Design of a Novel Cavopulmonary Assist Device for Fontan Procedures: CFD, PIV, and Hydraulic Testing

2010 ◽  
Author(s):  
Jeffrey R. Kennington ◽  
Steven Frankel ◽  
Jun Chen ◽  
Mark D. Rodefeld ◽  
Guruprasad A. Giridharan
Keyword(s):  
Inferior Vena ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Hydraulic Testing ◽  
Assist Device ◽  
Lung Resistance ◽  
Left And Right ◽  
The Right ◽  
Cavopulmonary Connection ◽  
Cavopulmonary Assist Device

Single ventricle heart disease is the leading cause of death for birth defects in children under one years of age [1]. The current surgical procedure requires the use of a shunt for the first stage of the surgery. The following surgeries remove the shunt but cannot be performed on a newborn due to higher lung resistance during the first weeks of life. The overall surgical process, known as the Fontan procedure, results in a reconstructed anatomy where the left and right pulmonary arteries are sutured to the superior and inferior vena cavae (SVC/IVC), hence bypassing the right heart. This anatomy is called a total cavopulmonary connection or TCPC.

Modeling of Patient-Specific Fontan Physiology From MRI Images for CFD Testing of a Cavopulmonary Assist Device

2011 ◽  
Author(s):  
Jonathan DeGan ◽  
Jeffrey Kennington ◽  
Kameswararao Anupindi ◽  
Dinesh Shetty ◽  
Jun Chen ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Patient Specific ◽  
Systemic Blood Flow ◽  
Congenital Condition ◽  
Left And Right ◽  
Fontan Physiology ◽  
Cavopulmonary Connection ◽  
Cavopulmonary Assist Device

Single ventricle heart disease is a congenital condition characterized by the inoperability of one ventricle of an infant’s heart. Those suffering from this condition face a series of palliative surgeries called the Fontan procedure, which bypasses the non-functional ventricle by creating a total cavopulmonary connection, or TCPC. This TCPC forms from the anastomosis of the superior and inferior vena cavae (SVC, IVC) to the left and right pulmonary arteries (LPA, RPA), thus allowing systemic blood flow to bypass the heart and flow passively to the lungs. The Fontan procedure creates this junction with three surgeries separated by months or years.

High-Order Large Eddy Simulation of Flow in Idealized and Patient-Specific Total Cavopulmonary Connections

2011 ◽  
Author(s):  
Kameswararao Anupindi ◽  
Steven Frankel ◽  
Jun Chen ◽  
Dinesh Shetty ◽  
Jeffrey Kennington ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Patient Specific ◽  
Complex Congenital Heart Disease ◽  
Eddy Simulation ◽  
Large Eddy ◽  
Left And Right ◽  
Viscous Impeller Pump ◽  
Cavopulmonary Connection

The Fontan procedure is used in pediatric situations in which infants have complex congenital heart disease or a single effective ventricle. This procedure by-passes right heart by connecting the left and right pulmonary arteries (LPA/RPA) to the superior and inferior vena cavae (SVC/IVC). The resulting reconstructed anatomy is called total cavopulmonary connection or TCPC. Knowledge of fluid dynamics in TCPC helps in optimizing the connection itself for reduced resistance as well as aids in designing cavopulmonary assist devices like viscous impeller pump (VIP) [1].

Investigation of Vessel Growth and its Impact on Hemodynamics in Patients With Lateral Tunnel Total Cavopulmonary Connection

