Annals of Biomedical Engineering

, Volume 38, Issue 7, pp 2302–2313 | Cite as

Computational Hemodynamic Analysis in Congenital Heart Disease: Simulation of the Norwood Procedure

  • Y. QianEmail author
  • J. L. Liu
  • K. Itatani
  • K. Miyaji
  • M. Umezu


Hypoplastic left heart syndrome (HLHS) is a congenital heart disease which should be treated at neonate. Even now, its operation is one of the greatest challenges. However, currently there are no quantitative standards to evaluate and predict the outcome of the therapy. In this study, computational fluid dynamics (CFD) was used to estimate the performance of first stage HLHS surgery, the Norwood operation. An image data transfer system was developed to convert clinical images into three-dimensional geometry. To confirm software applicability, a validation process was carried out to eliminate any influence of numerical procedures. The velocities derived from echocardiography measurements were used as boundary conditions, and pressure waves measured by a cardiac catheter simultaneous with an electrocardiogram (ECG) were employed to validate the results of CFD simulation. Calculated results were congruent with the in vivo measurement results. The blood flow circulations were successfully simulated and the distribution of blood flow in each vessel was estimated. Time-varying energy losses (EL), local pressure and wall shear stress (WSS) were analyzed to estimate clinical treatment. The results indicated that pulsatile simulation is essential in quantitative evaluation. Computational hemodynamics may be applied in the surgical optimization for the treatment of HLHS.


Hypoplastic left heart syndrome Norwood operation Computational fluid dynamics Hemodynamics 



We thank Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) for supporting this research; grant number A09314800.


