Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics

Marsden, Alison L.; Bernstein, Adam J.; Reddy, V. Mohan; Shadden, Shawn C.; Spilker, Ryan L.; Chan, Frandics P.; Taylor, Charles A.; Feinstein, Jeffrey A.

doi:10.1016/j.jtcvs.2008.06.043

Cited by 181 publications

(178 citation statements)

References 38 publications

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“…Slight improvements in performance in terms of local fluid dynamics were demonstrated by the Y-TCPC model, with better flow distribution, greater efficiency and minor power losses both at rest and in exercise. Although such results are in line with the recent literature studies [7,19], the enhancement in clinical outcome brought by a Y-graft configuration is not yet demonstrated.…”

Section: Discussionsupporting

confidence: 58%

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Virtual surgeries in patients with congenital heart disease: a multi-scale modelling test case

Baretta

Corsini

Yang

et al. 2011

Phil. Trans. R. Soc. A.

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The objective of this work is to perform a virtual planning of surgical repairs in patients with congenital heart diseases-to test the predictive capability of a closed-loop multi-scale model. As a first step, we reproduced the pre-operative state of a specific patient with a univentricular circulation and a bidirectional cavopulmonary anastomosis (BCPA), starting from the patient's clinical data. Namely, by adopting a closed-loop multi-scale approach, the boundary conditions at the inlet and outlet sections of the three-dimensional model were automatically calculated by a lumped parameter network. Successively, we simulated three alternative surgical designs of the total cavopulmonary connection (TCPC). In particular, a T-junction of the venae cavae to the pulmonary arteries (T-TCPC), a design with an offset between the venae cavae (O-TCPC) and a Y-graft design (Y-TCPC) were compared. A multi-scale closed-loop model consisting of a lumped parameter network representing the whole circulation and a patient-specific three-dimensional finite volume model of the BCPA with detailed pulmonary anatomy was built. The three TCPC alternatives were investigated in terms of energetics and haemodynamics. Effects of exercise were also investigated. Results showed that the pre-operative caval flows should not be used as boundary conditions in post-operative simulations owing to changes in the flow waveforms post-operatively. The multi-scale approach is a possible solution to overcome this incongruence. Power losses of the Y-TCPC were lower than all other TCPC models both at rest and under exercise conditions and it distributed the inferior vena cava flow evenly to both lungs. Further work is needed to correlate results from these simulations with clinical outcomes.*Author for correspondence (giancarlo.pennati@polimi.it).One contribution of 11 to a Theme Issue 'Towards the virtual physiological human: mathematical and computational case studies'.This journal is

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Section: Discussionsupporting

confidence: 58%

“…Computational modelling, clinical observation and experimental studies have suggested that the geometry of the TCPC plays a key role in energy losses and fluid dynamics [2,4] and previous work has considered both offset and Y-shaped alternative designs [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Virtual surgeries in patients with congenital heart disease: a multi-scale modelling test case

Baretta

Corsini

Yang

et al. 2011

Phil. Trans. R. Soc. A.

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“…Numerical techniques allow us to examine the effects of the geometry of the Fontan connection that plays an important role in the overall success of the surgery, and assess blood flow characteristics and energy losses associated with a given surgical design. There are numerous articles on the total cavopulmonary connection simulation (see, e.g., [7,11,22,25,26]) that do a very careful CFD analysis on complex patient-specific configurations in an attempt to answer some of these questions. Some of the earlier work in computational fluid dynamics applied to congenital heart disease compared energy loss in the standard "t" junction Fontan with the proposed "offset" model, and led to the adoption of the offset model as the currently preferred method [9,10,28,29].…”

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confidence: 99%

Computational fluid–structure interaction: methods and application to a total cavopulmonary connection

et al. 2009

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The Fontan procedure is a surgery that is performed on single-ventricle heart patients, and, due to the wide range of anatomies and variations among patients, lends itself nicely to study by advanced numerical methods. We focus on a patient-specific Fontan configuration, and perform a fully coupled fluid-structure interaction (FSI) analysis of hemodynamics and vessel wall motion. To enable physiologically realistic simulations, a simple approach to constructing a variable-thickness blood vessel wall description is proposed. Rest and exercise conditions are simulated and rigid versus flexible vessel wall simulation results are compared. We conclude that flexible wall modeling plays an important role in predicting quantities of hemodynamic interest in the Fontan connection. To the best of our knowledge, this paper presents the first three-dimensional patientspecific fully coupled FSI analysis of a total cavopulmonary connection that also includes large portions of the pulmonary circulation.

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“…Incorporating human pulmonary morphometry data to determine the impedance of the downstream vascular trees with patient-specific resistances determined from catheterization data has emerged as a successful strategy, providing physiologically sound boundary conditions and successfully capturing patient-specific pressure levels and flow characteristics. 28,43 These types of boundary conditions also allow for the straightforward modeling of PVR reduction during exercise. 29,45 Moving Walls…”

Section: Outflow Boundary Conditionsmentioning

confidence: 99%

Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure

Zélicourt

Kurtcuoglu

2015

Ann Biomed Eng

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The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework.

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Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics

Cited by 181 publications

References 38 publications

Virtual surgeries in patients with congenital heart disease: a multi-scale modelling test case

Virtual surgeries in patients with congenital heart disease: a multi-scale modelling test case

Computational fluid–structure interaction: methods and application to a total cavopulmonary connection

Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure

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