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Multiphysiologic State Computational Fluid Dynamics Modeling for Planning Fontan With Interrupted Inferior Vena Cava.
Hoganson, David M; Govindarajan, Vijay; Schulz, Noah E; Eickhoff, Emily R; Breitbart, Roger E; Marx, Gerald R; Del Nido, Pedro J; Hammer, Peter E.
Afiliación
  • Hoganson DM; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Govindarajan V; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Schulz NE; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Eickhoff ER; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Breitbart RE; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Marx GR; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Del Nido PJ; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Hammer PE; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
JACC Adv ; 3(7): 101057, 2024 Jul.
Article en En | MEDLINE | ID: mdl-39129987
ABSTRACT

Background:

Single ventricle (SV) patients with interrupted inferior vena cava (iIVC) and azygos continuation are at high risk for unbalanced hepatic venous flow (HVF) distribution to the lungs after Fontan completion and subsequent pulmonary arteriovenous malformations (AVMs) formation.

Objectives:

The aim of the study was to utilize computational fluid dynamics (CFD) analysis to avoid maldistribution of HVF to the lungs after Fontan surgery.

Methods:

Four SV subjects with iIVC were prospectively studied with a 3-dimensional (3D) modeling workflow with digital 3D models created from segmented magnetic resonance images or computer tomography scans, virtual surgery, and CFD analysis over multiple physiologic states for the evaluation of operative plans to achieve balanced HVF to both lungs. Three of the patients were Fontan revision candidates with existing AVMs. All patients underwent Fontan completion or revision surgery.

Results:

CFD predicted that existing or proposed Fontan completion in all patients would result in 100% of HVF to one lung. Improved HVF balance was achieved with CFD analysis of alternative surgical approaches resulting in the average distribution of HVF to the right/left pulmonary arteries of 37%/63% ± 10.4%. A hepatoazygos shunt was required in all patients and additional creation of an innominate vein in one. CFD analysis was validated by the comparison of pre-operative predicted and postoperative MRI-measured total right/left pulmonary flow (51%/49% ± 5.4% vs 49%/51% ± 8.5%).

Conclusions:

A 3D modeling workflow with CFD simulation for SV patients with iIVC may avoid HVF maldistribution and development of AVMs after Fontan completion.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: JACC Adv Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: JACC Adv Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos