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Updated: Dec 26, 2025
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Flow profile characteristics in Fontan circulation are associated with the single ventricle dilation and function:
Michal Schäfer1, Benjamin S Frank1, Stephen M Humphries2
1Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado.
Summary
Flow patterns in Fontan circulation, analyzed using principal component analysis, reveal connections between pulmonary artery flow variations and single ventricle function. Diastolic-dominant flow indicates better ventricular volume and systolic function in Fontan patients.
Area of Science:
- Cardiovascular Physiology
- Medical Imaging
- Pediatric Cardiology
Background:
- Fontan circulation is a unique physiological state characterized by nonpulsatile flow without a pressure-generating ventricle.
- Despite the absence of a ventricle, oscillatory flow waves are present due to pressure changes from the systemic single ventricle.
- Understanding these flow patterns is crucial for assessing single ventricle performance in Fontan patients.
Purpose of the Study:
- To identify discrete flow patterns within the Fontan circuit using principal component analysis (PCA).
- To correlate these identified flow patterns with standard MRI-derived indices of ventricular function, volume, and aortopulmonary collateral flow.
- To elucidate the physiological significance of flow oscillations in Fontan circulation.
Main Methods:
- Phase-contrast MRI was performed on the right pulmonary artery of 97 patients with Fontan circulation to obtain subject-specific flow waveforms.
- Principal Component Analysis (PCA) was applied to the preprocessed flow waveforms to identify dominant patterns of flow variation.
- The principal components (PCs) were correlated with MRI indices including end-diastolic volume, end-systolic volume, cardiac index, ejection fraction, and aortopulmonary collateral flow.
Main Results:
- The first PC, explaining 31.3% of flow variance, distinguished systolic versus diastolic-dominant flow and correlated significantly with ventricular volumes, cardiac index, and collateral flow.
- Diastolic-dominant cavopulmonary flow was associated with lower ventricular volumes and reduced aortopulmonary collateral flow.
- The second PC (19.5% variance) characterized late diastolic acceleration/deceleration and correlated with ejection fraction, with diastolic deceleration linked to higher ejection fraction.
Conclusions:
- Flow variations in the pulmonary arteries of Fontan patients, as identified by PCA, are directly related to single ventricle function and volumes.
- Diastolic-dominant flow, particularly without late acceleration, appears to be indicative of preserved ventricular volume and systolic function.
- This study provides novel insights into the physiological significance of flow dynamics in Fontan circulation, linking specific flow patterns to ventricular health.
