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Numerical Investigation of the Effect of Additional Pulmonary Blood Flow on Patient-Specific Bilateral Bidirectional Glenn Hemodynamics

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Abstract

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.

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Acknowledgments

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.

Funding

This study was funded by National Key Basic Research Program of China (Grant Number 2013CB945403).

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Mechanics and Engineering Science, Fudan University, No. 220, Handan Road, Shanghai, China

    Biao Si & Guanghong Ding

  2. Institute of Cardiovascular Disease, General Hospital of Jinan Military Region, Jinan, China

    Biao Si, Bin Qiao, Meng Zhu, Fengyu Zhao, Tongjian Wang & Na Li

  3. Institute of Computational Science and Cardiovascular Disease, Nanjing Medical University, Nanjing, China

    Biao Si & Bin Qiao

  4. Wuxi Mingci Cardiovascular Hospital, Wuxi, China

    Guang Yang

  5. Shandong Medical Imaging Research Institute, Shandong University, Jinan, China

    Xiaopeng Ji

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  1. Biao Si
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  2. Bin Qiao
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  3. Guang Yang
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Correspondence to Guanghong Ding.

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Associate Editor Mark Fogel and Ajit P. Yoganathan oversaw the review of this article.

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Si, B., Qiao, B., Yang, G. et al. Numerical Investigation of the Effect of Additional Pulmonary Blood Flow on Patient-Specific Bilateral Bidirectional Glenn Hemodynamics. Cardiovasc Eng Tech 9, 193–201 (2018). https://doi.org/10.1007/s13239-018-0341-6

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