In vitro flow experiments for determination of optimal geometry of total cavopulmonary connection for surgical repair of children with functional single ventricle

Sharma, Sanjeevan; Goudy, Sean; Walker, Peter G.; Panchal, Samir; Ensley, A.; Kanter, Kirk R.; Tam, Vincent K.H; Fyfe, Derek A.; Yoganathan, Ajit P.

doi:10.1016/0735-1097(95)00598-6

Cited by 126 publications

(110 citation statements)

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“…Conserving as much as possible the mechanical energy of blood that flows through the connection is of crucial importance, considering that the single ventriele is respon sible fo r both the systemic and the pulmonary circulation. As a result, the fluid mechanical optimization of the TCPC has becn invcstigated through several in vitro, numerical and in vivo studi es [5][6][7][8][9][10][11][12][13][14][15][16][17][18], leading to improvements in the connection between thc caval and pulmonary vessels .…”

Section: Introductionmentioning

confidence: 99%

Noninvasive quantification of fluid mechanical energy losses in the total cavopulmonary connection with magnetic resonance phase velocity mapping

Venkatachari

Halliburton

Setser

et al. 2007

Magnetic Resonance Imaging

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Section: Introductionmentioning

confidence: 99%

Noninvasive quantification of fluid mechanical energy losses in the total cavopulmonary connection with magnetic resonance phase velocity mapping

Venkatachari

Halliburton

Setser

et al. 2007

Magnetic Resonance Imaging

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“…In our in vitro experiments we studied three different designs of the TCPC with quantitative assessment of energy losses and correlated the losses with flow visual ization [7,10,11]. This gave information regarding con nections that would conserve energy and those that were particularly detrimental in this regard.…”

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confidence: 99%

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

Sharma¹,

Ensley

Hopkins

et al. 2001

The Annals of Thoracic Surgery

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Background. The total cavopulmonary connection (TCPC) design continues to be refined on the basis of flow analysis at the connection site. These refinements are of importance for myocardial energy conservation in the univentricular supported circulation. In vivo mag netic resonance phase contrast imaging provides semiquantitative flow visualization information. The purpose of this study was to understand the in vivo TCPC flow characteristics obtained by magnetic resonance phase contrast imaging and compare the results with our pre vious in vitro TCPC flow experiments in an effort to further refine TCPC surgical design.Methods. Twelve patients with TCPC underwent se dated three-dimensional, multislice magnetic resonance phase contrast imaging. Seven patients had intraatrial lateral tunnel TCPC and 5 had extracardiac TCPC.Results. In all patients in both groups a disordered flow pattern was observed in the inferior caval portion of the TCPC. Flow at the TCPC site appeared to be determined by connection geometry, being streamlined at the superior

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“…On the basis of the results of those experiments, they advocated the use of TCPC that was designed to produce a more streamlined flow pattern that should lead to less energy loss. Subsequent in vitro 7,[17][18][19][20][21] and computational 8,18,19 studies confirmed those observations. The effect of progressive right atrial dilatation on energy loss and resistance to flow was recently studied by Lardo and associates 20 in an in vitro flow model of explanted sheep hearts with APA-type Fontan pathways.…”

Section: Discussionmentioning

confidence: 56%

“…To date, however, nonrandomized clinical studies comparing outcome for APA versus TCPC have yielded equivocal results. 4,5 Recent studies performed on in vitro models 7 and computer-based simulations 8 demonstrated that energy loss is greater and flow is more disturbed in Fontan circulation with APA compared with TCPC. These in vitro studies, however, may not accurately reflect in vivo conditions, and any differences between APA and TCPC pathways in this regard still remain unknown.…”

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In Vivo Evaluation of Fontan Pathway Flow Dynamics by Multidimensional Phase-Velocity Magnetic Resonance Imaging

et al. 1998

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Background-Hemodynamic efficiency of Fontan circulation is believed to be a major determinant of outcome. Prior research on flow dynamics in different modifications of Fontan circulation used in vitro models and computer-based simulation. This study was designed to compare in vivo flow dynamics in the systemic venous pathway between patients with atriopulmonary anastomosis (APA) and those with total cavopulmonary connection (TCPC). Methods and Results-Multidimensional phase-velocity magnetic resonance imaging (PV-MRI) studies were performed on 10 patients who had undergone a modified Fontan operation (5 with TCPC and 5 with APA) and were free of symptoms. The groups were comparable in terms of age and body surface area. The interval since surgery was longer for APA than for TCPC subjects. In each subject, the phase-velocity data sets were used to generate dynamic velocity-vector maps and to calculate quantitative flow indices describing the 3-dimensional blood-flow patterns throughout the cardiac cycle at the widest diameter of the Fontan pathway. Mean flow rate was comparable between groups. Velocity-vector maps showed areas of flow reversal, flow stagnation, and circular flow within APA but not TCPC pathways. Analysis of quantitative flow indices showed that compared with the APA group, flow velocities in the TCPC patients were significantly higher (mean velocity, 14Ϯ6 cm/s versus 5Ϯ3 cm/s; Pϭ0.02), less variable (coefficient of variation, 19Ϯ2% versus 37Ϯ3.5%; PϽ0.0001), and more unidirectional (degree of unidirectionality, 89Ϯ7% versus 71Ϯ12%; Pϭ0.03). APA pathways were significantly more dilated than were TCPC pathways (PϽ0.01) and showed a trend toward larger diameter with increased interval since surgery (R

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In vitro flow experiments for determination of optimal geometry of total cavopulmonary connection for surgical repair of children with functional single ventricle

Abstract: The results strongly suggest the incorporation of caval offsets in future total cavopulmonary connections.

Cited by 126 publications

References 9 publications

Noninvasive quantification of fluid mechanical energy losses in the total cavopulmonary connection with magnetic resonance phase velocity mapping

Noninvasive quantification of fluid mechanical energy losses in the total cavopulmonary connection with magnetic resonance phase velocity mapping

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

In Vivo Evaluation of Fontan Pathway Flow Dynamics by Multidimensional Phase-Velocity Magnetic Resonance Imaging

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