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A new multiparameter approach to computational simulation for Fontan assessment and redesign
Alison L Marsden1, V Mohan Reddy, Shawn C Shadden
1Mechanical and Aerospace Engineering Department, University of California, San Diego, CA 92093-0411, USA. amarsden@ucsd.edu
Congenital Heart Disease
|April 24, 2010
Summary
Computational modeling of Fontan circulation is advancing. A multi-parameter approach reveals that energy efficiency alone is insufficient for ranking patient performance, highlighting the need for comprehensive simulation strategies.
Area of Science:
- Cardiovascular Physiology
- Computational Fluid Dynamics
- Medical Simulation
Background:
- Prior Fontan simulations have been limited by a singular focus on energy loss parameters.
- Clinical translation of computational methods in Fontan circulation has been minimal.
- A multi-parameter modeling approach is needed to enhance clinical relevance and decision-making.
Purpose of the Study:
- To develop and apply a multi-parameter computational model for Fontan circulation.
- To evaluate patient performance using a comprehensive set of hemodynamic parameters.
- To assess the clinical utility of computational modeling for interventional strategy evaluation.
Main Methods:
- Time-dependent, 3-D blood flow simulations on patient-specific Fontan models.
- Incorporation of detailed pulmonary anatomy, catheterization pressures, and MRI-derived flow with respiration.
- Ranking of patients based on energy efficiency, vena cava pressures, wall shear stress, and flow distribution at rest and during exercise.
Main Results:
- Simulated pressures correlated well with catheterization data; however, low Fontan pressure did not predict high efficiency.
- Patient efficiency varied significantly (74-96% rest, 63-91% exercise) with differing IVC flow distributions.
- A virtual transcatheter intervention demonstrated improved energy efficiency, showcasing the model's utility.
Conclusions:
- Fontan patient performance rankings differ based on the parameter assessed (e.g., energy efficiency vs. others).
- Energy efficiency alone is not a sufficient metric for comprehensive Fontan performance evaluation.
- Multi-parameter computational models are essential for evaluating new Fontan designs and interventions.
