Details

Autor(en) / Beteiligte

• Yang, Weiguang, PhD
• Chan, Frandics P., MD, PhD
• Reddy, V. Mohan, MD
• Marsden, Alison L., PhD
• Feinstein, Jeffrey A., MD, MPH

Titel

Flow simulations and validation for the first cohort of patients undergoing the Y-graft Fontan procedure

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2015-01, Vol.149 (1), p.247-255

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Objectives In this study, with the use of computational fluid dynamics, we evaluate the postoperative hemodynamic performance of the first cohort of patients undergoing a handcrafted Y-graft Fontan procedure and validate simulation predictions of hepatic blood flow distribution against in vivo clinical data. Methods An 18-12 × 2–mm handcrafted Y-graft modification of the Fontan procedure was performed in 6 patients. Early (at the time of discharge) and 6-month postoperative 3-dimensional magnetic resonance imaging data were collected. Patient-specific models were constructed for flow simulations. Results Hepatic blood flow distribution varied among patients. Lung perfusion data (n = 3) showed good agreement with simulations. Postoperative asymmetry in hepatic blood flow distribution was reduced 6 months postoperatively. In 1 patient, low wall shear stress was found in the left limb of the Y-graft, corresponding to the location of subsequent thrombosis in the patient. Conclusions The credibility and accuracy of simulation-based predictions of postoperative hepatic flow distribution for the Fontan surgery have been validated by in vivo lung perfusion data. The performance of the Y-graft design is highly patient-specific. The anastomosis location is likely the most important factor influencing hepatic blood flow distribution. Although the development of thrombosis is multifactorial, the occurrence in 1 patient suggests that simulations should not solely consider the hepatic blood flow distribution but also aim to avoid low wall shear stress in the limbs.