Toward Optimal Hemodynamics: Computer Modeling of the Fontan Circuit

Bove, Edward L.; Leval, Marc R. de; Migliavacca, Francesco; Balossino, Rossella; Dubini, Gabriele

doi:10.1007/s00246-007-9009-y

Cited by 55 publications

(41 citation statements)

References 22 publications

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“…Therefore, stimuli that reduce stressed volume (venodilation from any source, blood loss and dehydration) do no good. Second, nonpulsatile PBF due to the loss of the right ventricle increases PVR by approximately 100% than that seen with pulsatile flow because recruiting distal pulmonary vasculature is lost without pulsatile flow energy, thereby reducing the area of the pulmonary vascular bed [50]. In addition, long-term loss of pulsatile PBF is accompanied by reduction of endothelial release of nitric oxide [51].…”

Section: The Physiology Of Fontan Circulationmentioning

confidence: 99%

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

2011

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Patients with congenital heart diseases are a growing population, and noncardiac surgeries will become an important health care issue. Patients with single ventricle physiology are a particularly challenging population who will undergo staged, palliative repair toward a final step of Fontan circulation. Although Fontan surgery creates a serial circulation in which the ventricle pumps blood to the systemic circuit, pulmonary blood flow occurs without a dedicated ventricle. Despite progress in outcomes, this abnormal circulation remains associated with various co-morbidities such as ventricular dysfunction, arrhythmias, protein losing enteropathy, and plastic bronchitis. Health care professionals must prepare for these patients to present to noncardiac surgery at any stage of intervention, possibly with complications. Given that staged, palliative repair has undergone multiple modifications, patients who present for surgery can vary in types and timing of the repair. Anesthesiologists who care for them must be familiar with perioperative issues to optimize outcomes, especially because congenital heart disease is a risk factor for increased mortality for noncardiac surgery.

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Section: The Physiology Of Fontan Circulationmentioning

confidence: 99%

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

2011

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“…For some populations of congenital heart disease patients, such as the total cavopulmonary connection (aka Fontan), 5,24 complex numerical analyses have been performed to better understand, characterize, and index the efficiency of post-operative physiology, and in some cases have been helpful in subsequent medical and/or surgical management. An example is the use of ventricular stroke work (SW) as a parameter to assess contractile function.…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data

2010

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Repaired tetralogy of Fallot (rTOF) patients develop right ventricular (RV) dilatation and dysfunction. To prevent their demise, pulmonary valve replacement is necessary, though appropriate timing for it is challenged by a paucity of reliable diagnostic parameters. In this pilot study, we hypothesized that stroke work (SW) and energy calculations would delineate the inefficiency of RV performance in rTOF. RV SW was calculated for both an rTOF and a normal subject by utilizing RV pressure and volume measurements obtained during cardiac catheterization and MRI studies. Energy transfer rate and ratio were computed at the main pulmonary artery (PA). Compared to the normal RV, the rTOF RV had higher operating pressure, lower computed SW (0.078 J vs. 0.115 J for normal), and higher negative energy transfer at the PA (0.044 J vs. 0.002 J for normal). Furthermore, the energy transfer ratio was nearly twice as high for the normal RV (1.06) as for the rTOF RV (0.56). RV SW and energy transfer ratio delineate important operational efficiency differences in blood flow from the RV to the PA between rTOF and normal subjects. Our pilot data suggest that the rTOF RV is significantly less efficient than normal.

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“…In a recent article, Bove et al [29], working on advanced computing models, analyzed the principles of the search for the ideal Fontan hemodynamics: lower power dissipation through anastomoses without sharp angles, stenosis or dilatation, reduced of the possible presence of a rigid material, fixed and impermeable; and distribution of the homogeneous pulmonary flow. Another classic study, performed by Amodeo et al [12] showed that the direction of the flow of the inferior vena cava to the left pulmonary artery branch creates a vortex effect in the pulmonary artery, which regulates the distribution of blood between the pulmonary branches and promotes a pattern of savings more favorable compared to the situation in which the anastomoses of superior and inferior vena cava are in opposition.…”

Section: Discussionmentioning

confidence: 99%

Operação de Fontan: uma técnica em evolução

Fantini¹,

Gontijo²,

Martins³

et al. 2009

Rev Bras Cir Cardiovasc

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Objectives: Recent experimental flow studies based on angiography and magnetic resonance have shown that total cavopulmonary anastomosis (TCPA) is a valid concept for surgical treatment of many congenital heart defects, but there is not agreement of the best surgical arrangement. The aim of this study is to assess the immediate results with three different techniques of TCPA.Methods: Clinical study of all TCPA performed from January 2005 to July 2008; there were 40 patients, all with previous Glenn anastomosis, with mean age of 6.4 ± 3.2 years. Three different techniques were employed: Group 1 (G1) lateral tunnel, Group 2 (G2) extracardiac conduits, Group 3 (G3) intracardiac conduit directed to the left pulmonary branch. All patients had a fenestration performed and pre-and postoperative variables were assessed.Results: G1 had 11 patients, G2 10 patients and G3 19 patients. Preoperative variables were similar in the 3 groups (P>0.05). Surgical mortality was higher in Groups 1 and 2 (9.1% and 10%) compared to Group 3 (0%) but there was no statistical significance (P=0.3841). Pleural effusion was absent in Group 3 (0%), which was statistically significant in relation to the other groups (P=0.0128). The length of hospital stay was also significantly lower in G3 (8 days) in relation to G1 (18 days) and G2 (13 days) (P=0.0164). Conclusion:Intracardiac TCPA was associated with lower postoperative morbidity and is currently our preferred technique on total cavopulmonary anastomosis. Rev Bras Cir Cardiovasc 2009; 24(4): 463-469 technique in which a olytetrafluoroethylene (PTFE) conduit is placed between the inferior vena cava and pulmonary artery, through the right atrium via the foramen ovale into the left atrium roof, where it is exteriorized and sutured to the trunk or left pulmonary artery branch. This technique allowed to reach the left pulmonary artery branch with a prosthesis smaller, with fewer curves and angles, thus minimizing the presence of inflexible material in the system. The aim of this study was to review the immediate results of patients undergoing the Fontan operation at a single institution with three models of total cavopulmonary anastomosis. FANTINI, FA ET AL -Fontan operation: a technique in evolution METHODS Study designWe performed clinical trial with 40 patients with univentricular physiology undergoing the Fontan operation in Biocor Institute,

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Toward Optimal Hemodynamics: Computer Modeling of the Fontan Circuit

Cited by 55 publications

References 22 publications

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data

Operação de Fontan: uma técnica em evolução

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