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Impact of Collateral Vessels on Fontan Circulation: 0- to 1-Dimensional Fontan Circulation Model and Concept of

Koichi Sughimoto1, Toru Miki1, Ruichen Li1

  • 1Graduate School of Engineering, Chiba University, Japan.

Annals of Thoracic Surgery Short Reports
|October 30, 2025
PubMed

Insights

This study models Fontan circulation with collaterals, finding vasodilators may improve oxygenation, while dobutamine has limited effects. Further validation is needed for clinical application in Fontan patients.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Physiology
  • Medical Modeling

Background:

  • Single ventricle physiology often necessitates the Fontan operation.
  • Long-term Fontan outcomes are compromised by collateral vessels (APCs, VVCs), leading to cyanosis and heart failure.
  • The hemodynamic impact of collaterals on Fontan circulation requires theoretical clarification.

Purpose of the Study:

  • To investigate the effects of dobutamine and vasodilators on Fontan circulation.
  • To analyze the influence of aortopulmonary collaterals (APCs) and venovenous collaterals (VVCs) on hemodynamics.
  • To theoretically explain the impact of collaterals on Fontan patient outcomes.

Main Methods:

  • Developed a computational Fontan hemodynamic model incorporating VVCs and APCs.
  • Simulated scenarios by adjusting dobutamine dosage and oxygen delivery/consumption.
  • Evaluated cardiac function using cardiac output, arterial elastance, ejection fraction, and stroke work to pressure-volume ratio.

Main Results:

  • Fontan circulations with collaterals exhibited lower arterial and venous oxygen saturations (92%, 54%) compared to those without (96%, 62%).
  • Poor tissue perfusion was indicated by decreased arterial elastance and increased stroke work to pressure-volume ratio.
  • Dobutamine (10 μg/kg/min) improved venous oxygen but decreased arterial oxygen in the presence of collaterals.

Conclusions:

  • Pulmonary vasodilators may enhance oxygenation and perfusion in Fontan patients with collaterals, aligning with clinical observations.
  • Dobutamine demonstrates limited efficacy in improving oxygenation in this model.
  • Model validation with actual patient data is crucial for enhanced accuracy and clinical relevance.
Abstract

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