2012 ◽  
Author(s):  
Maria Restrepo ◽  
Lucia Mirabella ◽  
Elaine Tang ◽  
Chris Haggerty ◽  
Mark A. Fogel ◽  
...  
Keyword(s):  
Heart Defects ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Lateral Tunnel ◽  
Vessel Growth ◽  
Original Size ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle heart defects affect 2 per 1000 live births in the US and are lethal if left untreated. The Fontan procedure used to treat these defects consists of a series of palliative surgeries to create the total cavopulmonary connection (TCPC), which bypasses the right heart. In the last stage of this procedure, the inferior vena cava (IVC) is connected to the pulmonary arteries (PA) using one of the two approaches: the extra-cardiac (EC), where a synthetic graft is used as the conduit; and the lateral tunnel (LT) where part of the atrial wall is used along with a synthetic patch to create the conduit. The LT conduit is thought to grow in size in the long term because it is formed partially with biological tissue, as opposed to the EC conduit that retains its original size because it contains only synthetic material. The growth of the LT has not been yet quantified, especially in respect to the growth of other vessels forming the TCPC. Furthermore, the effect of this growth on the hemodynamics has not been elucidated. The objective of this study is to quantify the TCPC vessels growth in LT patients from serial magnetic resonance (MR) images, and to understand its effect on the connection hemodynamics using computational fluid dynamics (CFD).

Effect of Caval Waveform on Energy Dissipation of Failing Fontan Patients

2009 ◽  
Author(s):  
Onur Dur ◽  
Ergin Kocyildirim ◽  
Curt G. Degroff ◽  
Peter Wearden ◽  
Victor Morell ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Superior Vena ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Surgical Reconstruction ◽  
Power Losses ◽  
Last Stage ◽  
Cavopulmonary Connection ◽  
Failing Fontan ◽  
Fontan Patients

Last stage of the palliative surgical reconstruction (i.e. Fontan procedure) for the infants with functional single-ventricle is total cavopulmonary connection (TCPC), where the superior vena cavae (SVC) and inferior vena cavae (IVC) are routed directly into the pulmonary arteries. Limited pumping energy available due to the absence of right-ventricle and altered venous characteristics require optimized hemodynamics inside the TCPC pathway, which can be achieved by minimizing the power losses.

Evaluation of Hemodynamic Efficiency in a New “Y-Graft” Design for the Fontan Operation

2007 ◽  
Author(s):  
Adam J. Bernstein ◽  
Alison L. Marsden ◽  
Ryan L. Spilker ◽  
V. Mohan Reddy ◽  
Charles A. Taylor ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Survival Rates ◽  
Pulmonary Arteries ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Blood Flows ◽  
Left Heart Syndrome ◽  
Cavopulmonary Connection

Hypoplastic left heart syndrome is a congenital heart defect that occurs in 20 per 100,000 live births. Patients are born with severe underdevelopment of the left side of the heart which, if left untreated, is uniformly fatal. A series of operations is performed, including a cavopulmonary (Glenn) shunt and total cavopulmonary connection (Fontan procedure), which connect the superior (SVC) and inferior vena cavae (IVC) respectively in an end-to-side fashion to the left (LPA) and right pulmonary arteries (RPA), resulting in a T-shaped junction. This bypasses the heart on the venous side as blood flows from the IVC and SVC directly into the pulmonary arteries. Early survival rates following the Fontan are as high as 90%. However, these figures drop to 60% survival after 10 years [1], and most patients exhibit diminished exercise capacity.

scholarly journals Ventilation/perfusion mismatch during lung aeration at birth

2014 ◽  
Vol 117 (5) ◽  
pp. 535-543 ◽  
Author(s):  
Justin A. R. Lang ◽  
James T. Pearson ◽  
Arjan B. te Pas ◽  
Megan J. Wallace ◽  
Melissa L. Siew ◽  
...  
Keyword(s):  
Pulmonary Arteries ◽  
Left Lung ◽  
X Ray ◽  
Lung Aeration ◽  
X Ray Imaging ◽  
Iodine Level ◽  
Pulmonary Shunting ◽  
Left And Right ◽  
Near Term ◽  
The Right

