Impact of Free-Breathing Phase-Contrast MRI on Decision-Making in Fontan Surgical Planning

  • Zhenglun Alan Wei
  • Phillip M. Trusty
  • Yingnan Zhang
  • Elaine Tang
  • Kevin K. Whitehead
  • Mark A. Fogel
  • Ajit P. YoganathanEmail author
Original Article


Fontan surgical planning ranks proposed surgical options according to their hemodynamics assessed by computational fluid dynamic (CFD) modeling. CFD commonly utilizes blood flow acquired under breath-holding (BH) conditions. Ignoring the free-breathing (FB) effect on blood flow waveforms may impact the ranking of surgical options. This study investigates such a potential impact by including ten Fontan patients who had blood flow acquisitions under both BH and FB conditions. A virtual surgery platform was used to generate two surgical options for each patient: (1) a traditional Fontan conduit and (2) a Y-graft. These options were ranked based on clinically relevant hemodynamic metrics: power loss (PL) and hepatic flow distribution (HFD). No difference was found in the ranking of options between using FB and BH flow acquisitions. The findings indicated that decision-making is not affected by the types of flow acquisition for Fontan surgical planning.


Fontan surgical planning Computational fluid dynamics Phase-contrast MRI 





Computational fluid dynamics




Hepatic flow distribution


Inferior vena cava


Left pulmonary artery


Magnetic resonance


Pulmonary arteriovenous malformation


Phase-contrast magnetic resonance imaging


Power loss


Right pulmonary artery


Real-time phase-contrast magnetic resonance imaging


Superior vena cava



The authors acknowledge the use of ANSYS software, which was provided through an Academic Partnership between ANSYS, Inc. and the Cardiovascular Fluid Mechanics Lab at the Georgia Tech.

Funding Information

This study was supported by the National Heart, Lung, and Blood Institute Grants HL067622 and HL098252.

Compliance with Ethical Standards

Human Subjects/Informed Consent Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients and all study protocols complied with the Institutional Review Boards of the participating institutions: Georgia Institute of Technology and Children’s Hospital of Philadelphia (IRB Number H05236, Understanding/Improving Fontan Flow Dynamics II).

Conflict of Interest

The authors declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Zhenglun Alan Wei
    • 1
  • Phillip M. Trusty
    • 1
  • Yingnan Zhang
    • 1
  • Elaine Tang
    • 2
  • Kevin K. Whitehead
    • 3
  • Mark A. Fogel
    • 3
  • Ajit P. Yoganathan
    • 1
    Email author
  1. 1.Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology & Emory UniversityAtlantaUSA
  2. 2.School of Chemical and Biomolecular EngineeringGeorgia Institute of TechnologyAtlantaUSA
  3. 3.Division of CardiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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