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global mathematical modelling of the norwood circulation: a multiscale approach for the study of the pulmonary and coronary arterial perfusions

Published online by Cambridge University Press:  23 September 2005

francesco migliavacca
Affiliation:
bioengineering department and laboratory of biological structure mechanics, politecnico di milano, milan, italy
katia laganà
Affiliation:
bioengineering department and laboratory of biological structure mechanics, politecnico di milano, milan, italy
giancarlo pennati
Affiliation:
bioengineering department and laboratory of biological structure mechanics, politecnico di milano, milan, italy
marc r. de leval
Affiliation:
cardiothoracic unit, great ormond street hospital for children nhs trust, london, great britain
edward l. bove
Affiliation:
section of cardiac surgery, the university of michigan school of medicine, ann arbor, mi, usa
gabriele dubini
Affiliation:
structural engineering and laboratory of biological structure mechanics, politecnico di milano, milan, italy

Abstract

the norwood procedure involves three separate stages of operative corrections. the first stage involves re-fashioning the pulmonary trunk into a neo-aorta so that it is possible to establish an unrestricted systemic circulation. an interpositional, or systemic-to-pulmonary arterial, shunt is then created between the neo-aorta and the pulmonary arteries to allow pulmonary perfusion and gas exchange. two of the available options for the systemic-to-pulmonary shunt are the central shunt and the right modified blalock-taussig shunt. in the setting of a central shunt, pulmonary perfusion is derived from a conduit placed between the pulmonary arterial bed and the neo-aorta whereas, in the modified blalock-taussig shunt, the conduit is interposed between one of the pulmonary arteries and the brachiocephalic artery. in subsequent stages, pulmonary perfusion is provided directly by deoxygenated blood. this is achieved by connecting, first, the superior caval vein, and then the inferior caval vein, to the pulmonary arteries. it is usually during the second stage that the systemic-to-pulmonary shunt is removed.

Type
original article
Copyright
2004 cambridge university press

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