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The recent developments in imaging techniques have created new opportunities to give an accurate description of the three-dimensional morphology of vessels. Such three-dimensional reconstruction of anatomical structures from medical images has achieved importance in several applications, such as the reconstruction of human bones, spine portions, and vascular districts.
The identification of the important relationship between shape and function of ventricular chambers represents a milestone of modern cardiology. Application of the law of Laplace for an ideal sphere furnishes intuitive insights on the progression of heart failure. A dilated heart, by virtue of its large size, must generate greater stress in the myocardial wall to achieve sufficient pressure so as to eject the required amount of blood. The mural hypertrophy represents a compensatory mechanism, guaranteeing a lower stress. When the ratio between the radius of the chamber and the thickness of its wall increases abnormally, the heart fails.
Whatever the specific anatomy, the Fontan circulation, be it created directly or subsequent to a bi-directional cavopulmonary anastomosis, transforms completely the pattern of circulation of the blood. In essence, it converts a network of circulations in parallel into one in series. The haemodynamic consequences are numerous. The most important and direct among them is, perhaps, the increase in afterload, as well as the reduction in preload, for the systemic ventricle. From the clinical point of view, the most immediate and relevant implication is the amelioration of cyanosis, this being the consequence of removing the common mixing of systemic and pulmonary venous blood within the heart.
Many complex cardiac defects produce a functionally single ventricle, in which there is mixing of the systemic and pulmonary circulations. The output from the functionally single ventricle is divided between the two circulations: the proportion going to the systemic and pulmonary vascular beds being determined by the relative resistance to flows within the respective circulations.
cardiac surgery is a discipline aimed at restoring the best cardiac function of diseased hearts. it is often necessary to implant devices, and surgical tools are of great help in achieving faster and safer procedures. paediatric cardiac surgery is a more recent specialization of cardiac surgery. in paediatric cardiac surgery, the problem is usually related to congenital malformations, consisting in the main of anatomical abnormalities which produce, among other problems, poor oxygenation of the blood, high cardiac afterload, cardiac failure, hemodynamic problems during growth, and so on. the paediatric cardiac surgeon uses his skill and experience to determine the optimal correction in each individual case. in many cases, however, it is not easy to predict the effects of the given surgical procedure that, for success, depends on many different parameters.
a hydraulic circulatory duplicator is a hydraulic circuit, closed or open that physically reproduces one human district, along with the effects of any connected apparatus, on local fluid dynamics. such hydraulic circulatory duplicators are usually made up of rigid or deformable pipes, pressure loss generators, such as valves or sponge elements, compliant elements such as a pneumatic room, elastic elements, pumping elements, which may be centrifugal, axial, or roller, and tanks. all the elements are connected by joints. the systems are completed by transducers of pressure or flow, and systems for visualising flow or measuring other parameters of interest.
patients with congenitally malformed hearts characterised by a functionally single ventricle are currently treated using several procedures that bypass the right heart, such as the fontan and hemi-fontan operations, the bidirectional cavopulmonary anastomosis, and the total cavopulmonary connection. all these options are based on the procedures introduced for palliative correction of tricuspid atresia by fontan and baudet in 1971. introduced with the purpose of reducing the pre-operative volume overload, the surgical task mainly consists of separating the pulmonary from the systemic circulation. irrespective of the specific operation performed, we can call the resulting circulation the fontan circulation.
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