Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational...

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.