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

Published online by Cambridge University Press:  05 April 2017

Koichi Sughimoto*
Affiliation:
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Australia
Yuta Asakura
Affiliation:
Graduate School of Engineering, Chiba University, Chiba, Japan
Christian P. Brizard
Affiliation:
Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
Fuyou Liang
Affiliation:
School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CUICRC), Shanghai Jiao Tong University, Shanghai, China
Takashi Fujiwara
Affiliation:
Graduate School of Engineering, Chiba University, Chiba, Japan
Kagami Miyaji
Affiliation:
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
Hao Liu*
Affiliation:
Graduate School of Engineering, Chiba University, Chiba, Japan Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CUICRC), Shanghai Jiao Tong University, Shanghai, China
*
Correspondence to: K. Sughimoto, MD, PhD, Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ward, Sagamihara 252-0375, Japan. Tel: +81 427 78 8111; Fax: +81 427 778 8574; E-mail: ksughimoto@gmail.com; H. Liu, PhD, Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba 263-8522, Japan. Tel: +81 43 290 3228; Fax: +81 43 290 3228; E-mail: hliu@faculty.chba-u.jp
Correspondence to: K. Sughimoto, MD, PhD, Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ward, Sagamihara 252-0375, Japan. Tel: +81 427 78 8111; Fax: +81 427 778 8574; E-mail: ksughimoto@gmail.com; H. Liu, PhD, Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba 263-8522, Japan. Tel: +81 43 290 3228; Fax: +81 43 290 3228; E-mail: hliu@faculty.chba-u.jp

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.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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