Fontan hemodynamics from 100 patient-specific cardiac magnetic resonance studies: A computational fluid dynamics analysis

Haggerty, Christopher M.; Restrepo, Maria; Tang, Elaine; Zélicourt, Diane de; Sundareswaran, Kartik S.; Mirabella, Lucia; Bethel, James; Whitehead, Kevin K.; Fogel, Mark A.; Yoganathan, Ajit P.

doi:10.1016/j.jtcvs.2013.11.060

Cited by 95 publications

(92 citation statements)

References 35 publications

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“…Application of 4D flow in a cohort of various Fontan circuit connections revealed different energy loss with different connections (Fig. 4) [32]. Increasing power loss is found to be associated with reduction in aerobic exercise capacity [33].…”

Section: Flowsmentioning

confidence: 94%

Role of cardiac MRI and CT in Fontan circulation

Yeong

Loughborough

Hamilton

et al. 2017

J Congenit Heart Dis

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A Fontan circulation is a series of palliative surgical procedures, which result in the diversion of the systemic venous return into pulmonary arterial circulation without passing through a ventricle. It is one of the available surgical strategies for patients with cardiac defects that preclude a successful bi-ventricular repair, which encompass a range of complex anatomy. This surgical repair has gone through a series of modifications since the concept was introduced in 1971. Echocardiography remains a vital tool in assessing patients with Fontan circulations but its limitations are well recognised. Cross-sectional imaging modalities such as cardiac MRI and CT are essential components in the systematic clinical evaluation of these patients. The purpose of this review is to understand the information that can be obtained with each cross-sectional modality as well as highlight the challenges that each modality faces.

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Section: Flowsmentioning

confidence: 94%

Role of cardiac MRI and CT in Fontan circulation

Yeong

Loughborough

Hamilton

et al. 2017

J Congenit Heart Dis

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“…The total cavopulmonary connection (TCPC), created in the last stage of the Fontan procedure, comprises a resistance unit that functions in series with the SV and influences ventricular loading [5][6][7][8]. A number of cross-sectional studies have focused on the interactions between TCPC hemodynamics and the overall circulation [6,9], ventricular function [10,11], venous return [11], and vessel stenosis [12]. However, there are little data on serial evaluation of patient-specific anatomic, hemodynamic, and energetic changes with time.…”

mentioning

confidence: 99%

Energetic Implications of Vessel Growth and Flow Changes Over Time in Fontan Patients

Restrepo

Tang

Haggerty

et al. 2015

The Annals of Thoracic Surgery

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“…12 This difference is not unexpected given that, by construction, intra-atrial TCPCs typically feature no or little offset, so that the effect of that variable is only weakly present across intra-atrial patients. In fact, when grouping intra-atrial (n = 67) and extra-cardiac (n = 41) TCPCs together, Tang et al 38 demonstrated that IVC-SVC offset and angle and pulmonary flow distribution were the independent predictors of HFD across TCPC templates.…”

Section: The Key Drivers Of Hepatic Flow Distributionmentioning

confidence: 96%

“…The resistances of completed patient-specific TCPCs were shown to account for 15-20% of the PVR at rest. 12,37 When included in an albeit simple lumped parameter model of the Fontan circulation, higher resistance TCPCs significantly limited the ventricular preload, leading to a blunted increase in cardiac output with heart rate suggesting a limited exercise capacity. 37 But it was only very recently that clinical relationships were established demonstrating that TCPC iPL were negatively correlated to aerobic threshold for exercise 19 and to resting ventricular end-diastolic and stroke volumes.…”

Section: Patient-specific Simulations Of the Fontan What Have We Leamentioning

confidence: 99%

“…As mentioned above, minimum baffle and PA diameters have been identified as the two main deter- minants of iPL, 12,38 setting the priority on the correction of local stenoses and avoidance of undersized baffles. However, as highlighted both in idealized 14 and patient-specific 43 configurations, bigger is not always better as excessive vessel dimensions favor the onset of flow stagnation regions and potential thrombosis.…”

Section: Bigger Is Not Always Bettermentioning

confidence: 99%

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Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure

Zélicourt

Kurtcuoglu

2015

Ann Biomed Eng

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The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework.

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Fontan hemodynamics from 100 patient-specific cardiac magnetic resonance studies: A computational fluid dynamics analysis

Abstract: Fontan power loss varies from patient to patient, and elevated levels are correlated with lower systemic flow and cardiac index. Fontan connection type does not influence hemodynamic efficiency, but an undersized or stenosed Fontan pathway or pulmonary arteries can be highly dissipative.

Cited by 95 publications

References 35 publications

Role of cardiac MRI and CT in Fontan circulation

Role of cardiac MRI and CT in Fontan circulation

Energetic Implications of Vessel Growth and Flow Changes Over Time in Fontan Patients

Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure

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