Impact of the location of the fenestration on Fontan circulation haemodynamics: a three-dimensional, computational model study.

Abstract:

OBJECTIVES:There is no consensus or theoretical explanation regarding the optimal location for the fenestration during the Fontan operation. We investigated the impact of the location of the fenestration on Fontan haemodynamics using a three-dimensional Fontan model in various physiological conditions. METHODS:A three-dimensional Fontan model was constructed on the basis of CT images, and a 4-mm-diameter fenestration was located between the extracardiac Fontan conduit and the right atrium at three positions: superior, middle, and inferior part of the conduit. Haemodynamics in the Fontan route were analysed using a three-dimensional computational fluid dynamic model in realistic physiological conditions, which were predicted using a lumped parameter model of the cardiovascular system. The respiratory effect of the caval flow was taken into account. The flow rate through the fenestration, the effect of lowering the central venous pressure, and wall shear stress in the Fontan circuit were evaluated under central venous pressures of 10, 15, and 20 mmHg. The pulse power index and pulsatile energy loss index were calculated as energy loss indices. RESULTS:Under all central venous pressures, the middle-part fenestration demonstrated the most significant effect on enhancing the flow rate through the fenestration while lowering the central venous pressure. The middle-part fenestration produced the highest time-averaged wall shear stress, pressure pulse index, and pulsatile energy loss index. CONCLUSIONS:Despite slightly elevated energy loss, the middle-part fenestration most significantly increased cardiac output and lowered central venous pressure under respiration in the Fontan circulation.

journal_name

Cardiol Young

journal_title

Cardiology in the young

authors

Sughimoto K,Asakura Y,Brizard CP,Liang F,Fujiwara T,Miyaji K,Liu H

doi

10.1017/S1047951117000099

subject

Has Abstract

pub_date

2017-09-01 00:00:00

pages

1289-1294

issue

7

eissn

1047-9511

issn

1467-1107

pii

S1047951117000099

journal_volume

27

pub_type

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