Toward designing the optimal total cavopulmonary connection: An in vitro study
Toward designing the optimal total cavopulmonary connection: An in vitro study
复制标题
DOI：
10.1016/s0003-4975(99)00560-3
复制
发表时间：
1999-10-01
影响因子：
4.6
通讯作者：
Yoganathan, AP
中科院分区：
文献类型：
--
作者：
Ensley, AE;Lynch, P;Yoganathan, AP
背景了解全腔静脉连接（TCPC）血流动力学可能会导致改进的外科手术，从而导致更有效的改良循环。减少的能量损失将转化为单心室的更少工作，尽管单心室生理学复杂，但这种改善可能有助于改善术后结局。因此，为了节省能量，一个手术目标是优化TCPC几何形状。根据这一目标，本研究调查了在连接处增加腔静脉曲率或扩口是否可以节省能量。TCPC模型通过改变腔静脉入口的曲率或通过张开吻合口制成。进行稳态压力测量，以计算在肺血流分流范围（70：30至30：70）内归因于每种连接设计的功率损失。对每种设计进行颗粒流可视化，并与功率损失进行定性比较。结果表明，只有当来自腔室的流速与流向肺动脉的流速相匹配时，将腔室朝向一个肺动脉弯曲才是有利的。在其他肺血流分离条件下，曲线模型中的损失是显著的。相比之下，完全张开吻合口减少了肺血流分裂范围内的损失。与扩口相比，弯曲的功率损失大56%。与之前没有扩口的型号相比，没有腔静脉偏移的完全扩口减少了45%的损失。如果在腔静脉偏移的情况下在所有侧面进行扩口，则与相同的非扩口模型相比，功率损失减少68%。结果表明，优先弯曲腔室仅在特定肺血流条件下是最佳的，并且在所有临床病例中可能不是有效的。吻合口的扩口具有很大的节能潜力，在未来的TCPC手术中应予以考虑。(C)1999年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Understanding the total cavopulmonary connection (TCPC) hemodynamics may lead to improved surgical procedures which result in a more efficient modified circulation. Reduced energy loss will translate to less work for the single ventricle and although univentricular physiology is complex, this improvement could contribute to improved postoperative outcomes. Therefore to conserve energy, one surgical goal is optimization of the TCPC geometry. In line with this goal, this study investigated whether addition of caval curvature or flaring at the connection conserves energy.Methods. TCPC models were made varying the curvature of the caval inlet or by flaring the anastomosis. Steady now pressure measurements were made to calculate the power loss attributed to each connection design over a range of pulmonary flow splits (70:30 to 30:70). Particle flow visualization was performed for each design and was qualitatively compared to the power losses.Results. Results indicate that curving the cavae toward one pulmonary artery is advantageous only when the flow rate from that cavae matches the flow to the pulmonary artery. Under other pulmonary flow split conditions, the losses in the curved models are significant. In contrast, fully flaring the anastomosis reduced losses over the range of pulmonary flow splits. Power losses were 56% greater for the curving as compared to flaring. Fully flaring without caval offset reduced losses 45% when compared to previous models without flaring. If flaring on all sides was implemented with caval offset, power lasses reduced 68% compared to the same nonflared model.Conclusions. The results indicate that preferentially curving the cavae is only optimal under specific pulmonary flow conditions and may not be efficient in all clinical cases. Flaring of the anastomosis has great potential to conserve energy and should be considered in future TCPC procedures. (C) 1999 by The Society of Thoracic Surgeons.