Journal
CONGENITAL HEART DISEASE
Volume 5, Issue 2, Pages 104-117Publisher
WILEY
DOI: 10.1111/j.1747-0803.2010.00383.x
Keywords
Fontan Surgery; Patient-Specific Modeling; Hemodynamics; Exercise; Computational Fluid Dynamics
Categories
Funding
- Burroughs Wellcome Fund
- American Heart Association
- Beginning Grant in Aid award
- National Science Foundation [0205741]
- Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University
- Division of Computing and Communication Foundations
- Direct For Computer & Info Scie & Enginr [0205741] Funding Source: National Science Foundation
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Introduction. Despite an abundance of prior Fontan simulation articles, there have been relatively few clinical advances that are a direct result of computational methods. We address a few key limitations of previous Fontan simulations as a step towards increasing clinical relevance. Previous simulations have been limited in scope because they have primarily focused on a single energy loss parameter. We present a multi-parameter approach to Fontan modeling that establishes a platform for clinical decision making and comprehensive evaluation of proposed interventions. Methods. Time-dependent, 3-D blood flow simulations were performed on six patient-specific Fontan models. Key modeling advances include detailed pulmonary anatomy, catheterization-derived pressures, and MRI-derived flow with respiration. The following performance parameters were used to rank patients at rest and simulated exercise from best to worst performing: energy efficiency, inferior and superior vena cava (IVC, SVC) pressures, wall shear stress, and IVC flow distribution. Results. Simulated pressures were well matched to catheterization data, but low Fontan pressure did not correlate with high efficiency. Efficiency varied from 74% to 96% at rest, and from 63% to 91% with exercise. Distribution of IVC flow ranged from 88%/12% (LPA/RPA) to 53%/47%. A transcatheter virtual intervention demonstrates the utility of computation in evaluating interventional strategies, and is shown to result in increased energy efficiency. Conclusions. A multiparameter approach demonstrates that each parameter results in a different ranking of Fontan performance. Ranking patients using energy efficiency does not correlate with the ranking using other parameters of presumed clinical importance. As such, current simulation methods that evaluate energy dissipation alone are not sufficient for a comprehensive evaluation of new Fontan designs.
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