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Computational modeling of Fontan physiology: at the crossroads of pediatric cardiology and biomedical engineering

Abstract

The Fontan operation has evolved over the last four and a half decades and is now widely applied to patients with various forms of “single ventricle” congenital heart disease. Survival has greatly improved since the early years, but long-term morbidity and mortality continue to occur. Modeling of Fontan geometries, both in vitro and using computational fluid dynamics, has been instrumental in designing novel changes to Fontan’s operation, including the application of staged surgical procedures leading to a total cavopulmonary anastomosis, lateral tunnel, extracardiac conduit, and most recently bifurcated Y-graft modifications. In this review, the history of modeling of Fontan physiologies, current state-of-the-art methodologies, and future directions are explored. The application of these techniques to cardiac magnetic resonance imaging to construct patient specific anatomies offers the possibility of individualized surgical planning to optimize hemodynamics, including minimizing power loss, balancing hepatic factor distribution, and ultimately improving patient outcomes.

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Correspondence to Timothy C. Slesnick.

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Supplementary material 7 (MP4 362 kb)

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Slesnick, T.C., Yoganathan, A.P. Computational modeling of Fontan physiology: at the crossroads of pediatric cardiology and biomedical engineering. Int J Cardiovasc Imaging 30, 1073–1084 (2014). https://doi.org/10.1007/s10554-014-0442-8

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Keywords

  • Congenital heart disease
  • Single ventricle
  • Fontan
  • Computational modeling