Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part II

Abstract

Several components of the Fontan circulation other than the TCPC actually have equal, or greater, impact on CI under certain conditions.

A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

“…Lastly, several groups have considered mathematical descriptions of the Fontan physiology. A collection of papers by Watrous et al and Chin et al present a general software framework, complete with a graphical user interface, for computational hemodynamics using zero–dimensional models, and consider examples of normal and Fontan circulations [21,22]. Kung et al and Van De Bruaene et al created Fontan models to investigate the effect of exercise, and carefully refined their approach with clinical data [23,24].…”

Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part III

“…In such a regime, several components of the Fontan circulation other than the total cavopulmonary connection (TCPC) actually had equal, or greater, impact on CI at rest. 23 Not surprisingly, ventricular effective end-diastolic elastance (stiffness) was found to have a dramatic effect on CI as well as on flow across the fenestration.…”

“…Hence, a plausible explanation for the resting CI in Fontan patients being two-thirds of normal may be either a disparity in overall contractility in single-ventricle disorders or, more likely, a chamber-specific factor affecting the sarcomeric, extrasarcomeric, 21 or extracellular characteristics. 22 In our next series of experiments, 23 we evaluated the hemodynamic impact of nine cardiovascular perturbations while operating the model of a two-year-old Fontan patient in an open-loop mode, that is, without automatic feedback. In such a regime, several components of the Fontan circulation other than the total cavopulmonary connection (TCPC) actually had equal, or greater, impact on CI at rest.…”

“…In our next series of experiments, 23 we evaluated the hemodynamic impact of nine cardiovascular perturbations while operating the model of a two-year-old Fontan patient in an open-loop mode, that is, without automatic feedback. In such a regime, several components of the Fontan circulation other than the total cavopulmonary connection (TCPC) actually had equal, or greater, impact on CI at rest.…”