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Impact of the location of the fenestration on Fontan circulation haemodynamics: a three-dimensional, computational model study

Published online by Cambridge University Press:  05 April 2017

Koichi Sughimoto ,
Yuta Asakura ,
Christian P. Brizard ,
Fuyou Liang ,
Takashi Fujiwara ,
Kagami Miyaji  and
Hao Liu
Koichi Sughimoto*
Affiliation:
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Australia
Yuta Asakura
Affiliation:
Graduate School of Engineering, Chiba University, Chiba, Japan
Christian P. Brizard
Affiliation:
Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
Fuyou Liang
Affiliation:
School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CUICRC), Shanghai Jiao Tong University, Shanghai, China
Takashi Fujiwara
Affiliation:
Graduate School of Engineering, Chiba University, Chiba, Japan
Kagami Miyaji
Affiliation:
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
Hao Liu*
Affiliation:
Graduate School of Engineering, Chiba University, Chiba, Japan Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CUICRC), Shanghai Jiao Tong University, Shanghai, China
*
Correspondence to: K. Sughimoto, MD, PhD, Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ward, Sagamihara 252-0375, Japan. Tel: +81 427 78 8111; Fax: +81 427 778 8574; E-mail: [email protected]; H. Liu, PhD, Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba 263-8522, Japan. Tel: +81 43 290 3228; Fax: +81 43 290 3228; E-mail: [email protected]
Correspondence to: K. Sughimoto, MD, PhD, Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ward, Sagamihara 252-0375, Japan. Tel: +81 427 78 8111; Fax: +81 427 778 8574; E-mail: [email protected]; H. Liu, PhD, Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba 263-8522, Japan. Tel: +81 43 290 3228; Fax: +81 43 290 3228; E-mail: [email protected]
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Abstract

Objectives

There is no consensus or theoretical explanation regarding the optimal location for the fenestration during the Fontan operation. We investigated the impact of the location of the fenestration on Fontan haemodynamics using a three-dimensional Fontan model in various physiological conditions.

Methods

A three-dimensional Fontan model was constructed on the basis of CT images, and a 4-mm-diameter fenestration was located between the extracardiac Fontan conduit and the right atrium at three positions: superior, middle, and inferior part of the conduit. Haemodynamics in the Fontan route were analysed using a three-dimensional computational fluid dynamic model in realistic physiological conditions, which were predicted using a lumped parameter model of the cardiovascular system. The respiratory effect of the caval flow was taken into account. The flow rate through the fenestration, the effect of lowering the central venous pressure, and wall shear stress in the Fontan circuit were evaluated under central venous pressures of 10, 15, and 20 mmHg. The pulse power index and pulsatile energy loss index were calculated as energy loss indices.

Results

Under all central venous pressures, the middle-part fenestration demonstrated the most significant effect on enhancing the flow rate through the fenestration while lowering the central venous pressure. The middle-part fenestration produced the highest time-averaged wall shear stress, pressure pulse index, and pulsatile energy loss index.

Conclusions

Despite slightly elevated energy loss, the middle-part fenestration most significantly increased cardiac output and lowered central venous pressure under respiration in the Fontan circulation.

Keywords

Fontanfenestrationcomputer fluid dynamicshaemodynamics
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1289 - 1294
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Copyright
© Cambridge University Press 2017 

