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Thorac Cardiovasc Surg 2020; 68(01): 038-044
DOI: 10.1055/s-0038-1677490
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Influence of Offset on Hemodynamics of Intra-atrial Conduit Fontan's Procedure and Its Clinical Implications

Jie Hu
1   Department of Pediatric Cardio-Thoracic Surgery, Shanghai Children's Medical Center, Shanghai, China
,
Qian Wang
2   Department of Radiology, Shanghai Children's Medical Center, Shanghai, China
,
Zhirong Tong
3   Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai, China
,
Juanya Shen
3   Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai, China
,
Jinlong Liu
3   Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai, China
,
Yanjun Sun
1   Department of Pediatric Cardio-Thoracic Surgery, Shanghai Children's Medical Center, Shanghai, China
,
Haibo Zhang
1   Department of Pediatric Cardio-Thoracic Surgery, Shanghai Children's Medical Center, Shanghai, China
› Author Affiliations Funding This research was supported by National Nature Science Foundation of China (grant number 81570281); the Science and Technology Commission of Shanghai Municipality (grant number 14411961600); the Fund of The Shanghai Committee of Science and Technology (grant number 15411964100) the Project was funded by Science and Technology Committee of Pudong District (grant number PKJ2015-Y01).
Further Information

Publication History

07 October 2018

04 December 2018

Publication Date:
22 January 2019 (online)

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Abstract

Background The desirable distance, defined as offset, between the central line of the superior vena cava (SVC) and the intra-atrial conduit after an intra-atrial conduit (IAC) Fontan's procedure remained unclear. We compared the hemodynamic features using virtual surgery with different offset designs in our study.

Methods Three-dimensional models of IAC Fontan's procedure were reconstructed according to the magnetic resonance imagings (MRIs) of three patients, then four models for each patient with different offsets equaling 100, 67, 33, and 0% of the diameter of the IVC were reconstructed. Computational fluid dynamics (CFD) were performed in each model to predict the best hemodynamic features, including streamlines of blood flow, wall shear stress (WSS), energy loss (EL), and the hepatic flow distribution (HFD) ratio.

Results Comprehensive evaluation of WSS, EL, and HFD revealed than an offset of 33% presents the best hemodynamic performance among the three patients modeled. In patient A, an offset of 33% resulted in the best HFD (left pulmonary artery/right pulmonary artery [LPA/RPA] = 35/65%). In patient B, the best trade-off between HFD (35/65%), and WSS was achieved with an offset of 33%. In patient C, EL peaked at an offset of 0% and significantly dropped at an offset of 33% with a desirable HFD (60/40%).

Conclusions We verified that the offset distance influences hemodynamic performance in IAC Fontan's procedure. Considering several hemodynamic parameters, the best trade-offs between hemorheology, pulmonary perfusion, and energy efficiency were achieved at an offset of 33%. This distance should be taken into consideration and optimized during the surgical planning for the IAC Fontan's procedure.

Keywords

cardiac - congenital heart disease - CHD - bioengineering - pulmonary arteries/veins
 

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