Hepatic Venous Blood Flow Distribution in the Total Cavopulmonary Connection: Patient-Specific Anatomical Models

2007 ◽  
Author(s):  
Lakshmi Dasi ◽  
Kerem Pekkan ◽  
Kevin Whitehead ◽  
Mark Fogel ◽  
Ajit Yoganathan
Keyword(s):  
Single Ventricle ◽  
Venous Blood ◽  
Vena Cava ◽  
Flow Distribution ◽  
Experimental Models ◽  
Cfd Modeling ◽  
Normal Lung ◽  
Patient Specific ◽  
Circulation System ◽  
Venous Blood Flow

CFD modeling of the anatomical pathways (TCPC) created by the palliative single-ventricle heart defect surgeries is an area studied by several research groups [1–5]. To the best of our knowledge except Walker et al. (in idealized experimental models) [6], all studies focused on the prediction of hydrodynamic power losses or dissipation function and ignored venous hepatic flow distribution to the left and right lungs. Hepatic flow coming from the inferior vena cava (IVC) transports essential growth factors that are required for normal lung growth. Inadequate IVC blood distribution also cause protein loosing enteropathy [7], a serious complex pathology leading to total failure of the surgically created single-ventricle circulation system. Early TCPC configurations distributing the hepatic flow unidirectionaly to one of the lungs [8] were promptly discontinued from the operating rooms and replaced with “+” shaped connections for these reasons, Fig 1.

scholarly journals Repetitive and Brief Occlusion of Total Right Atrium Venous Blood Flow Improves Experimental Pulmonary Arterial Hypertension: a novel potential therapeutic strategy

2020 ◽  
Author(s):  
Nan Liu ◽  
Ying Xing ◽  
Chen Wang
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Therapeutic Strategy ◽  
Superior Vena ◽  
Venous Blood ◽  
Vena Cava ◽  
Vegf Receptor ◽  
Venous Blood Flow ◽  
History Of ◽  
Pulmonary Arterial

AbstractPulmonary arterial hypertension (PAH) is a vascular disorder associated with significant morbidity and mortality. The pathophysiology of PAH remains controversial, but the only currently available therapies for PAH are pharmacological pulmonary artery vasodilation, decreasing right ventricular (RV) afterload, and relieving symptoms. By now, there is no therapy being able to minimize vascular remodeling processes and thus to reverse or delay the natural history of the disease. It has been generally thought that reduction of RV preload was detrimental, which deteriorated the systemic hemodynamics. In the present study, however, we repetitively and briefly occluded (RBO) both superior vena cava and inferior vena cava by ligation (occlusion for less than 5 seconds then re-open for 30 seconds and repeated 5 cycles as one sequence, 1 sequence every 6 hours) to intermittently restrict RV preload, for continuous 24 hours, total 5 sequences, in the Sugen 5416 (VEGF receptor blocker) and hypoxia induced PAH rat models and we found this strategy was beneficial for lowering pulmonary vascular resistance (PVR).

scholarly journals Effect of spontaneous breathing on umbilical venous blood flow and placental transfusion during delayed cord clamping in preterm lambs

2019 ◽  
Vol 105 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Emma Brouwer ◽  
Arjan B te Pas ◽  
Graeme R Polglase ◽  
Erin V McGillick ◽  
Stefan Böhringer ◽  
...  
Keyword(s):  
Blood Flow ◽  
Body Weight ◽  
Spontaneous Breathing ◽  
Venous Blood ◽  
Vena Cava ◽  
Venous Blood Flow ◽  
Delayed Cord Clamping ◽  
Venous Flow ◽  
Cord Clamping ◽  
Pregnant Sheep

IntroductionDuring delayed umbilical cord clamping, the factors underpinning placental transfusion remain unknown. We hypothesised that reductions in thoracic pressure during inspiration would enhance placental transfusion in spontaneously breathing preterm lambs.ObjectiveInvestigate the effect of spontaneous breathing on umbilical venous flow and body weight in preterm lambs.MethodsPregnant sheep were instrumented at 132–133 days gestational age to measure fetal common umbilical venous, pulmonary and cerebral blood flows as well as arterial and intrapleural (IP) pressures. At delivery, doxapram and caffeine were administered to promote breathing. Lamb body weights were measured continuously and breathing was assessed by IP pressure changes.ResultsIn 6 lambs, 491 out of 1117 breaths were analysed for change in body weight. Weight increased in 46.6% and decreased in 47.5% of breaths. An overall mean increase of 0.02±2.5 g per breath was calculated, and no net placental transfusion was observed prior to cord clamping (median difference in body weight 52.3 [−54.9–166.1] g, p=0.418). Umbilical venous (UV) flow transiently decreased with each inspiration, and in some cases ceased, before UV flow normalised during expiration. The reduction in UV flow was positively correlated with the standardised reduction in (IP) pressure, increasing by 109 mL/min for every SD reduction in IP pressure. Thus, the reduction in UV flow was closely related to inspiratory depth.ConclusionsSpontaneous breathing had no net effect on body weight in preterm lambs at birth. UV blood flow decreased as inspiratory effort increased, possibly due to constriction of the inferior vena cava caused by diaphragmatic contraction, as previously observed in human fetuses.

