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Computational Investigation of a Self-Powered Fontan Circulation

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Abstract

Children born with anatomic or functional “single ventricle” must progress through two or more major operations to sustain life. This management sequence culminates in the total cavopulmonary connection, or “Fontan” operation. A consequence of the “Fontan circulation”, however, is elevated central venous pressure and inadequate ventricular preload, which contribute to continued morbidity. We propose a solution to these problems by increasing pulmonary blood flow using an “injection jet” (IJS) in which the source of blood flow and energy is the ventricle itself. The IJS has the unique property of lowering venous pressure while enhancing pulmonary blood flow and ventricular preload. We report preliminary results of an analysis of this circulation using a tightly-coupled, multi-scale computational fluid dynamics model. Our calculations show that, constraining the excess volume load to the ventricle at 50% (pulmonary to systemic flow ratio of 1.5), an optimally configured IJS can lower venous pressure by 3 mmHg while increasing systemic oxygen delivery. Even this small decrease in venous pressure may have substantial clinical impact on the Fontan patient. These findings support the potential for a straightforward surgical modification to decrease venous pressure, and perhaps improve clinical outcome in selected patients.

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Abbreviations

CFD:

Computational fluid dynamics

CHD:

Congenital heart disease

IJS:

Injection jet shunt

IVC:

Inferior vena cava

LPM:

Lumped parameter model

NES:

No entrainment shunt

PVR:

Pulmonary vascular resistance

RPA:

Right pulmonary artery

SVC:

Superior vena cava

TCPC:

Total cavopulmonary connection

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Authors and Affiliations

  1. Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, 32816, USA

    Marcus W. Ni, Ray O. Prather, Giovanna Rodriguez & Alain J. Kassab

  2. College of Medicine, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, USA

    Rachel Quinn & William M. DeCampli

  3. Department of Mechanical Engineering, Embry-Riddle Aeronautical University, 600 S Clyde Morris Blvd, Daytona Beach, FL, USA

    Eduardo Divo

  4. The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA

    Mark Fogel

  5. Division of Cardiology/Department of Pediatrics and the Department of Radiology, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA

    Mark Fogel

  6. Arnold Palmer Hospital for Children, 92 W Miller St, Orlando, FL, USA

    William M. DeCampli

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  1. Marcus W. Ni
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  7. Alain J. Kassab
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  8. William M. DeCampli
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Corresponding author

Correspondence to Marcus W. Ni.

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Funding

This study was funded by an Innovative Grant award from the American Heart Association (AHA 5IRG22470015).

Conflict of interest

Marcus Ni declares that he has no conflict of interest. Ray Prather declares that he has no conflict of interest. Giovanna Rodriguez declares that she has no conflict of interest. Rachel Quinn declares that she has no conflict of interest. Eduardo Divo declares that he has no conflict of interest. Mark Fogel declares that he has no conflict of interest. Alain Kassab declares that he has no conflict of interest. William DeCampli declares that he has no conflict of interest.

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This study does not contain any studies with human participants or animals performed by the authors.

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Associate Editors Alison Marsden and Ajit P. Yoganathan oversaw the review of this article.

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Ni, M.W., Prather, R.O., Rodriguez, G. et al. Computational Investigation of a Self-Powered Fontan Circulation. Cardiovasc Eng Tech 9, 202–216 (2018). https://doi.org/10.1007/s13239-018-0342-5

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