Numerical simulation of a self-powered Fontan based on venturi effect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Fang ¹ , WEN Chen ¹ , SHI Guocheng ¹ , ZHANG Qian ¹ , LIU Jinlong ¹ , ZHANG Hang ² , ZHU Zhongqun ¹ ,  CHEN Huiwen ¹

1. Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, P.R.China;
2. Department of Cardiothoracic Surgery, Puer People’s Hospital, Puer, 665000, Yunnan, P.R.China;

Corresponding author：

CHEN Huiwen, Email: chenhuiwen@scmc.com.cn

Keywords：

Computational fluid dynamics; venturi effect; Fontan procedure

DOI：

10.7507/1007-4848.201812051

Video：

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Objective To investigate the effects of a self-powered conduit in different patients’ models who underwent extracardiac Fontan procedure.Methods Four children who underwent extracardiac Fontan procedure in Shanghai Children's Medical Center from 2011 to 2017 year were selected. Venae cavae and pulmonary arteries were reconstructed using Mimics 19.0®. In silico, a venturi conduit was introduced to the anastomosis of venae cavae and pulmonary artery. Then computational fluid dynamics simulation was performed using patients’ clinical data.Results When inferior venae cavae were directly to or to the left of superior venae cavae, the venturi conduit could assist the return of venous blood and reduce the pressures of venae cavae about 0.5 mm Hg. And the pressure differences between venae cavae and pulmonary arteries were about –0.7 mm Hg, which suggested that the conduit could generate right ventricle-like effect.Conclusion The venturi conduit can reduce the pressure of venae cavae, increase pulmonary circulation flow and improve Fontan hemodynamics.

Citation： ZHU Fang, WEN Chen, SHI Guocheng, ZHANG Qian, LIU Jinlong, ZHANG Hang, ZHU Zhongqun, CHEN Huiwen. Numerical simulation of a self-powered Fontan based on venturi effect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(9): 895-898. doi: 10.7507/1007-4848.201812051 Copy

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2.	Pundi KN, Johnson JN, Dearani JA, et al. 40-year follow-up after the fontan operation: long-term outcomes of 1,052 patients. J Am Coll Cardiol, 2015, 66(15): 1700-1710.
3.	d’Udekem Y, Iyengar AJ, Galati JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation, 2014, 130(11 Suppl 1): S32-S38.
4.	Dennis M, Zannino D, du Plessis K, et al. Clinical outcomes in adolescents and adults after the Fontan procedure. J Am Coll Cardiol, 2018, 71(9): 1009-1017.
5.	Rijnberg FM, Hazekamp MG, Wentzel JJ, et al. Energetics of blood flow in cardiovascular disease: concept and clinical implications of adverse energetics in patients with a Fontan circulation. Circulation, 2018, 137(22): 2393-2407.
6.	Pozrikidis C. Fluid dynamics: theory, computation, and numerical simulation. 2nd ed. London: Springer, 2009.
7.	Granger RA. Fluid mechanics. Dover, ed. New York: Dover Publications, 1995.
8.	Zikanov O. Essential computational fluid dynamics. Hoboken, New Jersey: Wiley, 2010.
9.	米杰, 王天有, 孟玲慧, 等. 中国儿童青少年血压参照标准的研究制定. 中国循证儿科杂志, 2010, 5(1): 4-14.
10.	Gewillig M, Brown SC. The Fontan circulation after 45 years: update in physiology. Heart, 2016, 102(14): 1081-1086.
11.	Chen H, Hong H, Zhu Z, et al. Extracardiac Fontan with direct cavopulmonary connections: midterm results. Eur J Cardiothorac Surg, 2013, 43(2): 318-323.
12.	Slesnick TC, Yoganathan AP. Computational modeling of Fontan physiology: at the crossroads of pediatric cardiology and biomedical engineering. Int J Cardiovasc Imaging, 2014, 30(6): 1073-1084.
13.	Marsden AL, Bernstein AJ, Reddy VM, et al. Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics. J Thorac Cardiovasc Surg, 2009, 137(2): 394-403.
14.	Restrepo M, Crouch AC, Haggerty CM, et al. Hemodynamic impact of superior vena cava placement in the Y-graft Fontan connection. Ann Thorac Surg, 2016, 101(1): 183-189.
15.	Esmaily-Moghadam M, Hsia TY, Marsden AL, et al. The assisted bidirectional Glenn: a novel surgical approach for first-stage single-ventricle heart palliation. J Thorac Cardiovasc Surg, 2015, 149(3): 699-705.
16.	Ni MW, Prather RO, Rodriguez G, et al. Computational investigation of a self-powered Fontan circulation. Cardiovasc Eng Technol, 2018, 9(2): 202-216.

1. de Leval MR, Deanfield JE. Four decades of Fontan palliation. Nat Rev Cardiol, 2010, 7(9): 520-527.
2. Pundi KN, Johnson JN, Dearani JA, et al. 40-year follow-up after the fontan operation: long-term outcomes of 1,052 patients. J Am Coll Cardiol, 2015, 66(15): 1700-1710.
3. d’Udekem Y, Iyengar AJ, Galati JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation, 2014, 130(11 Suppl 1): S32-S38.
4. Dennis M, Zannino D, du Plessis K, et al. Clinical outcomes in adolescents and adults after the Fontan procedure. J Am Coll Cardiol, 2018, 71(9): 1009-1017.
5. Rijnberg FM, Hazekamp MG, Wentzel JJ, et al. Energetics of blood flow in cardiovascular disease: concept and clinical implications of adverse energetics in patients with a Fontan circulation. Circulation, 2018, 137(22): 2393-2407.
6. Pozrikidis C. Fluid dynamics: theory, computation, and numerical simulation. 2nd ed. London: Springer, 2009.
7. Granger RA. Fluid mechanics. Dover, ed. New York: Dover Publications, 1995.
8. Zikanov O. Essential computational fluid dynamics. Hoboken, New Jersey: Wiley, 2010.
9. 米杰, 王天有, 孟玲慧, 等. 中国儿童青少年血压参照标准的研究制定. 中国循证儿科杂志, 2010, 5(1): 4-14.
10. Gewillig M, Brown SC. The Fontan circulation after 45 years: update in physiology. Heart, 2016, 102(14): 1081-1086.
11. Chen H, Hong H, Zhu Z, et al. Extracardiac Fontan with direct cavopulmonary connections: midterm results. Eur J Cardiothorac Surg, 2013, 43(2): 318-323.
12. Slesnick TC, Yoganathan AP. Computational modeling of Fontan physiology: at the crossroads of pediatric cardiology and biomedical engineering. Int J Cardiovasc Imaging, 2014, 30(6): 1073-1084.
13. Marsden AL, Bernstein AJ, Reddy VM, et al. Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics. J Thorac Cardiovasc Surg, 2009, 137(2): 394-403.
14. Restrepo M, Crouch AC, Haggerty CM, et al. Hemodynamic impact of superior vena cava placement in the Y-graft Fontan connection. Ann Thorac Surg, 2016, 101(1): 183-189.
15. Esmaily-Moghadam M, Hsia TY, Marsden AL, et al. The assisted bidirectional Glenn: a novel surgical approach for first-stage single-ventricle heart palliation. J Thorac Cardiovasc Surg, 2015, 149(3): 699-705.
16. Ni MW, Prather RO, Rodriguez G, et al. Computational investigation of a self-powered Fontan circulation. Cardiovasc Eng Technol, 2018, 9(2): 202-216.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Numerical simulation of a self-powered Fontan based on venturi effect

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