regent’s Professor, Associate Chair for Translational Research, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, ajit.yoganathan@bme.gatech.edu, Phone: 404-894-2849 Fax: 404-385-1268.


Research Funding:

This study was supported by the National Heart, Lung, and Blood Institute Grants R01HL67622 and R01HL098252; and a Pre-Doctoral Fellowship (10PRE3720002) from the American Heart Association.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Respiratory System
  • Surgery
  • Cardiovascular System & Cardiology
  • FLOW

Fontan hemodynamics from 100 patient-specific cardiac magnetic resonance studies: A computational fluid dynamics analysis


Journal Title:

Journal of Thoracic and Cardiovascular Surgery


Volume 148, Number 4


, Pages 1481-1489

Type of Work:

Article | Post-print: After Peer Review


Objectives: This study sought to quantify average hemodynamic metrics of the Fontan connection as reference for future investigations, compare connection types (intra-atrial vs extracardiac), and identify functional correlates using computational fluid dynamics in a large patient-specific cohort. Fontan hemodynamics, particularly power losses, are hypothesized to vary considerably among patients with a single ventricle and adversely affect systemic hemodynamics and ventricular function if suboptimal. Methods: Fontan connection models were created from cardiac magnetic resonance scans for 100 patients. Phase velocity cardiac magnetic resonance in the aorta, vena cavae, and pulmonary arteries was used to prescribe patient-specific time-averaged flow boundary conditions for computational fluid dynamics with a customized, validated solver. Comparison with 4-dimensional cardiac magnetic resonance velocity data from selected patients was used to provide additional verification of simulations. Indexed Fontan power loss, connection resistance, and hepatic flow distribution were quantified and correlated with systemic patient characteristics. Results: Indexed power loss varied by 2 orders of magnitude, whereas, on average, Fontan resistance was 15% to 20%of published values of pulmonary vascular resistance in single ventricles. A significant inverse relationship was observed between indexed power loss and both systemic venous flow and cardiac index. Comparison by connection type showed no differences between intra-atrial and extracardiac connections. Instead, the least efficient connections revealed adverse consequences from localized Fontan pathway stenosis. Conclusions: Fontan power loss varies from patient to patient, and elevated levels are correlated with lower systemic flow and cardiac index. Fontan connection type does not influence hemodynamic efficiency, but an undersized or stenosed Fontan pathway or pulmonary arteries can be highly dissipative.

Copyright information:

© 2014 The American Association for Thoracic Surgery.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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