Premium
A numerical model of neonatal pulmonary atresia with intact ventricular septum and RV‐dependent coronary flow
Author(s) -
Mynard J. P.,
Davidson M. R.,
Penny D. J.,
Smolich J. J.
Publication year - 2010
Publication title -
international journal for numerical methods in biomedical engineering
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.741
H-Index - 63
eISSN - 2040-7947
pISSN - 2040-7939
DOI - 10.1002/cnm.1384
Subject(s) - cardiology , pulmonary atresia , medicine , stenosis , atresia , fistula , pulmonary artery , artery , right coronary artery , blood flow , coronary circulation , context (archaeology) , hemodynamics , surgery , myocardial infarction , coronary angiography , paleontology , biology
Abstract We developed a numerical model of the neonatal arterial and coronary circulations in the context of pulmonary atresia with intact ventricular septum (PAIVS). PAIVS is a congenital heart defect characterized by a blocked pulmonary valve orifice and elevated right ventricular (RV) pressure, and is often associated with an abnormal connection (fistula) between the RV cavity and a coronary artery (e.g. the left anterior descending artery, LAD). A proximal coronary stenosis is also common and can result in RV‐dependent coronary flow, where decompression of the RV by surgical repair of the atresia leads to compromised coronary flow (ischaemia). Using a combined one‐dimensional and lumped parameter model, we simulated PAIVS to investigate the effects of an RV‐LAD fistula, LAD stenosis and RV decompression on coronary haemodynamics. We also simulated coronary collaterals, which develop in response to inadequate blood flow, and found that these may provide little protection against ischaemia in the setting of PAIVS with RV‐LAD fistula and LAD stenosis if collateral flow is preferentially directed to the low‐resistance fistula. While the focus of this study was PAIVS, the techniques presented may be applied to a variety of complex congenital heart defects that include abnormal vascular connections and unusual coronary anatomy. Copyright © 2010 John Wiley & Sons, Ltd.