  1. 1.
    Bargeron, C. B., O. J. Deters, F. F. Mark, and M. H. Friedman. Effect of flow partition on wall shear in a cast of a human coronary artery. Cardiovasc. Res. 22(5):340–344, 1988.CrossRefPubMedGoogle Scholar
  2. 2.
    Bove, E. L., M. R. de Leval, F. Migliavacca, G. Guadagni, and G. Dubini. Computational fluid dynamics in the evaluation of hemodynamics performance of cavopulmonary connections after norwood procedure for hypoplastic left heart syndrome. J. Thorac. Cardiovasc. Surg. 126:1040–1047, 2003.CrossRefPubMedGoogle Scholar
  3. 3.
    Bove, E. L., and T. R. Lloyd. Staged reconstruction for hypoplastic left heart syndrome: Contemporary results. Ann. Surg. 224(3):387–395, 1996.CrossRefPubMedGoogle Scholar
  4. 4.
    de Zelicouet, D. A., K. Pekkan, J. Parks, K. Kanter, M. Fogel, and A. P. Yoganathan. Flow study of an extracardiac connection with persistent left superior vena cava. J. Thorac. Cardiovasc. Surg. 131(4):785–791, 2006.CrossRefGoogle Scholar
  5. 5.
    Fung, Y. C. Biomechanics. Springer-Verlag, 1981.Google Scholar
  6. 6.
    Fung, Y. C. Biomechnics Circulation, Chap 3, 2nd edn. New York: Springer, 1997.Google Scholar
  7. 7.
    Gimbrone, M. A., N. Resnick, T. Nagel, et al. Hemodynamics, endothelial gene expression, and atherogenesis. Ann. NY Acad. Sci. 15:1–10, 1997.CrossRefGoogle Scholar
  8. 8.
    Hart, J. D. Nonparametric Smoothing and Lack-of-Fit Tests, 1st edn. New York: Springer-Verlag, 1997.Google Scholar
  9. 9.
    He, X., and D. N. Ku. Pulsatile flow in the human left coronary artery bifurcation: average conditions. J. Biomech. Eng. 118:74–82, 1996.CrossRefPubMedGoogle Scholar
  10. 10.
    Kilner, P. J., G. Z. Yang, R. H. Mohiaddin, D. N. Firmin, and D. B. Longmore. Helical and retrograde secondary flow patterns in the aortic arch studied by three-dimensional magnetic resonance velocity mapping. Circulation 88:2235–2247, 1993.PubMedGoogle Scholar
  11. 11.
    Ku, D. N. Blood flow in arteries. Annu. Rev. Fluid Mech. 29:399–434, 1997.CrossRefGoogle Scholar
  12. 12.
    Ku, D. N., and D. P. Giddens. Laser Doppler anemometer measurement of pulsatile flow in a model carotid bifurcation. J. Biomech. 20:407–421, 1987.CrossRefPubMedGoogle Scholar
  13. 13.
    Launder, B. E., and B. I. Sharma. Application of the energy dissipation model of turbulence to the calculation of flow near a spinning disc. Lett. Heat Mass Transf. 1:131–138, 1974.CrossRefGoogle Scholar
  14. 14.
    Launder, B. E., and D. B. Spalding. The numerical computation of turbulent flows. Comput. Methods Appl. Mech. Eng. 3:269–289, 1974.CrossRefGoogle Scholar
  15. 15.
    Linderkamp, O., P. Y. K. Wu, and H. J. Meiselman. Deformability of density separated red blood cells in normal newborn infants and adults. Pediatr. Res. 16(11):964–968, 1982.CrossRefPubMedGoogle Scholar
  16. 16.
    Long, J. A., A. Undar, K. B. Manning, and S. Deutsch. Viscoelasticity of pediatric blood and its implications for the testing of a pulsatile pediatric blood pump. Am. Soc. Artif. Int. Org. 563–566, 2005.Google Scholar
  17. 17.
    Mackintosh, T. F., and C. H. M. Walker. Blood viscosity in the newborn. Arch. Dis. Child. 48:547–553, 1973.CrossRefPubMedGoogle Scholar
  18. 18.
    McDonald, D. A. Blood Flow in Arteries. Edward Arnold Ltd., 1974.Google Scholar
  19. 19.
    McGuirk, S. P., M. Griselli, O. F. Stumper, E. M. Rumball, P. Miller, R. Dhillon, J. V. Giovanni, J. G. Wright, et al. Staged surgical management of hypoplastic left heart syndrome: a single institution 12-year experience. Heart 92:364–370, 2005.CrossRefPubMedGoogle Scholar
  20. 20.
    Migliavacca, F., G. Pennati, G. Dubini, R. Fumero, et al. Modeling of the Norwood circulation: effects of shunt size, vascular, resistances and heart rare. Am. J. Physiol. Heart Circ. 280:H2076–H2086, 2001.Google Scholar
  21. 21.
    Nerem, R. M., W. A. Seed, and N. B. Wood. An experimental study of the velocity distribution and transition to turbulence in the aorta. J. Fluid Mech. 52:137–160, 1972.CrossRefGoogle Scholar
  22. 22.
    Prakash, S., and C. R. Ethier. Requirements for mesh resolution in 3D computational hemodynamics. J. Biomech. Eng. 123:134–144, 2001.CrossRefPubMedGoogle Scholar
  23. 23.
    Qian, Y., H. Takao, K. Fukui, M. Umezu, T. Ishibashi, and Y. Murayama. Computational risk parameter analysis and geometric estimation for cerebral aneurysm growth and rupture. Stroke 39:527–729, 2008.CrossRefGoogle Scholar
  24. 24.
    Rodriguez, E., M. Al-Ahmadi, and T. L. Spray. Surgical approach to hyploplastic left heart syndrome Norwood Stage I, Multimedia manual of cardio-thoracic surgery. European Association for Cardio-thoracic Surgery, 2007.Google Scholar
  25. 25.
    Steinke, W., and M. Hennerici. Three-dimensional ultrasound imaging of carotid artery plaques. J. Cardiovasc. Technol. 8:15–22, 1989.Google Scholar
  26. 26.
    Steinman, D. A. Image-based computational fluid dynamics modeling in realistic arterial geometries. Ann. Biomed. Eng. 30:483–497, 2002.CrossRefPubMedGoogle Scholar
  27. 27.
    Steinman, D. A., J. S. Milner, C. J. Norley, S. P. Lownie, and D. W. Holdsworth. Image-based computational simulation of flow dynamics in a giant intracranial aneurysm. Am. Soc. Neuroradiol. 24:559–566, 2003.Google Scholar
  28. 28.
    Tang, T. D. Periodic flow in a bifurcating tube at moderate Reynolds number. PhD dissertation, Georgia Institute of Technology, Atlanta, 1990.Google Scholar
  29. 29.
    Taubin, G. A signal processing approach to fair surface design. Proceedings of the 22nd Annual Conference on Computer Graphics and Interactive Techniques, pp. 351–358, 1995.Google Scholar
  30. 30.
    Whitehead, K. K., K. Pekkan, H. D. Kitajima, S. M. Paridon, A. P. Yoganathan, and M. A. Fogel. Nonlinear power loss during exercise in single-ventricle patients after the Fontan: insights from computational fluid dynamics. Circulation 116:166–171, 2007.CrossRefGoogle Scholar
  31. 31.
    Younis, H. F., M. R. Kaazempur-Mofrad, C. Chung, R. C. Chan, and R. D. Kamm. Computational analysis of the effects of exercise on hemodynamics in the carotid bifurcation. Ann. Biomed. Eng. 31:995–1006, 2003.CrossRefPubMedGoogle Scholar

Copyright information

© Biomedical Engineering Society 2010

Authors and Affiliations

  • Y. Qian
    • 1
    • 4
    Email author
  • J. L. Liu
    • 1
  • K. Itatani
    • 2
    • 3
  • K. Miyaji
    • 2
  • M. Umezu
    • 1
  1. 1.Center for Advanced Biomedical Science, TWInsWaseda UniversityTokyoJapan
  2. 2.School of MedicineKitasato UniversityKanagawaJapan
  3. 3.Graduate School of MedicineThe University of TokyoTokyoJapan
  4. 4.The Australian School of Advanced MedicineMacquarie UniversitySydneyAustralia

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