Computational haemodynamic analysis of patient-specific virtual operations for total cavopulmonary connection with dual superior venae cavae
Computational haemodynamic analysis of patient-specific virtual operations for total cavopulmonary connection with dual superior venae cavae
复制标题
双上腔静脉全腔肺连接的患者特异性虚拟手术的计算血流动力学分析
DOI：
10.1093/ejcts/ezt394
复制
发表时间：
2014-03-01
影响因子：
3.4
通讯作者：
Liu, Jinfen
中科院分区：
文献类型：
--
作者：
Sun, Qi;Liu, Jinlong;Liu, Jinfen
目的：本研究拟设计不同类型的双上级腔静脉（SVC）全腔静脉连接术（TCPC），考虑腔静脉与肺动脉（PA）的不同吻合部位，并比较这些虚拟手术设计的血流动力学特征。方法：将双侧双向Glenn（BBDG）连接和下腔静脉（IVC）连接心外管道的几何形状重建为三种，根据两名相同年龄的患者的磁共振图像（MRI）和虚拟手术设计了四种可能的TCPC模型，并在儿科心脏外科医生的指导下创建了四种可能的TCPC模型。在每个模型中以五个预定的肺血流分裂进行计算流体动力学（CFD）模拟，以预测术后血流。在每个模型上应用相同的边界条件，以简化分析配置对流动特性的影响。计算并比较了不同模型的控制容积功率损失和能量效率。结果：当右肺动脉（RPA）流量占肺动脉总流量的40-60%时，TCPC 2模型的控制容积功率损失低于其他3种模型，TCPC 4模型的控制容积功率损失高于其他3种模型。对于该患者，PA上的左上级腔静脉（LSVC）和右上级腔静脉（RSVC）关闭在一起将导致TCPC连接中的更高功率损耗和更低能效。如果在进行I期BBDG手术时将LSVC和RSVC尽可能靠近PA连接以刺激中央PA的生长，则在随后的TCPC手术中，将IVC的心外管道连接在吻合部位下方会更好，以避免高功率损失。
OBJECTIVES: This study set out to design different types of total cavopulmonary connections (TCPC) with dual superior venae cavae (SVC), taking into account different sites for anastomosis from venae cavae to pulmonary arteries (PAs), and to compare haemodynamic features in these virtual operative designs.METHODS: The geometries of bilateral bidirectional Glenn (BBDG) connection and inferior vena cava (IVC) connected extracardiac conduit were reconstructed to three-dimensional configurations according to the magnetic resonance images (MRIs) of two patients at the same age, and virtual operations were designed to create four possible TCPC models under the guidance of paediatric cardiac surgeons. Computational fluid dynamic (CFD) simulations were performed in each model at five predetermined pulmonary flow splits, to predict postoperative blood flows. The same boundary conditions were applied on each model, in order to simplify the analysis of the influence of configurations on the flow characteristics. Control volume power losses and energy efficiency in different models were calculated and compared. Flow patterns in the models were demonstrated by streamlines corresponding to the venae cavae.RESULTS: When the flow rate of the right pulmonary artery (RPA) was 40-60% of the total pulmonary flow, control volume power loss was lower than the other three models in the model of TCPC 2 and was higher than the other three models in the model of TCPC 4.CONCLUSIONS: For this patient, anastomosing the left superior vena cava (LSVC) and right superior vena cava (RSVC) on the PAs close together will cause higher power loss and lower energy efficiency in the TCPC connection. If the LSVC and RSVC had been connected to the PAs as near as possible to stimulate growth of the central PAs when performing I-stage BBDG procedure, the extracardiac conduit from IVC would be better connected just under the anastomotic site in the following TCPC procedure to avoid high power loss.