At birth, the transition to newborn life is triggered by lung aeration, which stimulates a large increase in pulmonary blood flow (PBF). Current theories predict that the increase in PBF is spatially related to ventilated lung regions as they aerate after birth. Using simultaneous phase-contrast X-ray imaging and angiography we investigated the spatial relationships between lung aeration and the increase in PBF after birth. Six near-term (30-day gestation) rabbits were delivered by caesarean section, intubated and an intravenous catheter inserted, before they were positioned for X-ray imaging. During imaging, iodine was injected before ventilation onset, after ventilation of the right lung only, and after ventilation of both lungs. Unilateral ventilation increased iodine levels entering both left and right pulmonary arteries (PAs) and significantly increased heart rate, iodine ejection per beat, diameters of both left and right PAs, and number of visible vessels in both lungs. Within the 6th intercostal space, the mean gray level (relative measure of iodine level) increased from 68.3 ± 11.6 and 70.3 ± 7.5%·s to 136.3 ± 22.6 and 136.3 ± 23.7%·s in the left and right PAs, respectively. No differences were observed between vessels in the left and right lungs, despite the left lung not initially being ventilated. The increase in PBF at birth is not spatially related to lung aeration allowing a large ventilation/perfusion mismatch, or pulmonary shunting, to occur in the partially aerated lung at birth.

scholarly journals Pulmonary Artery Intimal Sarcoma: A Case Report

2016 ◽  
Vol 9 (1) ◽  
pp. 267-272 ◽  
Author(s):  
Joseph P. Kriz ◽  
Nabil A. Munfakh ◽  
Gregory S. King ◽  
Juan O. Carden
Keyword(s):  
Pulmonary Artery ◽  
Malignant Tumors ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Filling Defect ◽  
Intimal Sarcoma ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
Left And Right ◽  
The Right

Pulmonary artery intimal sarcomas are rare and lethal malignant tumors that typically affect larger vessels: the aorta, inferior vena cava, and pulmonary arteries. Since symptoms and imaging of pulmonary arterial intimal sarcomas mimic pulmonary thromboembolism, the differential diagnosis of a patient presenting with chest pain, dyspnea, and filling defect within the pulmonary arteries should include intimal sarcoma. Often right ventricular failure is observed due to pulmonary hypertension caused by the obstructive effect of the tumor and concomitant chronic thromboembolism. We report the case of a 72-year-old African-American male with arterial intimal sarcoma of the left and right pulmonary artery with extension through the right artery into the bronchus and right lung.

Effect of Flow Pulsatility on Modeling the Total Cavopulmonary Hemodynamics: A Numerical Investigation

2012 ◽  
Author(s):  
Reza H. Khiabani ◽  
Maria Restrepo ◽  
Elaine Tang ◽  
Diane De Zélicourt ◽  
Mark Fogel ◽  
...  
Keyword(s):  
Boundary Conditions ◽  
Heart Defects ◽  
Superior Vena ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Venous Flow ◽  
Surgical Interventions ◽  
The Right

Single Ventricle Heart Defects (SVHD) are present in 2 per 1000 live births in the US. SVHD are characterized by cyanotic mixing between the de-oxygenated blood from the systemic circulation return and the oxygenated blood from the pulmonary arteries. Palliative surgical repairs (Fontan procedure) are performed to bypass the right ventricle in these patients. In current practice, the surgical interventions commonly result in the total cavopulmonary connection (TCPC). In this configuration the systemic venous returns (inferior vena cava, IVC, and superior vena cava, SVC) are directly routed to the right and left pulmonary arteries (RPA and LPA), bypassing the right heart. The resulting anatomy has complex and unsteady hemodynamics characterized by flow mixing and flow separation. Pulsation of the inlet venous flow during a cardiac cycle results in complex and unsteady flow patterns in the TCPC. Although various degrees of pulsatility have been observed in vivo, non-pulsatile (time-averaged) flow boundary conditions have traditionally been assumed in modeling TCPC hemodynamics, and only recently have pulsatile conditions been incorporated without completely characterizing their effect or importance. In this study, 3D numerical simulations were performed to predict TCPC hemodynamics with both pulsatile and non-pulsatile boundary conditions and to investigate the accuracy of applying non-pulsatile boundary conditions. Flow structures, energy dissipation rate and pressure drop were compared under rest and estimated exercise conditions. The results show that TCPC hemodynamics can be strongly influenced by the presence of pulsatile flow. However, there exists a minimum pulsatility threshold, identified by defining a weighted pulsatility index (wPI), above which the influence is significant.

