Flow simulations and validation for the first cohort of patients undergoing the Y-graft Fontan procedure

Abstract

The credibility and accuracy of simulation-based predictions of postoperative hepatic flow distribution for the Fontan surgery have been validated by in vivo lung perfusion data. The performance of the Y-graft design is highly patient-specific. The anastomosis location is likely the most important factor influencing hepatic blood flow distribution. Although the development of thrombosis is multifactorial, the occurrence in 1 patient suggests that simulations should not solely consider the hepatic blood flow distribution but also aim to avoid low wall shear stress in the limbs.

Patient-Specific Simulations Reveal Significant Differences in Mechanical Stimuli in Venous and Arterial Coronary Grafts

“…In addition, simulations have led to clinical translation of novel surgical methods in congenital heart disease with promising results [45, 46]. Development of simulation tools to predict venous graft failure poses additional challenges of incorporating long-term mechanobiological responses, and correlation with intermediate-long-term clinical outcomes.…”

Trends in Congenital Heart Disease

“…Three-dimensional printing techniques are already being used in demonstration for planning of complex surgical maneuvers in CHD (Figure 4), 39 and the development of anatomically specific valve and vascular prostheses will also likely make use of this technology. 40 Such innovation in this area will be further advanced and supported by exploration of the use of volume imaging technologies such as MRI for computational assessment of ventricular function, 41 hemodynamics, [42][43][44] outcome risk 41,45 and possibly even as a direct navigational tool for cardiac intervention 46 We also expect to see further development of novel robotic tools and augmented reality platforms for catheter-based and other less invasive cardiac interventions.…”

Fontan Revision with Y-Graft in a Patient with Unilateral Pulmonary Arteriovenous Malformation

“…For example, Haggerty et al [7] reported positive hemodynamic results in patients who underwent a Y-graft Fontan operation using computed tomography and MRI in a quantitative simulation. Yang et al [8] also found that asymmetric blood flow distribution was reduced after the Y-graft Fontan operation.…”