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

2021 ◽  
Vol 12 ◽  
Author(s):  
Yunus Ahmed ◽  
Christopher Tossas-Betancourt ◽  
Pieter A. J. van Bakel ◽  
Jonathan M. Primeaux ◽  
William J. Weadock ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Endovascular Repair ◽  
Computational Analysis ◽  
Single Ventricle ◽  
Vena Cava ◽  
Patient Specific ◽  
Clinical Team ◽  
Intervention Model ◽  
Venous Reflux ◽  
Anatomical Model

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.

scholarly journals SURGICAL ANATOMY OF VENOUS BLOOD FLOW OF THE I NFERIOR VENA CAVA SYSTEM

2021 ◽  
pp. 17-22
Author(s):  
V. I. Rusin ◽  
S. O. Boyko ◽  
V. V. Rusin ◽  
S. Sh. S. Boyko
Keyword(s):  
Blood Flow ◽  
Average Length ◽  
Venous Blood ◽  
Vena Cava ◽  
Anatomical Study ◽  
Surgical Anatomy ◽  
Hepatic Veins ◽  
Common Trunk ◽  
Clinical Anatomy ◽  
Venous Blood Flow

Summary. Purpose. Conduct an anatomical examination of the inferior vena cava (IVC) and its branches and determine the paths of collateral venous blood flow. Materials and methods. An anatomical examination of the IVC and its branches was performed on 27 corpses as a result of autopsy. The bodies of the corpses were hypostenic-normosthenic type. The organ complex was eviscerated by the Shore method. The degree of IVC coverage by the liver in relation to the circumference of the IVC was determined. Measurements of the total length of the IVC and for each of the individual 6 segments of the IVC were performed. The hepatic and lumbar veins were studied and the paths of collateral venous blood flow were analyzed. Results and discussion. The average length of IVC in the infrarenal segment was 107.6 mm, in the retrohepatic — 59.3 mm, in the suprarenal — 26.2 mm, in the interrenal — 23.4 mm, in the infradiaphragm — 15.2 mm, in the supradiaphragm — 12.0 mm, along the entire subdiaphragm segment — 197.8 mm. The coverage of IVC by the liver by 1/2 of its circumference was detected in 13 (48.1 %), by 2/3 — in 11 (40.7 %), by 1/3 — in 2 (7.4 %), by the whole length – in 1 (3.7 %) cases. Up to 23 venous trunks flow into the retrohepatic part of the IVC. The avascular area is located under the main hepatic veins with an average length of 13.1 mm and under the right renal vein with an average length of 17.8 mm. In 92.6 % of cases, the lumbar veins had an odd nature of confluence with the IVC – one common trunk. Conclusions: The anatomical study presented new knowledge of the clinical anatomy of IVС branches.

scholarly journals Congenital Extrahepatic Portosystemic Shunts: Spectrum of Findings on Ultrasound, Computed Tomography, and Magnetic Resonance Imaging

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Pankaj Gupta ◽  
Anindita Sinha ◽  
Kushaljit Singh Sodhi ◽  
Anupam Lal ◽  
Uma Debi ◽  
...  
Keyword(s):  
Portal Vein ◽  
Venous Blood ◽  
Vena Cava ◽  
Focal Liver Lesions ◽  
Nodular Regenerative Hyperplasia ◽  
Type I ◽  
Venous Blood Flow ◽  
Main Portal Vein ◽  
Portosystemic Shunts ◽  
Imaging Characteristics

Congenital extrahepatic portosystemic shunt (CEPS) is a rare disorder characterised by partial or complete diversion of portomesenteric blood into systemic veins via congenital shunts. Type I is characterised by complete lack of intrahepatic portal venous blood flow due to an end to side fistula between main portal vein and the inferior vena cava. Type II on the other hand is characterised by partial preservation of portal blood supply to liver and side to side fistula between main portal vein or its branches and mesenteric, splenic, gastric, and systemic veins. The presentation of these patients is variable. Focal liver lesions, most commonly nodular regenerative hyperplasia, are an important clue to the underlying condition. This pictorial essay covers imaging characteristics in abdominopelvic region.

T1 mapping to assess hepatic and myocardial characteristics in children with single ventricle circulation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Beigh ◽  
J.J Pagano ◽  
M Noga ◽  
D Harake ◽  
O Olugbuyi ◽  
...  
Keyword(s):  
Hepatic Fibrosis ◽  
T1 Mapping ◽  
Single Ventricle ◽  
Ventricular Dysfunction ◽  
Fontan Operation ◽  
Venous Blood ◽  
Region Of Interest ◽  
Venous Blood Flow ◽  
Continuous Variables ◽  
Myocardial T1