Is the “Perfect Fontan” operation routinely achievable in the modern era?

2008 ◽  
Vol 18 (3) ◽  
pp. 328-336 ◽  
Author(s):  
James K. Kirklin ◽  
Robert N. Brown ◽  
Ayesha S. Bryant ◽  
David C. Naftel ◽  
Edward V. Colvin ◽  
...  
Keyword(s):  
Operative Procedure ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Fontan Circulation ◽  
Caval Vein ◽  
Entire Cohort ◽  
Inferior Caval Vein ◽  
The Right

AbstractObjectiveIn 1990, Fontan, Kirklin, and colleagues published equations for survival after the so-called “Perfect Fontan” operation. After 1988, we evolved a protocol using an internal or external polytetraflouroethylene tube of 16 to 19 millimetres diameter placed from the inferior caval vein to either the right or left pulmonary artery along with a bidirectional cava-pulmonary connection. The objective of this study was to test the hypothesis that a “perfect” outcome is routinely achievable in the current era when using a standardized surgical procedure.MethodsBetween 1 January, 1988, and 12 December, 2005, 112 patients underwent the Fontan procedure using an internal or external polytetraflouroethylene tube plus a bidirectional cava-pulmonary connection, the latter usually having been constructed as a previous procedure. This constituted 45% of our overall experience in constructing the Fontan circulation between 1988 and 1996, and 96% of the experience between 1996 and 2005. Among all surviving patients, the median follow-up was 7.3 years. We calculated the expected survival for an optimal candidate, given from the initial equations, and compared this to our entire experience in constructing the Fontan circulation.ResultsAn internal tube was utilized in 61 patients, 97% of whom were operated prior to 1998, and an external tube in 51 patients, the latter accounting for 95% of all operations since 1999. At 1, 5, 10 and 15 years, survival of the entire cohort receiving polytetraflouroethylene tubes is superimposable on the curve calculated for a “perfect” outcome. Freedom from replacement or revision of the tube was 97% at 10 years.ConclusionUsing a standardized operative procedure, combining a bidirectional cavopulmonary connection with a polytetraflouroethylene tube placed from the inferior caval vein to the pulmonary arteries for nearly all patients with functionally univentricular hearts, early and late survival within the “perfect” outcome as predicted by the initial equations of Fontan and Kirklin is routinely achievable in the current era. The need for late revision or replacement of the tube is rare.

scholarly journals Analysis and regulation of the cardiovascular system of univentricular heart with different configurations of the total cavopulmonary connection

2021 ◽  
Vol 2091 (1) ◽  
pp. 012023
Author(s):  
A A Galiastov ◽  
D V Telyshev
Keyword(s):  
Cardiovascular System ◽  
Artificial Heart ◽  
Total Artificial Heart ◽  
Univentricular Heart ◽  
Total Cavopulmonary Connection ◽  
Assist Device ◽  
Ventricular Assist ◽  
Internal Parameters ◽  
The Right ◽  
Cavopulmonary Connection

Abstract The cardiovascular system (CVS) is a complex mechanism capable of reacting and regulating various changes in external and internal parameters. A particular problem is the study of CVS with univentricular heart. We studied the hemodynamic response of the CVS to the use of various configurations of bypassing the right side of the heart. During our research, we selected three different configurations of the total cavopulmonary connection. All configurations were made from Clear Flex 50 and tested in an experimental workbench. According to the research results, the TCPC-3 configuration is the most optimal. It has symmetrical output values of flows and pressures and there is no significant increase in inlet pressure. The results of this study can be used to optimize the control of the parameters of the ventricular assist device and the total artificial heart.

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