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References

1. Emani, SM, McElhinney, DB, Tworetzky, W, et al. Staged left ventricular recruitment after single-ventricle palliation in patients with borderline left heart hypoplasia. J Am Coll Cardiol 2012; 60: 1966–1974.Google Scholar
2. Tan, A-M, Iyengar, AJ, Donath, S, et al. Fontan completion rate and outcomes after bidirectional cavo-pulmonary shunt. Eur J Cardiothorac Surg 2010; 38: 59–65.Google Scholar
3. Bridges, ND, Mayer, JE, Lock, JE, Jonas, RA, Hanley, FL. Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation 1992; 86: 1762–1769.CrossRefGoogle ScholarPubMed
4. Fiore, AC, Tan, C, Armbrecht, E, et al. Comparison of fenestrated and nonfenestrated patients undergoing extracardiac Fontan. Ann Thorac Surg 2014; 97: 924–931; ; discussion 930–931.Google Scholar
5. Gewillig, M, Goldberg, DJ. Failure of the fontan circulation. Heart Fail Clin 2014; 10: 105–116.CrossRefGoogle ScholarPubMed
6. Gewillig, M, Brown, SC. The Fontan circulation after 45 years: update in physiology. Heart 2016; 102: 1081–1086.Google Scholar
7. Liang, F, Senzaki, H, Yin, Z, Fan, Y, Sughimoto, K, Liu, H. Transient hemodynamic changes upon changing a BCPA into a TCPC in staged Fontan operation: a computational model study. Sci World J 2013; 2013: 1–10.Google Scholar
8. Liang, F, Senzaki, H, Kurishima, C, Sughimoto, K, Inuzuka, R, Liu, H. Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 2014; 307: H1056–H1072.Google Scholar
9. Liang, F, Sughimoto, K, Matsuo, K, Liu, H, Takagi, S. Patient-specific assessment of cardiovascular function by combination of clinical data and computational model with applications to patients undergoing Fontan operation. Int J Numer Method Biomed Eng 2014; 30: 1000–1018.CrossRefGoogle ScholarPubMed
10. Sughimoto, K, Liang, F, Takahara, Y, et al. Assessment of cardiovascular function by combining clinical data with a computational model of the cardiovascular system. J Thorac Cardiovasc Surg 2013; 145: 1367–1372.Google Scholar
11. Liu, H, Liang, F, Wong, J, et al. Multi-scale modeling of hemodynamics in the cardiovascular system. Acta Mech Sin 2015; 31: 446–464.Google Scholar
12. Ruiz, E, Guerrero, R, d’Udekem, Y, Brizard, C. A technique of fenestration for extracardiac Fontan with long-term patency. Eur J Cardiothorac Surg 2009; 36: 200–202.Google Scholar
13. Sughimoto, K, Takahara, Y, Mogi, K, et al. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms. Heart Vessels. 2014; 29: 404–412.Google Scholar
14. Hjortdal, VE. Effects of exercise and respiration on blood flow in total cavopulmonary connection: a real-time magnetic resonance flow study. Circulation 2003; 108: 1227–1231.Google Scholar
15. Liu, J, Qian, Y, Sun, Q, Liu, J, Umezu, M. Use of computational fluid dynamics to estimate hemodynamic effects of respiration on hypoplastic left heart syndrome surgery: total cavopulmonary connection treatments. Sci World J 2013; 2013: 131597.Google Scholar
16. Lemler, MS, Scott, WA, Leonard, SR, Stromberg, D, Ramaciotti, C. Fenestration improves clinical outcome of the fontan procedure: a prospective, randomized study. Circulation 2002; 105: 207–212.CrossRefGoogle ScholarPubMed
17. Meadows, J, Lang, P, Marx, G, Rhodes, J. Fontan fenestration closure has no acute effect on exercise capacity but improves ventilatory response to exercise. J Am Coll Cardiol 2008; 52: 108–113.CrossRefGoogle ScholarPubMed
18. Albal, PG, Menon, PG, Kowalski, W, Undar, A, Turkoz, R, Pekkan, K. Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension. Artif Organs. 2013; 37: 66–75.CrossRefGoogle ScholarPubMed
19. Loomba, RS, Danduran, ME, Dixon, JE, Rao, RP. Effect of Fontan fenestration on regional venous oxygen saturation during exercise: further insights into Fontan fenestration closure. Pediatr Cardiol 2014; 35: 514–520.Google Scholar
20. Salazar, JD, Zafar, F, Siddiqui, K, et al. Fenestration during Fontan palliation: now the exception instead of the rule. J Thorac Cardiovasc Surg 2010; 140: 129–136.CrossRefGoogle ScholarPubMed
21. Schreiber, C, Hörer, J, Lange, R. To fenestrate or not to fenestrate. J Thorac Cardiovasc Surg 2011; 141: 598.CrossRefGoogle ScholarPubMed
22. Schreiber, C, Hörer, J, Vogt, M, Cleuziou, J, Prodan, Z, Lange, R. Nonfenestrated extracardiac total cavopulmonary connection in 132 consecutive patients. Ann Thorac Surg 2007; 84: 894–899.Google Scholar
23. Coon, PD, Rychik, J, Novello, RT, Ro, PS, Gaynor, JW, Spray, TL. Thrombus formation after the Fontan operation. Ann Thorac Surg 2001; 71: 1990–1994.Google Scholar
24. Balling, G, Vogt, M, Kaemmerer, H, Eicken, A, Meisner, H, Hess, J. Intracardiac thrombus formation after the Fontan operation. J Thorac Cardiovasc Surg 2000; 119: 745–752.Google Scholar
25. Yang, W, Chan, FP, Reddy, VM, Marsden, AL, Feinstein, JA. Flow simulations and validation for the first cohort of patients undergoing the Y-graft Fontan procedure. J Thorac Cardiovasc Surg 2015; 149: 247–255.Google Scholar
26. Dasi, LP, Whitehead, K, Pekkan, K, et al. Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac. J Thorac Cardiovasc Surg 2011; 141: 207–214.CrossRefGoogle ScholarPubMed
27. Grosse-Wortmann, L, Dragulescu, A, Drolet, C, et al. Determinants and clinical significance of flow via the fenestration in the Fontan pathway: a multimodality study. Int Cardiol 2013; 168: 811–817.CrossRefGoogle ScholarPubMed
28. Inuzuka, R, Kuwata, S, Kurishima, C, Liang, F, Sughimoto, K, Senzaki, H. Influence of cardiac function and loading conditions on the myocardial performance index – theoretical analysis based on a mathematical model. Circ J 2016; 80: 148–156.CrossRefGoogle ScholarPubMed