Numerical Investigation of the Effect of Additional Pulmonary Blood Flow on Patient-Specific Bilateral Bidirectional Glenn Hemodynamics
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The effect of additional pulmonary blood flow (APBF) on the hemodynamics of bilateral bidirectional Glenn (BBDG) connection was marginally discussed in previous studies. This study assessed this effect using patient-specific numerical simulation. A 15-year-old female patient who underwent BBDG was enrolled in this study. Patient-specific anatomy, flow waveforms, and pressure tracings were obtained using computed tomography, Doppler ultrasound technology, and catheterization, respectively. Computational fluid dynamic simulations were performed to assess flow field and derived hemodynamic metrics of the BBDG connection with various APBF. APBF showed noticeable effects on the hemodynamics of the BBDG connection. It suppressed flow mixing in the connection, which resulted in a more antegrade flow structure. Also, as the APBF rate increases, both power loss and reflux in superior venae cavae (SVCs) monotonically increases while the flow ratio of the right to the left pulmonary artery (RPA/LPA) monotonically decreases. However, a non-monotonic relationship was observed between the APBF rate and indexed power loss. A high APBF rate may result in a good flow ratio of RPA/LPA but with the side effect of bad power loss and remarkable reflux in SVCs, and vice versa. A moderate APBF rate could be favourable because it leads to an optimal indexed power loss and achieves the acceptable flow ratio of RPA/LPA without causing severe power loss and reflux in SVCs. These findings suggest that patient-specific numerical simulation should be used to assist clinicians in determining an appropriate APBF rate based on desired outcomes on a patient-specific basis.
KeywordsComputational fluid dynamics Single ventricle defects Glenn procedure Additional pulmonary blood flow
We are grateful to Xudong Liu and Jialiang Chen for technical support in performing the study. We heartily appreciate the selfless exertion and precious suggestions from my teachers and collègues.
Conflict of interest
All authors declare that they have no conflict of interest.
This study was funded by National Key Basic Research Program of China (Grant Number 2013CB945403).
This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Bove, E. L., M. R. de Leval, F. Migliavacca, G. Guadagni, and G. Dubini. Computational fluid dynamics in the evaluation of hemodynamic performance of cavopulmonary connections after the norwood procedure for hypoplastic left heart syndrome. unfiled. J. Thorac. Cardiovasc. Surg. 126:1040–1047, 2003.CrossRefGoogle Scholar
- 8.de Leval, M. R., G. Dubini, F. Migliavacca, H. Jalali, G. Camporini, A. Redington, and R. Pietrabissa. Use of computational fluid dynamics in the design of surgical procedures: application to the study of competitive flows in cavo-pulmonary connections. J. Thorac. Cardiovasc. Surg. 111:502–513, 1996.CrossRefGoogle Scholar
- 9.de Zélicourt, D. A., C. M. Haggerty, K. S. Sundareswaran, et al. Individualized computer-based surgical planning to address pulmonary arteriovenous malformations in patients with a single ventricle with an interrupted inferior vena cava and azygous continuation. J. Thorac. Cardiovasc. Surg. 141:1170–1177, 2011.CrossRefGoogle Scholar
- 10.Dubini, G., F. Migliavacca, G. Pennati, Leval M. R. De, and E. L. Bove. Ten years of modelling to achieve haemodynamic optimisation of the Total Cavopulmonary Connection. Biorheology 14:48–52, 2004.Google Scholar
- 18.Honjo, O., K. C. D. Tran, Z. Hua, P. Sapra, A. A. Alghamdi, J. L. Russell, C. A. Caldarone, and G. S. Van Arsdell. Impact of evolving strategy on clinical outcomes and central pulmonary artery growth in patients with bilateral superior vena cava undergoing a bilateral bidirectional cavopulmonary shunt. J. Thorac. Cardiovasc. Surg. 140:528.e1, 2010.CrossRefGoogle Scholar
- 27.Mirabella, L., C. M. Haggerty, T. Passerini, M. Piccinelli, A. J. Powell, P. J. Del Nido, A. Veneziani, and A. P. Yoganathan. Treatment planning for a TCPC test case: a numerical investigation under rigid and moving wall assumptions. Int J Numer Method Biomed Eng 29:197–216, 2013.MathSciNetCrossRefGoogle Scholar
- 28.Orlando, W., R. Shandas, and C. Degroff. Efficiency differences in computational simulations of the total cavo-pulmonary circulation with and without compliant vessel walls. Work 1:220–227, 2006.Google Scholar
- 30.Pekkan, K., B. Whited, K. Kanter, S. Sharma, D. De Zelicourt, K. Sundareswaran, D. Frakes, J. Rossignac, and A. P. Yoganathan. Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM). Medical Biol Eng Comput 46(11):1139–1152, 2008.CrossRefGoogle Scholar
- 33.Physiol, A. J., H. Circ, F. March, et al. Blood flow conditions in the proximal pulmonary arteries and vena cavae: healthy children during upright cycling exercise Blood flow conditions in the proximal pulmonary arteries and vena cavae: healthy children during upright cycling exercise. Am. J. Physiol. 2011. https://doi.org/10.1152/ajpheart.00022.2004.Google Scholar
- 35.Qian, Y., J. F. L. Liu, and J. F. L. Liu. Hemodynamic simulation for surgical treatment of congenital heart disease. Annu Int Conf IEEE EMBS 2012:661–664, 2012.Google Scholar
- 44.Xu, Y., Y. Liu, X. Lü, Y. Li, and C. Yu. Bilateral bidirectional superior cavopulmonary shunt is more beneficial in medium and long term clinical outcomes than unilateral shunt. Chin. Med. J. (Engl) 122:129–135, 2009.Google Scholar
- 45.Yamada, K., X. Roques, N. Elia, M. N. Laborde, M. Jimenez, A. Choussat, and E. Baudet. The short- and mid-term results of bidirectional cavopulmonary shunt with additional source of pulmonary blood flow as definitive palliation for the functional single ventricular heart. unfiled. Eur. J. Cardiothorac. Surg. 18:683–689, 2000.CrossRefGoogle Scholar