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Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions

  • Phillip M. Trusty
  • Timothy C. Slesnick
  • Zhenglun Alan Wei
  • Jarek Rossignac
  • Kirk R. Kanter
  • Mark A. Fogel
  • Ajit P. Yoganathan
Review

Abstract

The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.

Keywords

Fontan Patient specific Surgical planning Pre-operative planning Hepatic flow distribution 

Abbreviations

AZ

Azygous

CFD

Computational fluid dynamics

CHD

Congenital heart defect

CMR

Cardiac magnetic resonance

ECC

Extracardiac conduit

HFD

Hepatic flow distribution

IVC

Inferior vena cava

LPA

Left pulmonary artery

LPN

Lumped parameter network

LSVC

Left superior vena cava

PAVM

Pulmonary arteriovenous malformation

PCMRI

Phase-contrast magnetic resonance imaging

RPA

Right pulmonary artery

SSFP

Steady-state free precession

SVC

Superior vena cava

TCPC

Total cavopulmonary connections

VENC

Velocity encoding

Notes

Funding

This work was funded by the NHLBI Grants HL67622 and HL098252 as well as an American Heart Association Predoctoral fellowship 17PRE33630117.

Compliance with Ethical Standards

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. Informed consent was obtained from all patients for being included in the study. No animal studies were carried out by any of the authors for this article.

Conflict of Interest

Phillip Trusty, Timothy Slesnick, Alan Wei, Jarek Rossignac, Kirk Kanter, and Ajit Yoganathan declare that they have no conflict of interest. Mark Fogel received a research grant.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Phillip M. Trusty
    • 1
  • Timothy C. Slesnick
    • 2
  • Zhenglun Alan Wei
    • 1
    • 3
  • Jarek Rossignac
    • 4
  • Kirk R. Kanter
    • 5
  • Mark A. Fogel
    • 6
  • Ajit P. Yoganathan
    • 1
  1. 1.Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaUSA
  2. 2.Department of Pediatrics, Division of Cardiology, Children’s Healthcare of AtlantaEmory University School of MedicineAtlantaUSA
  3. 3.School of Life ScienceFudan UniversityShanghaiChina
  4. 4.School of Interactive ComputingGeorgia Institute of TechnologyAtlantaUSA
  5. 5.Division of Cardiothoracic Surgery, Children’s Healthcare of AtlantaEmory University School of MedicineAtlantaUSA
  6. 6.Division of CardiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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