Abstract Background Single ventricle (SV) palliation, culminating with the Fontan operation, results in passive systemic venous blood flow directly to the pulmonary circulation. Resulting inevitable hepatic venous congestion can lead to hepatic fibrosis. Previous studies suggest hepatic changes can occur prior to the Fontan completion. Besides fibrotic myocardial remodeling may lead to systolic and diastolic ventricular dysfunction, transmitting back pressure to the pulmonary system. Purpose To compare quantitative T1 cardiovascular magnetic resonance (CMR) imaging of the myocardium and liver between SV patients and controls, as a potential measure of myocardial and hepatic fibrosis. Methods Retrospective review of 16 SV patients with dominant single left ventricle (SLV, n=6) or single right ventricle (SRV, n=10), at various stages of palliation (pre-Glenn=6, post-Glenn=3, Fontan=7) underwent CMR with myocardial T1 mapping with the liver also in the plane of view. Biventricular patients found to have structurally normal hearts and normal cardiac function on CMR were used as controls (n=21). Native T1 times using a modified Look-Locker inversion recovery (MOLLI) approach in free-wall of the dominant ventricle at a mid-ventricular short axis in SV and the ventricular septum in controls and, a region of interest in the liver (avoiding any vessels) were measured in all patients. Median and inter-quartile ranges of continuous variables were compared between SV and controls using the Mann-Whitney U test. Results As compared to controls SV patients were (1) significantly younger, (2) had lower ejection fraction, (3) higher median myocardial T1, and (4) higher median liver T1. Also, there was no difference between SLV vs. SRV median myocardial T1 (1056 vs. 1065ms, p=0.43) or liver T1 (678 vs. 729ms, p=0.30) Conclusion Despite younger age, findings of increased myocardial T1 may suggest an element of myocardial fibrosis responsible for the ventricular dysfunction in this population, and that raised liver T1 may be an earlier marker of liver fibrosis, which warrants further study. Funding Acknowledgement Type of funding source: None

Kawashima by Fenestrated Hemi-Fontan for Palliation Following Prior Stage I Norwood Operation

2018 ◽  
Vol 9 (4) ◽  
pp. 451-453 ◽  
Author(s):  
Jenny E. Zablah ◽  
Michael Ross ◽  
Neil Wilson ◽  
Brian Fonseca ◽  
Max B. Mitchell
Keyword(s):  
Single Ventricle ◽  
Superior Vena ◽  
Fontan Procedure ◽  
Venous Blood ◽  
Young Infant ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Stage I ◽  
Azygos Continuation ◽  
Cavopulmonary Shunt

Single ventricle patients with interrupted inferior vena cava (IVC) and azygos continuation to the superior vena cava (SVC) are typically palliated with a bidirectional cavopulmonary shunt (BCPS), known as the Kawashima operation in this setting. Because the volume of venous blood directed to the pulmonary arteries is substantially greater in the presence of interrupted IVC, Kawashima procedures are commonly delayed to older age compared to other single ventricle patients undergoing BCPS. We report two young infant single ventricle patients with interrupted IVC and azygos continuation to the SVC who underwent stage I Norwood procedures for initial palliation. In both cases, a fenestrated hemi-Fontan procedure achieved successful Kawashima circulations.

Isolated hepatic perfusion with tumor necrosis factor and melphalan for unresectable cancers confined to the liver.

1998 ◽  
Vol 16 (4) ◽  
pp. 1479-1489 ◽  
Author(s):  
H R Alexander ◽  
D L Bartlett ◽  
S K Libutti ◽  
D L Fraker ◽  
T Moser ◽  
...  
Keyword(s):  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Venous Blood ◽  
Vena Cava ◽  
Venous Blood Flow ◽  
Treatment Technique ◽  
Axillary Vein ◽  
Hepatic Perfusion ◽  
Isolated Hepatic Perfusion ◽  
Necrosis Factor

PURPOSE To evaluate the efficacy and systemic and regional toxicities of hyperthermic isolated hepatic perfusion (IHP) using tumor necrosis factor (TNF) and melphalan for the treatment of unresectable primary or metastatic cancers confined to the liver. PATIENTS AND METHODS Thirty-four patients (18 men and 16 women; mean age, 49 years) underwent a 60-minute hyperthermic (39.5 degrees to 40.0 degrees C) IHP performed by laparotomy that used TNF 1.0 mg and melphalan 1.5 mg/kg. Perfusion inflow was through the gastroduodenal artery and outflow was from a cannula positioned in an isolated segment of retrohepatic inferior vena cava (IVC). Infrahepatic IVC and portal venous blood flow were shunted to the axillary vein using an external venoveno bypass circuit. Complete vascular isolation of the liver was confirmed by an I-131-labelled human serum albumin monitoring technique. RESULTS There was no operative mortality. Seventy-five percent of patients had reversible grade III or IV (National Cancer Institute Common Toxicity Criteria) hepatic toxicity with one treatment-related mortality (3%) because of hepatic venoocclusive disease. In 33 assessable patients, the overall response rate was 75% (complete response, one patient [3%]; partial response, 26 patients [72%]). With a median potential follow-up of 15 months, the mean duration of response was 9 months (range, 2 to 30 months). CONCLUSION IHP with TNF and melphalan results in significant regression of bulky hepatic cancers confined to the liver in the majority of patients. Based on these initial results, further refinement of this treatment technique is warranted; perhaps by the combination of IHP with other regional treatment strategies to provide long-term control of unresectable cancers confined to liver.

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