Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates
Identifieur interne : 004B39 ( Main/Curation ); précédent : 004B38; suivant : 004B40Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates
Auteurs : Kerem Pekkan [États-Unis] ; Lakshimi P. Dasi [États-Unis] ; Diane De Zélicourt [États-Unis] ; Kartik S. Sundareswaran [États-Unis] ; Mark A. Fogel [États-Unis] ; Kirk R. Kanter [États-Unis] ; Ajit P. Yoganathan [États-Unis]Source :
- Annals of biomedical engineering [ 0090-6964 ] ; 2008.
Abstract
Flow structures, hemodynamics and the hydrodynamic surgical pathway
resistances of the final stage functional single ventricle reconstruction,
namely the total cavopulmonary connection (TCPC) anatomy, have been investigated
extensively. However, the second stage surgical anatomy (i.e., bi-directional
Glenn or hemi-Fontan template) has received little attention. We thus initiated
a multi-faceted study, involving magnetic resonance imaging (MRI), phase
contrast MRI, computational and experimental fluid dynamics methodologies,
focused on the second stage of the procedure. Twenty three-dimensional computer
and rapid prototype models of 2nd stage TCPC anatomies were created, including
idealized parametric geometries (
Url:
DOI: 10.1007/s10439-008-9591-z
PubMed: 18987974
PubMed Central: 3734564
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PMC:3734564Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hemodynamic Performance of Stage-2 Univentricular Reconstruction:
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<author><name sortKey="Pekkan, Kerem" sort="Pekkan, Kerem" uniqKey="Pekkan K" first="Kerem" last="Pekkan">Kerem Pekkan</name>
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<front><div type="abstract" xml:lang="en"><p id="P1">Flow structures, hemodynamics and the hydrodynamic surgical pathway
resistances of the final stage functional single ventricle reconstruction,
namely the total cavopulmonary connection (TCPC) anatomy, have been investigated
extensively. However, the second stage surgical anatomy (i.e., bi-directional
Glenn or hemi-Fontan template) has received little attention. We thus initiated
a multi-faceted study, involving magnetic resonance imaging (MRI), phase
contrast MRI, computational and experimental fluid dynamics methodologies,
focused on the second stage of the procedure. Twenty three-dimensional computer
and rapid prototype models of 2nd stage TCPC anatomies were created, including
idealized parametric geometries (<italic>n</italic>
= 6), patient-specific
anatomies (<italic>n</italic>
= 7), and their virtual surgery variant
(<italic>n</italic>
= 7). Results in patient-specific and idealized models
showed that the Glenn connection template is hemodynamically more efficient with
(83% <italic>p</italic>
= 0.08 in patient-specific models and
66% in idealized models) lower power losses compared to hemi-Fontan
template, respectively, due to its direct end-to-side anastomosis. Among the
several secondary surgical geometrical features, stenosis at the SVC anastomosis
or in pulmonary branches was found to be the most critical parameter in
increasing the power loss. The pouch size and flare shape were found to be less
significant. Compared to the third stage surgery the hydrodynamic resistance of
the 2nd stage is considerably lower (both in idealized models and in anatomical
models at MRI resting conditions) for both hemi- and Glenn templates. These
results can impact the surgical design and planning of the staged TCPC
reconstruction.</p>
</div>
</front>
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