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Predicting Hemodynamic Performance of Fontan Operation for Glenn Physiology using Computational Fluid Dynamics: Ten
Elahe Javadi1, Sebastian Laudenschlager2, Vitaly Kheyfets3
1Mechanical and Industrial Engineering Department, Northeastern University, Boston, MA, USA.
Insights
Computational fluid dynamics (CFD) modeling accurately predicted blood flow in single-ventricle children undergoing Fontan operations. The Y-graft design showed improved hemodynamic performance, reducing power loss and enhancing hepatic flow distribution compared to the T-shape graft.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Computational Fluid Dynamics
Background:
- Single ventricle heart disease necessitates complex, multi-stage surgical palliation.
- The Fontan operation, the final stage, connects the inferior vena cava to the pulmonary arteries, bypassing the ventricle.
- Optimizing Fontan outcomes requires reducing complications like pulmonary arteriovenous malformations (PAVMs) and the need for revisions.
Purpose of the Study:
- To develop and validate a computational fluid dynamics (CFD) model for predicting Fontan operation hemodynamics.
- To compare the hemodynamic performance of two Fontan graft designs: T-shape and Y-graft.
- To assess the impact of graft design on power loss (PL) and hepatic flow distribution (HFD), key factors in PAVM development.
Main Methods:
- A CFD model was developed using data from ten pediatric patients with single-ventricle physiology and Glenn procedure.
- CFD-estimated blood flow to the pulmonary arteries was validated against cardiovascular magnetic resonance (CMR) measurements.
- In silico Fontan operations with T-shape and Y-graft conduits were simulated to predict post-surgical PL and HFD.
Main Results:
- CFD model predictions demonstrated excellent agreement with CMR measurements for pulmonary artery blood flow (ICC=0.98).
- The Y-graft conduit resulted in significantly lower power loss compared to the T-shape graft (P≤0.001).
- Hepatic flow distribution was significantly better balanced with the Y-graft compared to the T-shape graft (P=0.004).
Conclusions:
- Validated CFD models can accurately predict hemodynamic performance in Fontan operations.
- The Y-graft design offers superior hemodynamic advantages over the T-shape graft for Fontan palliation.
- These findings support the use of CFD modeling in optimizing Fontan surgical planning and graft selection.
Abstract:
Single ventricle hearts have only one ventricle that can pump blood effectively and the treatment requires three stages of operations to reconfigure the heart and circulatory system. At the second stage, Glenn procedure is performed to connect superior vena cava (SVC) to the pulmonary arteries (PA). For the third and most complex operation, called Fontan, an extracardiac conduit is used to connect inferior vena cava (IVC) to the PL and thereafter no deoxygenated blood goes to the heart. Predicting Hemodynamic Performance of Fontan Operation using computational fluid dynamics (CFD) is hypothesized to improve outcomes and optimize this treatment planning in children with single-ventricle heart disease. An important reason for this surgical planning is to reduce the development of pulmonary arteriovenous malformations (PAVM) and the need to perform Fontan revisions. The purpose of this study was to develop amodel for Fontan surgical planning and use this model to compare blood circulation in two designed graft types of Fontan operation known as T-shape and Y-graft. The functionality of grafts was compared in terms of power loss (PL) and hepatic flow distribution (HFD), a known factor in PAVM development. To perform this study, ten single-ventricle children with Glenn physiology were included and a CFD model was developed to estimate the blood flow circulation to the left and right pulmonary arteries. The estimated blood flow by CFD was compared with that measured by cardiovascular magnetic resonance. Results showed that there was an excellent agreement between the net blood flow in the right and left pulmonary arteries computed by CFD and CMR (ICC= 0.98, P-value ≥0.21). After validating the accuracy of each CFD model, Fontan operations using T-shape and Y-graft conduits were performed in silico for each patient and the developed CFD model was used to predict the post-surgical PL and HFD. We found that the PL in the Y-graft was significantly lower than in the T-shape (P-value ≤0.001) and HFD was significantly better balanced in Y-graft compared to the T-shape (P-value=0.004).
