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Published on: May 11, 2015
A computational pulsatile model of the bidirectional cavopulmonary anastomosis: the influence of pulmonary forward
F Migliavacca1, M R de Leval, G Dubini
1Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, U.K.
Insights
The bidirectional Glenn operation improves pulmonary perfusion for right heart defects. Increased pulsatile flow from the main pulmonary artery significantly impacts hemodynamics, ensuring balanced blood distribution to both lungs post-surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- The bidirectional cavopulmonary anastomosis (BCPA) is a surgical procedure for right heart congenital diseases.
- It diverts superior vena cava blood flow to the lungs, aiming for balanced perfusion and preventing elevated venous pressure.
Purpose of the Study:
- To analyze the influence of pulsatile blood flow from the main pulmonary artery on BCPA hemodynamics.
- Investigate how native pulmonary artery flow affects the outcomes of the surgically reconstructed circulation.
Main Methods:
- Development of a 3D finite element model simulating the BCPA.
- Utilized angiocardiogram and catheterization data for model geometry and hemodynamics.
- Conducted four simulations varying the pulsatile blood flow rate from the main pulmonary artery.
Main Results:
- Hemodynamics within the pulmonary arteries are significantly affected by the flow rate from the native main pulmonary artery.
- Superior vena cava flow facilitates near-equal blood distribution to both lungs.
- A slight preference for left lung perfusion was observed, consistent with clinical findings.
Conclusions:
- Pulsatile flow from the main pulmonary artery is a critical factor influencing BCPA hemodynamics.
- The BCPA effectively manages blood flow distribution, supporting clinical outcomes in patients with congenital heart disease.
Abstract:
The bidirectional cavopulmonary anastomosis (BCPA or bidirectional Glenn) is an operation to treat congenital heart diseases of the right heart by diverting the systemic venous return from the superior vena cava to both lungs. The main goal is to provide the correct perfusion to both lungs avoiding an excessive increase in systemic venous pressure. One of the factors which can affect the clinical outcome of the surgically reconstructed circulation is the amount of pulsatile blood flow coming from the main pulmonary artery. The purpose of this work is to analyse the influence of this factor on the BCPA hemodynamics. A 3-D finite element model of the BCPA has been developed to reproduce the flow of the surgically reconstructed district. Geometry and hemodynamic data have been taken from angiocardiogram and catheterization reports, respectively. On the basis of the developed 3-D model, four simulations have been performed with increasing pulsatile blood flow rate from the main pulmonary artery. The results show that hemodynamics in the pulmonary arteries are greatly influenced by the amount of flow through the native main pulmonary artery and that the flow from the superior vena cava allows to have a similar distribution of the blood to both lungs, with a little predilection for the left side, in agreement with clinical postoperative data.
