The first cohort of prospective Fontan surgical planning patients with follow-up data: How accurate is surgical planning?

Trusty, Phillip M.; Wei, Zhenglun Alan; Slesnick, Timothy C.; Kanter, Kirk R.; Spray, Thomas L.; Fogel, Mark A.; Yoganathan, Ajit P.

doi:10.1016/j.jtcvs.2018.11.102

Cited by 41 publications

(26 citation statements)

References 26 publications

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“…However, FSI has little impact on time-averaged quantities (pressure drop, power loss, HFD) under resting breath-held condition. Considering time-averaged hemodynamic quantities are the more common surrogates of patients' hemodynamic performance for surgical planning of TCPC, the results here support the notion that a rigid wall assumption is a reasonable assumption for such image-based surgical planning systems [29,[53][54][55][56]. The framework for a surgical planning system of TCPC already exists [57,58] to prospectively model different surgical configurations.…”

Section: Discussionsupporting

confidence: 74%

“…However, the differences in time-averaged pressure drops (0.01 mmHg) and power losses (0.1 mW) between the two simulations were small. Hepatic flow distribution was also quantified, which is a TCPC hemodynamic metric that was related to the risk of pulmonary arteriovenous malformations [11,12,53]. As shown in Figure 15, the instantaneous HFD varies within the simulated cycle between the rigid wall and FSI simulations.…”

Section: Discussionmentioning

confidence: 99%

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Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Tang

Wei

Fogel

et al. 2020

Biology

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Total cavopulmonary connection (TCPC) hemodynamics has been hypothesized to be associated with long-term complications in single ventricle heart defect patients. Rigid wall assumption has been commonly used when evaluating TCPC hemodynamics using computational fluid dynamics (CFD) simulation. Previous study has evaluated impact of wall compliance on extra-cardiac TCPC hemodynamics using fluid-structure interaction (FSI) simulation. However, the impact of ignoring wall compliance on the presumably more compliant intra-atrial TCPC hemodynamics is not fully understood. To narrow this knowledge gap, this study aims to investigate impact of wall compliance on an intra-atrial TCPC hemodynamics. A patient-specific model of an intra-atrial TCPC is simulated with an FSI model. Patient-specific 3D TCPC anatomies were reconstructed from transverse cardiovascular magnetic resonance images. Patient-specific vessel flow rate from phase-contrast magnetic resonance imaging (MRI) at the Fontan pathway and the superior vena cava under resting condition were prescribed at the inlets. From the FSI simulation, the degree of wall deformation was compared with in vivo wall deformation from phase-contrast MRI data as validation of the FSI model. Then, TCPC flow structure, power loss and hepatic flow distribution (HFD) were compared between rigid wall and FSI simulation. There were differences in instantaneous pressure drop, power loss and HFD between rigid wall and FSI simulations, but no difference in the time-averaged quantities. The findings of this study support the use of a rigid wall assumption on evaluation of time-averaged intra-atrial TCPC hemodynamic metric under resting breath-held condition.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Tang

Wei

Fogel

et al. 2020

Biology

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“…Realistic use of preoperative Fontan planning requires development of a tool that is quick, easy to use, requires standard clinical data for its inputs, and can turnaround accurate recommendations quickly and clearly to ensure accurate implantation of Fontan designs. Prior research demonstrated discrepancies between the pre-operative and post-operative results (6), however, it is difficult to separately quantify the relative contribution of errors in CFD prediction, surgical implantation, and vessel structure alternation to the difference between predicted and observed hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

“…These complications are linked to hemodynamics in post-operative Fontan geometries (3). The correlation between the development of PAVM and hepatic flow distribution (HFD) (4)(5)(6) and the negative correlation between decreased exercise capacity and power loss in Fontan (7) have been demonstrated by various groups.…”

