Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations

Leval, Marc R. de; Kilner, Philip J.; Gewillig, Marc; Bull, Catherine; McGoon, Dwight C.

doi:10.1016/s0022-5223(19)35174-8

Cited by 962 publications

(349 citation statements)

References 40 publications

Supporting

Mentioning

343

Contrasting

Unclassified

Order By: Relevance

“…Here, we apply the particle tracking algorithm to a model of a TCPC, also known as the Fontan procedure, a surgery performed in the palliation of single ventricle heart defects [34,35]. This surgery has been studied extensively by computer modeling [36][37][38][39][40][41], including FSI simulations [29,30,42], which makes it a compelling application to compare advective transport characteristics between FSI and rigid-vessel simulations.…”

Section: Resultsmentioning

confidence: 99%

Lagrangian analysis of hemodynamics data from FSI simulation

Duvernois

Marsden

Shadden

2012

Numer Methods Biomed Eng

View full text Add to dashboard Cite

We present the computation of Lagrangian-based flow characterization measures for time-dependent, deformable-wall, finite-element blood flow simulations. Applicability of the algorithm is demonstrated in a fluid–structure interaction simulation of blood flow through a total cavopulmonary connection (Fontan procedure), and results are compared with a rigid-vessel simulation. Specifically, we report on several important Lagrangian-based measures including flow distributions, finite-time Lyapunov exponent fields, particle residence time, and exposure time calculations. Overall, strong similarity in Lagrangian measures of the flow between deformable and rigid-vessel models was observed.

show abstract

Section: Resultsmentioning

confidence: 99%

Lagrangian analysis of hemodynamics data from FSI simulation

Duvernois

Marsden

Shadden

2012

Numer Methods Biomed Eng

View full text Add to dashboard Cite

show abstract

“…Since its original description, 1,2 this procedure has undergone many modifications to optimize the cavopulmonary circuit. [2][3][4][5] In most of the centers including ours, the extracardiac TCPC has replaced the lateral tunnel TCPC as the procedure of choice in patients who do not require an associated intracardiac procedure. In patients undergoing this operation after prior bidirectional Glenn (BDG), complete dissection with cannulation of the superior vena cava (SVC) and dissection of the ipsilateral pulmonary artery is required, unless the total circulatory arrest is used.…”

Section: Introductionmentioning

confidence: 99%

An alternative technique for completion of the total cavopulmonary connection

et al. 2019

View full text Add to dashboard Cite

Background Total Cavopulmonary connection (Fontan) is the final palliation for patients with a functionally univentricular heart. This is commonly accomplished after a prior bidirectional Glenn on cardiopulmonary bypass (CPB) with separate cannulation of the aorta, superior vena cava (SVC), and inferior vena cava. We describe an alternative technique of Fontan completion that eliminates the need for cannulation and dissection of the SVC, and pulmonary artery dissection. Methods Between January and October 2018, 17 patients underwent completion Fontan using an alternate technique at our institute. All operations were conducted on CPB at normothermia without cannulating the SVC Results Mean CPB time was 60 ± 16.8 minutes (range, 39‐102 minutes). There were no early deaths. Mean postoperative Fontan pressures were 15.6 ± 1.2 mm Hg with no gradient between the SVC and IVC pressures. Mean duration of hospital stay was 15.6 ± 3.6 days (range, 10‐22 days). No patient developed phrenic nerve paresis or palsy. Conclusions Completion without cannulating the SVC is simple, reproducible, and easy to teach. It avoids the disadvantages associated with routine techniques.

show abstract

“…It directs the superior vena caval (SVC) blood to the right pulmonary artery (RPA) through the cavo-pulmonary anastomosis and the inferior vena caval (IVC) blood to the left lung via the right atrium. 1 A process to streamline Fontan circulation to reduce energy loss due to atriopulmonary connection was studied by de Leval et al 2 They recommended sending the inferior caval blood by the total cavopulmonary connection (TCPC, see Figure 1) directly to the pulmonary artery rather than through the right atrium. Such refinements in surgical planning and practices of the Fontan procedure have considerably improved the life expectancies of single ventricle heart patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of hemodynamic performance of total cavopulmonary connection (TCPC) with porous inserts

Dhayananth

Narasimhan

2017

Numer Methods Biomed Eng

View full text Add to dashboard Cite

Infants born with univentricular heart disease undergo Fontan surgery to establish separate systemic and pulmonary circulations. This surgery results in better blood circulation across a single ventricle that supplies oxygenated blood to the body and passively returns venous blood to the lungs through the total cavopulmonary connection (TCPC). Reducing the pressure drop across the TCPC during Fontan circulation helps in reducing the work load of univentricular heart, and various designs have been proposed for this purpose. The goal of this work is to analyze the effect of placing a porous insert at an appropriate position in the pulmonary artery, on the pressure drop across the TCPC. A 3D computational model of a total TCPC connection provided with a porous insert is developed and solved by finite volume method, under assumptions of steady, laminar, and Newtonian flows. The effects of the porous medium properties-porosity and permeability-across the connection, are analyzed. Compared to the no-porous medium case, TCPC with the porous medium insert exhibits a maximum reduction of 27% in energy loss for the flow range studied. The porous medium used in TCPC connection lowers the energy dissipation by curtailing the flow recirculation zones across the connection. The influences of the diameter of the blood vessel, total cardiac output, and the thickness, permeability, and position of porous media on energy loss are analyzed. The criteria to select the porous medium properties and position for a given Fontan geometry are also determined.

show abstract

Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations

Cited by 962 publications

References 40 publications

Lagrangian analysis of hemodynamics data from FSI simulation

Lagrangian analysis of hemodynamics data from FSI simulation

An alternative technique for completion of the total cavopulmonary connection

Evaluation of hemodynamic performance of total cavopulmonary connection (TCPC) with porous inserts

Contact Info

Product

Resources

About