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Fluid dynamics simulation of right ventricular outflow tract oversizing.
Denis Berdajs1, Selim Mosbahi2, Jan Vos3
1Department of Surgery and Anesthesiology, Cardiovascular Research, University Hospital Lausanne, Lausanne, Switzerland denis.berdajs@bluewin.ch.
Interactive Cardiovascular and Thoracic Surgery
|April 28, 2015
Summary
Oversizing right ventricular outflow tract (RVOT) conduits by 4 mm may improve graft durability. This study used CFD to analyze hemodynamic factors in oversized RVOT models, finding optimal conditions similar to native RVOT.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Fluid Dynamics
Background:
- Right ventricular outflow tract (RVOT) repair in children has a high reoperation rate.
- Intimal hyperplasia and arteriosclerosis limit graft durability.
- Local shear stress and pressure influence intimal hyperplasia.
Purpose of the Study:
- To investigate hemodynamic factors in oversized RVOT models using CFD.
- To identify the optimal degree of oversizing for a 12-mm native RVOT.
- To reduce reoperation rates in pediatric cardiac surgery.
Main Methods:
- Implanted valve conduits of varying sizes (12, 16, 18, 20 mm) in 20 pigs.
- Measured pressure and flow at different rates in RVOT and pulmonary arteries.
- Performed 3D CFD simulations to analyze local shear stress and pressure.
Main Results:
- Low shear stress (0-2 Pa) and high-pressure areas (11.5-12.1 mmHg) were observed at distal anastomoses and pulmonary artery ostia.
- These conditions occurred across all tested flow rates and oversized geometries.
- The 16-mm model showed hemodynamic profiles similar to the native 12-mm RVOT.
Conclusions:
- Oversizing a 12-mm native RVOT by no more than 4 mm is suggested.
- Hemodynamic conditions in the 16-mm oversized model mimic the native RVOT.
- This approach may mitigate intimal hyperplasia and improve graft durability.
