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Presurgical Evaluation of F ontan Connection Options for Patients With Apicocaval Juxtaposition Using Computational Fluid Dynamics
Author(s) -
Me Prahlad G.,
Yoshida Masahiro,
Pekkan Kerem
Publication year - 2013
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2012.01555.x
Subject(s) - electrical conduit , ventricle , apex (geometry) , connection (principal bundle) , anastomosis , medicine , cardiology , inferior vena cava , pulmonary artery , anatomy , surgery , geometry , computer science , telecommunications , mathematics
Apicocaval juxtaposition ( ACJ ) is a rare congenital heart defect associated with single ventricle physiology where optimal positioning of the F ontan conduit for completion of total cavopulmonary connection ( TCPC ) is still controversial. In ACJ , the cardiac apex is ipsilateral with the inferior vena cava ( IVC ), risking kinking and collapse of the F ontan conduit at the apex of the heart. The purpose of this study is to evaluate two viable routes for F ontan conduit connection in patients with ACJ , using computational fluid dynamics. Internal energy loss evaluations were used to determine contribution of conduit curvature to the energy efficiency of each cavopulmonary anastomosis configuration. This percentage of energy loss contribution was found to be greater in the case of a curved extracardiac conduit connection (44%, 4.1 m W ) traveling behind the ventricular apex, connecting the IVC to the left pulmonary artery, than the straighter lateral tunnel conduit (6%, 1.4 m W ) installed through the ventricular apex. In contrast, net energy loss across the anastomosis was significantly lower with extracardiac TCPC (9.3 mW) in comparison with lateral tunnel TCPC (23.2 m W ), highlighting that a curved F ontan conduit is favorable provided that it is traded off for a superior cavopulmonary connection efficiency. Therefore, a relatively longer and curved F ontan conduit has been demonstrated to be a suitable connection option independent of anatomical situations.