Fontan Conversion Templates: Patient-Specific Hemodynamic Performance of the Lateral Tunnel Versus the Intraatrial Conduit With Fenestration
Fontan Conversion Templates: Patient-Specific Hemodynamic Performance of the Lateral Tunnel Versus the Intraatrial Conduit With Fenestration
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Fontan 转换模板：侧通道与开窗心房导管的患者特定血流动力学性能
DOI：
10.1007/s00246-013-0669-5
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发表时间：
2013-08-01
影响因子：
1.6
通讯作者：
Liu, Jinfen
中科院分区：
文献类型：
--
作者：
Hong, Haifa;Dur, Onur;Liu, Jinfen
房内管道Fontan被认为是心外和外侧隧道Fontan的改良。在本研究中，基于作者的患者队列，研究了作为转换模板的心房内管道和开窗侧隧道Fontan的患者特定血流动力学性能。脉动计算流体动力学模拟使用心房内管道和外侧隧道Fontan患者的患者特定模型进行。实时“同步”下腔静脉和上级腔静脉、肺动脉和开窗血流波形通过超声采集。研究了多个血流动力学性能指标，特别关注脉动流性能的评价。对于患者特异性心输出量和标准化连接尺寸，外侧隧道Fontan内的功率损耗似乎显著高于心房内管道Fontan。在平均流量为0.24 L/min时纳入4 mm开窗导致两种Fontan连接的腔静脉压力梯度较低，时间平均功率损失较小。心房内管道内的血流结构比外侧隧道内的血流结构更均匀。在两种手术连接中，肝血流主要偏向左肺：从外侧隧道转换为心房内管道Fontan导致更好的血液动力学，功率损失更少，压力梯度更低，管道沿线的停滞血流区沿着更少。该患者特定的计算病例研究表明，心房内管道Fontan的血流动力学优于有或无开窗的外侧隧道Fontan，并且在将外侧隧道转换为心房内管道后性能得到改善。非均匀肝血流分布的几何形状特异性效应可能会激发手术设计的新原理。
Intraatrial-conduit Fontan is considered a modification of both extracardiac and lateral-tunnel Fontan. In this study, the patient-specific hemodynamic performance of intraatrial-conduit and lateral-tunnel Fontan with fenestration, considered as conversion templates, was investigated based on the authors’ patient cohort. Pulsatile computational fluid dynamics simulations were performed using patient-specific models of intraatrial-conduit and lateral-tunnel Fontan patients. Real-time “simultaneous” inferior and superior vena cava, pulmonary artery, and fenestration flow waveforms were acquired from ultrasound. Multiple hemodynamic performance indices were investigated, with particular focus on evaluation of the pulsatile flow performance. Power loss inside the lateral-tunnel Fontan appeared to be significantly higher than with the intraatrial-conduit Fontan for patient-specific cardiac output and normalized connection size. Inclusion of the 4-mm fenestration at a 0.24 L/min mean flow resulted in a lower cavopulmonary pressure gradient and less time-averaged power loss for both Fontan connections. Flow structures within the intraatrial conduit were notability more uniform than within the lateral tunnel. Hepatic flow majorly favored the left lung in both surgical connections: conversion from lateral-tunnel to intraatrial-conduit Fontan resulted in better hemodynamics with less power loss, a lower pressure gradient, and fewer stagnant flow zones along the conduit. This patient-specific computational case study demonstrated superior hemodynamics of intraatrial-conduit Fontan over those of lateral-tunnel Fontan with or without fenestration and improved performance after conversion of the lateral tunnel to the intraatrial conduit. The geometry-specific effect of the nonuniform hepatic flow distribution may motivate new rationales for the surgical design.