Fontan hemodynamics: Importance of pulmonary artery diameter
Fontan hemodynamics: Importance of pulmonary artery diameter
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DOI：
10.1016/j.jtcvs.2008.04.036
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发表时间：
2009-03-01
影响因子：
6
通讯作者：
Yoganathan, Ajit P.
中科院分区：
文献类型：
--
作者：
Dasi, Lakshmi P.;Rema, Resmi Krishnankutty;Yoganathan, Ajit P.
目的：我们量化心外和外侧隧道Fontan手术方案的几何和血流动力学特征，并将某些解剖学特征与血流动力学效率和患者心脏指数相关联。方法与结果：对22例行Fontan手术的患者进行回顾性研究，其中11例为心外手术，11例为外侧隧道手术。使用骨架化方法量化总腔隙肺连接几何参数，如血管面积、曲率和偏移量。从先前的体外实验和计算流体动力学模拟中分别获得了5例和9例患者的总腔隙肺连接连接处的能量损失。所有患者均可获得心脏指数数据。肺动脉的平均和最小横截面积在心外和外侧隧道组之间无显著差异。总腔隙肺连接内的指数化能量耗散与肺动脉最小横截面积密切相关（R-2值为0.90,P < 0.0002），而所有其他几何特征，包括形状特征，均无显著相关性。最后，心脏指数与最小肺动脉面积显著相关（P = 0.006），表明总腔隙肺连接能量损失显著影响静息心输出量。结论：全腔肺连接最小出口尺寸（即肺动脉最小横切面）对全腔肺连接能量损失特性的影响强于心外和外侧隧道构型对应的形状变化。在比较心外和外侧隧道几何形状之间的能量损失时，必须考虑肺动脉大小的差异。
Objective: We quantify the geometric and hemodynamic characteristics of extracardiac and lateral tunnel Fontan surgical options and correlate certain anatomic characteristics with their hemodynamic efficiency and patient cardiac index.Methods and Results: The study was conducted retrospectively on 22 patients undergoing Fontan operations ( 11 extracardiac and 11 lateral tunnel operations). Total cavopulmonary connection geometric parameters such as vessel areas, curvature, and offsets were quantified using a skeletonization method. Energy loss at the total cavopulmonary connection junction was available from previous in vitro experiments and computational fluid dynamic simulations for 5 and 9 patients, respectively. Cardiac index data were available for all patients. There was no significant difference in the mean and minimum cross-sectional vessel areas of the pulmonary artery between the extracardiac and lateral tunnel groups. The indexed energy dissipation within the total cavopulmonary connection was strongly correlated to minimum cross-sectional area of the pulmonary arteries (R-2 value of 0.90 and P < .0002), whereas all other geometric features, including shape characteristics, had no significant correlation. Finally, cardiac index significantly correlated with the minimum pulmonary artery area (P = .006), suggesting that total cavopulmonary connection energy losses significantly affect resting cardiac output.Conclusions: The minimum outlet size of the total cavopulmonary connection (ie, minimum cross section of pulmonary artery) governs the energy loss characteristics of the total cavopulmonary connection more strongly than variations in the shapes corresponding to extracardiac and lateral tunnel configurations. Differences in pulmonary artery sizes must be accounted for when comparing energy losses between extracardiac and lateral tunnel geometries.