Multiphysiologic State Computational Fluid Dynamics Modeling for Planning Fontan With Interrupted Inferior Vena Cava

Area of Science:

• Congenital Heart Surgery
• Pediatric Cardiology
• Medical Imaging and Simulation

Background:

• Single ventricle (SV) physiology with interrupted inferior vena cava (iIVC) poses risks for unbalanced hepatic venous flow (HVF) distribution post-Fontan surgery.
• This imbalance can lead to the development of pulmonary arteriovenous malformations (AVMs), a serious complication.

Purpose of the Study:

• To employ computational fluid dynamics (CFD) analysis to optimize HVF distribution to the lungs in SV patients with iIVC.
• To prevent maldistribution of HVF and reduce the incidence of AVMs following Fontan completion or revision.

Main Methods:

• A 3D modeling workflow integrating segmented imaging (MRI/CT) was used for four SV patients with iIVC.
• Virtual surgical planning and CFD simulations were performed across various physiological states.
• CFD analysis guided the evaluation of operative strategies to achieve balanced HVF to both lungs.

Main Results:

• Pre-operative CFD analysis predicted significant HVF maldistribution (100% to one lung) with standard Fontan completion.
• Alternative surgical strategies, informed by CFD, achieved a balanced HVF distribution (average 37%/63% ±10.4% to right/left lungs).
• CFD predictions were validated against post-operative MRI measurements, confirming the accuracy of the simulation.

Conclusions:

• A 3D modeling and CFD simulation workflow is effective in managing HVF maldistribution in SV patients with iIVC.
• This approach can potentially prevent the development of AVMs after Fontan surgery, improving patient outcomes.