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Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational
Fuyou Liang1, Hideaki Senzaki2, Clara Kurishima2
1Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China; fuyouliang@sjtu.edu.cn.
Insights
Computational models reveal key factors influencing Fontan circulation hemodynamics. Pulmonary vascular resistance, diastolic function, and systemic compliance significantly impact cardiac output (CO) and central venous pressure stability.
Area of Science:
- Cardiovascular Physiology
- Computational Biology
- Pediatric Cardiology
Background:
- The Fontan circulation presents unique physiological challenges with limited understanding of factors beyond pulmonary vascular resistance affecting hemodynamics.
- Previous research has primarily focused on pulmonary vascular resistance's role in cardiac output (CO) in Fontan patients, neglecting other cardiovascular properties.
- Optimizing Fontan circulation management requires a comprehensive understanding of its complex hemodynamic determinants.
Purpose of the Study:
- To systematically investigate the impact of various cardiovascular properties on hemodynamic variables in Fontan circulation using computational modeling.
- To compare hemodynamic characteristics of Fontan circulation with normal biventricular circulation.
- To identify key determinants of cardiac output and central venous pressure stability in the Fontan physiology.
Main Methods:
- Development and application of computational models to simulate Fontan and biventricular circulations.
- Systematic variation of cardiovascular model parameters to quantify effects on hemodynamic variables.
- Numerical experiments to analyze the relationships between cardiovascular properties and clinical outcomes like CO and central venous pressure.
Main Results:
- Pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance were identified as major determinants of CO in Fontan circulation.
- Heart rate, ventricular contractility, and systemic vascular resistance played secondary roles in regulating CO.
- CO exhibited nonlinear relationships with individual cardiovascular properties, influenced by interactions with other factors. Central venous pressure stability was significantly reduced in Fontan circulation.
Conclusions:
- Fontan circulation hemodynamics are codetermined by multiple cardiovascular properties, not solely pulmonary vascular resistance.
- A holistic, patient-specific assessment of cardiovascular conditions is crucial for effective management and treatment optimization in Fontan patients.
- Computational modeling provides a valuable tool for dissecting complex cardiovascular physiology and informing clinical strategies.
Abstract:
The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patient-specific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.