Section: Introductionmentioning

confidence: 99%

Computational Fontan Analysis: Preserving accuracy while expediting workflow

Liu

Aslan

Kim

et al. 2021

Preprint

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BackgroundPost-operative outcomes of the Fontan operation have been linked to graft shape after implantation. Computational fluid dynamics (CFD) simulations are used to explore different surgical options. The objective of this study is to perform a systematic in vitro validation for investigating the accuracy and efficiency of CFD simulation to predict Fontan hemodynamics.MethodsCFD simulations were performed to measure indexed power loss (iPL) and hepatic flow distribution (HFD) in 10 patient-specific Fontan models, with varying mesh and numerical solvers. The results were compared with a novel in vitro flow loop setup with 3D printed Fontan models. A high-resolution differential pressure sensor was used to measure the pressure drop for validating iPL predictions. Microparticles with particle filtering system were used to measure HFD. The computational time was measured for a representative Fontan model with different mesh sizes and numerical solvers.ResultsWhen compared to in vitro setup, variations in CFD mesh sizes had significant effect on HFD (p = 0.0002) but no significant impact on iPL (p = 0.069). Numerical solvers had no significant impact in both iPL (p = 0.50) and HFD (P = 0.55). A transient solver with 0.5 mm mesh size requires computational time 100 times more than a steady solver with 2.5 mm mesh size to generate similar results.ConclusionsThe predictive value of CFD for Fontan planning can be validated against an in vitro flow loop. The prediction accuracy can be affected by the mesh size, model shape complexity and flow competition.

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“…Computational fluid dynamics (CFD) is a well-established technique that has been widely used to study hemodynamics of cardiovascular diseases ( Taylor and Figueroa, 2009 ), and can be used to assess the hemodynamic effect of planned surgical interventions ( Bove et al, 2003 ; Sundareswaran et al, 2009 ; de Zélicourt et al, 2011 ; Restrepo et al, 2015 ; van Bakel T. M. J. et al, 2018 ; Trusty et al, 2019 ; Toma et al, 2020 ; Tossas-Betancourt et al, 2020 ; Li et al, 2021 ; Primeaux et al, 2021 ). In this work, we evaluated the feasibility of an endovascular repair considered by the pediatric cardiology team at the University of Michigan C.S.…”

Section: Introductionmentioning

confidence: 99%

Interventional Planning for Endovascular Revision of a Lateral Tunnel Fontan: A Patient-Specific Computational Analysis

et al. 2021

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IntroductionA 2-year-old female with hypoplastic left heart syndrome (HLHS)-variant, a complex congenital heart defect (CHD) characterized by the underdevelopment of the left ventricle, presented with complications following single ventricle palliation. Diagnostic work-up revealed elevated Fontan pathway pressures, as well as significant dilation of the inferior Fontan pathway with inefficient swirling flow and hepatic venous reflux. Due to the frail condition of the patient, the clinical team considered an endovascular revision of the Fontan pathway. In this work, we performed a computational fluid dynamics (CFD) analysis informed by data on anatomy, flow, and pressure to investigate the hemodynamic effect of the endovascular Fontan revision.MethodsA patient-specific anatomical model of the Fontan pathway was constructed from magnetic resonance imaging (MRI) data using the cardiovascular modeling software CardiovasculaR Integrated Modeling and SimulatiON (CRIMSON). We first created and calibrated a pre-intervention 3D-0D multi-scale model of the patient’s circulation using fluid-structure interaction (FSI) analyses and custom lumped parameter models (LPMs), including the Fontan pathway, the single ventricle, arterial and venous systemic, and pulmonary circulations. Model parameters were iteratively tuned until simulation results matched clinical data on flow and pressure. Following calibration of the pre-intervention model, a custom bifurcated endograft was introduced into the anatomical model to virtually assess post-intervention hemodynamics.ResultsThe pre-intervention model successfully reproduced the clinical hemodynamic data on regional flow splits, pressures, and hepatic venous reflux. The proposed endovascular repair model revealed increases of mean and pulse pressure at the inferior vena cava (IVC) of 6 and 29%, respectively. Inflows at the superior vena cava (SVC) and IVC were each reduced by 5%, whereas outflows at the left pulmonary artery (LPA) and right pulmonary artery (RPA) increased by 4%. Hepatic venous reflux increased by 6%.ConclusionOur computational analysis indicated that the proposed endovascular revision would lead to unfavorable hemodynamic conditions. For these reasons, the clinical team decided to forgo the proposed endovascular repair and to reassess the management of this patient. This study confirms the relevance of CFD modeling as a beneficial tool in surgical planning for single ventricle CHD patients.

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The first cohort of prospective Fontan surgical planning patients with follow-up data: How accurate is surgical planning?

Cited by 41 publications

References 26 publications

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Fluid-Structure Interaction Simulation of an Intra-Atrial Fontan Connection

Computational Fontan Analysis: Preserving accuracy while expediting workflow

Interventional Planning for Endovascular Revision of a Lateral Tunnel Fontan: A Patient-Specific Computational Analysis

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