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Updated: Jun 29, 2025

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Impact of Age-Related Change in Caval Flow Ratio on Hepatic Flow Distribution in the Fontan Circulation

Vijay Govindarajan1,2,3, Lauren Marshall1, Akshita Sahni1

  • 1Departments of Cardiovascular Surgery (V.G., L.M., A.S., M.A.C., E.E.E., J.D., N.S.C., N.E.S., D.M.H., P.E.H., S.J.G., A.P., P.J.d.N.), Boston Children's Hospital, MA.

Circulation. Cardiovascular Imaging
|April 3, 2024
PubMed

Insights

The Fontan operation

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomedical Engineering

Background:

  • The Fontan operation is a palliative surgical procedure for single ventricle heart defects.
  • Achieving balanced hepatic flow distribution (HFD) is crucial for preventing complications like cyanosis.
  • HFD is influenced by local hemodynamics, which can change with age.

Purpose of the Study:

  • To evaluate how age-related changes in superior vena cava (SVC) and inferior vena cava (IVC) inflows affect HFD in Fontan patients.
  • To analyze the impact of different Fontan connection types (extracardiac vs. lateral tunnel) on HFD over time.

Main Methods:

  • Collected SVC and IVC flow data from 414 Fontan patients to correlate SVC:IVC flow ratio with age.
  • Utilized patient-specific computational fluid dynamics (CFD) modeling in 60 patients (30 extracardiac, 30 lateral tunnel) at ages 3, 8, and 15 years.
  • Quantified HFD and its relationship with varying SVC:IVC flow ratios.

Main Results:

  • The SVC:IVC flow ratio inverted around age 8, indicating a shift towards lower body flow predominance.
  • HFD variation due to age-related inflow changes was not significant in extracardiac but was significant in lateral tunnel cohorts.
  • A positive correlation between IVC flow distribution and HFD was observed, though its strength decreased with age (SVC:IVC ratio from 2 to 0.5).

Conclusions:

  • Age-related changes in caval inflows significantly impact long-term HFD in Fontan patients, particularly those with lateral tunnel connections.
  • Understanding SVC:IVC ratio variations over time is vital for managing Fontan hemodynamics and improving patient outcomes.
  • This study offers quantitative insights into Fontan physiology, aiding clinical decision-making and future research.
Abstract

Keywords:
cyanosisheart diseases, congenitalhemodynamicshepatic veinspulmonary artery

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