Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T08:07:15.709Z Has data issue: false hasContentIssue false

Magnetic resonance imaging-guided surgical design: can we optimise the Fontan operation?

Published online by Cambridge University Press:  09 January 2014

Christopher M. Haggerty
Affiliation:
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, United States of America
Ajit P. Yoganathan
Affiliation:
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, United States of America
Mark A. Fogel*
Affiliation:
Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, United States of America Department of Radiology, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, United States of America
*
Correspondence to: Dr Mark A. Fogel, MD, FACC, FAHA, FAAP, The Children's Hospital of Philadelphia, Division of Cardiology, 34th St. and Civic Center Blvd., Philadelphia, PA 19104, United States of America. Tel: +215 590 7566; Fax: +215 590 5825; E-mail: [email protected]

Abstract

The Fontan procedure, although an imperfect solution for children born with a single functional ventricle, is the only reconstruction at present short of transplantation. The haemodynamics associated with the total cavopulmonary connection, the modern approach to Fontan, are severely altered from the normal biventricular circulation and may contribute to the long-term complications that are frequently noted. Through recent technological advances, spear-headed by advances in medical imaging, it is now possible to virtually model these surgical procedures and evaluate the patient-specific haemodynamics as part of the pre-operative planning process. This is a novel paradigm with the potential to revolutionise the approach to Fontan surgery, help to optimise the haemodynamic results, and improve patient outcomes. This review provides a brief overview of these methods, presents preliminary results of their clinical usage, and offers insights into its potential future directions.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240248.Google Scholar
2.Khairy, P, Fernandes, SM, John, E, et al. Long-term survival, modes of death, and predictors of martality in patients with fontan surgery. Circulation 2008; 117: 8592.Google Scholar
3.Anderson, PAW, Sleeper, LA, Mahony, L, et al. Contemporary outcomes after the Fontan procedure. J Am CollCardiol 2008; 52: 8598.Google Scholar
4.Duncan, BW, Desai, S. Pulmonary arteriovenous malformations after cavopulmonary anastomosis. Ann Thorac Surg 2003; 76: 17591766.Google Scholar
5.De Zelicourt, D, Haggerty, CM, Sundareswaran, KS, et al. Individualized computer-based surgical planning to address pulmonary ateriovenous malformations in patients with a single ventricle with an interrupted inferior vena cava and azygous continuation. J Thorac Cardiovasc Surg 2011; 141: 11701177.CrossRefGoogle Scholar
6.Sundareswaran, K, de Zélicourt, D, Sharma, S, et al. Correction of pulmonary arteriovenous malformation using image based surgical planning. JACC Imaging 2009; 2: 10241030.CrossRefGoogle ScholarPubMed
7.Whitehead, KK, Pekkan, K, Kitajima, HD, et al. Nonlinear power loss during exercise in single-ventricle patients after the fontan: insights from computational fluid dynamics. Circulation 2007; 116: I-165I-171.Google Scholar
8.Sundareswaran, KS, Pekkan, K, Dasi, LP, et al. The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise. Am J Physiol 2008; 295: H2427H2435.Google ScholarPubMed
9.Dasi, LP, Krishnankutty, R, Kitajima, H, et al. Fontan hemodynamics: importance of pulmonary artery diameter. J Thorac Cardiovasc Surg 2009; 137: 560564.CrossRefGoogle ScholarPubMed
10.Ensley, A, Lynch, P, Chatzimavroudis, GP, et al. Toward designing the optimal total cavopulmonary connection: an in vitro study. Ann Thorac Surg 1999; 68: 13841390.Google Scholar
11.Marsden, AL, Bernstein, AJ, Reddy, VM, et al. Evaluation of a novel y-shaped extracardiac fontan baffle using computational fluid dynamics. J Thorac Cardiovasc Surg 2009; 137: 394403.Google Scholar
12.Haggerty, CM, Kanter, KR, Restrepo, M, et al. Simulating hemodynamics of the fontan y-graft based on patient-specific in vivo connections. J Thorac Cardiovasc Surg 2013; 145: 663670.Google Scholar
13.Sundareswaran, KS, Haggerty, CM, de Zélicourt, D, et al. Visualization of flow structures in fontan patients using 3-dimensional phase contrast magnetic resonance imaging. J Thorac Cardiovasc Surg 2011.Google Scholar
14.Pekkan, K, Whited, B, Kanter, K, et al. Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM). Med Biol Eng Comput 2008; 46: 11391152.CrossRefGoogle ScholarPubMed
15.Haggerty, CM, de Zelicourt, D, Restrepo, M, et al. Comparing pre- and post-operative fontan hemodynamic simulations: implications for the reliability of surgical planning. Ann Biomed Eng 2012; 40: 26392651.Google Scholar
16.de Zélicourt, D, Ge, L, Wang, C, et al. Flow simulations in arbitrarily complex cardiovascular anatomies – an unstructured cartesian grid approach. Computers & Fluids 2009; 38: 17491762.Google Scholar
17.Pennati, G, Corsini, C, Cosentino, D, et al. Boundary conditions of patient-specific fluid dynamics modelling of cavopulmonary connections: possible adaptation of pulmonary resistances results is a critical issue for virtual surgical planning. Interface Focus 2011; 1: 297307.Google Scholar
18.Mirabella, L, Haggerty, CM, Passerini, T, et al. Treatment planning for a TCPC test case: a numerical investigation under rigid and moving wall assumptions. Int J Num Method Biomed Eng 2013; 29: 197216.CrossRefGoogle Scholar
19.Kanter, KR, Haggerty, CM, Restrepo, M, et al. Preliminary clinical experience with a bifurcated y-graft fontan procedure – a feasibility study. J Thorac Cardiovasc Surg 2012; 144: 383389.CrossRefGoogle ScholarPubMed
20.Desai, K, Haggerty, CM, Kanter, KR, et al. Haemodynamic comparison of a novel flow-divider Optiflo geometry and a traditional total cavopulmonary connection. Interact Cardiovasc Thorac Surg 2013; 7: 17.Google Scholar