Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions

Abstract

The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.

Discrete Subaortic Stenosis: Perspective Roadmap to a Complex Disease

“…Computational engineering tools have been used as diagnosis and surgical planning tools to assess patient-specific hemodynamics in the context of Fontan and valve replacement procedures ( 112 , 113 ). Similarly, CFD could be used to assess the potential benefits of resection in DSS patients.…”

A novel TBX5 mutation predisposes to familial cardiac septal defects and atrial fibrillation as well as bicuspid aortic valve

“…Although vast advance in cardiac surgery allows over 90% of CHD newborns to survive into adulthood, it results in an increasing adult CHD population, and mow CHD adults outnumber CHD children (Bouma and Mulder, 2017;Benjamin et al, 2019). Moreover, the late complications and mortality substantially increase in adult CHD patients (Bouma and Mulder, 2017;Spector et al, 2018;Trusty et al, 2018). Despite clinical importance, the etiologies of CHD in the majority of cases are still elusive.…”

Invited commentary: Personalized surgical planning by computational and visual methods in 21st‐century medical engineering

“…A domain of particular interest and growth has been in personalized surgical planning, whereby clinical teams previsualize and plan the optimal treatment strategy given the pathology and patient-specific anatomic challenges. [1][2][3] Realization of milestone achievements in surgical planning stem from substantial advancements in computational modeling (computational fluid dynamics [CFD], finite element analysis, and fluid-structure interaction [FSI] studies), cutting-edge imaging methods (3D/4D magnetic resonance images [MRI], CT, SPECT scans, ultrasound), and state-of-the-art 3D rapid prototyping. CFD simulations were formerly reserved for the most complex applications, because the solutions required extensive computational power, time, and resources, which limited widespread use.…”