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Pulsatile venous waveform quality affects the conduit performance in functional and “failing” Fontan circulations

Published online by Cambridge University Press:  19 October 2011

Onur Dur ,
Ergin Kocyildirim ,
Ozlem Soran ,
Peter D. Wearden ,
Victor O. Morell ,
Curt G. DeGroff  and
Kerem Pekkan
Onur Dur
Affiliation:
Department of Biomedical Engineering, Carnegie Mellon University, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Ergin Kocyildirim
Affiliation:
Section of Pediatric Cardiothoracic Surgery of the Heart, Lung and Esophageal Surgical Institute, University of Pittsburgh Medical School, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Ozlem Soran
Affiliation:
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Peter D. Wearden
Affiliation:
Section of Pediatric Cardiothoracic Surgery of the Heart, Lung and Esophageal Surgical Institute, University of Pittsburgh Medical School, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Victor O. Morell
Affiliation:
Section of Pediatric Cardiothoracic Surgery of the Heart, Lung and Esophageal Surgical Institute, University of Pittsburgh Medical School, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Curt G. DeGroff
Affiliation:
Congenital Heart Center, University of Florida, Gainesville, Florida, United States of America
Kerem Pekkan*
Affiliation:
Department of Biomedical Engineering, Carnegie Mellon University, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
*
Correspondence to: Dr K. Pekkan, PhD, Assistant Professor, Biomedical Engineering Department, Carnegie Mellon University, 700 Technology Drive, Pittsburgh, Pennsylvania 15219, United States of America. Tel: 412 268 3027; Fax: 404 268 9807; E-mail: [email protected]
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Abstract

Objective

To investigate the effect of pulsatility of venous flow waveform in the inferior and superior caval vessels on the performance of functional and “failing” Fontan patients based on two primary performance measures – the conduit power loss and the distribution of inferior caval flow (hepatic factors) to the lungs.

Methods

Doppler angiography flows were acquired from two typical extra-cardiac conduit “failing” Fontan patients, aged 13 and 25 years, with ventricle dysfunction. Using computational fluid dynamics, haemodynamic efficiencies of “failing”, functional, and in vitro-generated mechanically assisted venous flow waveforms were evaluated inside an idealised total cavopulmonary connection with a caval offset. To investigate the effect of venous pulsatility alone, cardiac output was normalised to 3 litres per minute in all cases. To quantify the pulsatile behaviour of venous flows, two new performance indices were suggested.

Results

Variations in the pulsatile content of venous waveforms altered the conduit efficiency notably. High-frequency and low-amplitude oscillations lowered the pulsatile component of the power losses in “failing” Fontan flow waveforms. Owing to the offset geometry, hepatic flow distribution depended strongly on the ratio of time-dependent caval flows and the pulsatility content rather than mixing at the junction. “Failing” Fontan flow waveforms exhibited less balanced hepatic flow distribution to lungs.

Conclusions

The haemodynamic efficiency of single-ventricle circulation depends strongly on the pulsatility of venous flow waveforms. The proposed performance indices can be calculated easily in the clinical setting in efforts to better quantify the energy efficiency of Fontan venous waveforms in pulsatile settings.

Keywords

“Failing” Fontan patientcongenital cardiac diseasepulsatility indexcomputational fluid dynamicspower losshepatic flow distribution
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 3 , June 2012 , pp. 251 - 262
Copyright
Copyright © Cambridge University Press 2012

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