Hepatic blood flow distribution and performance in conventional and novel Y-graft Fontan geometries: A case series computational fluid dynamics study.

Abstract : OBJECTIVES: A novel Y-shaped baffle has been proposed for the Fontan operation with promising initial results. However, previous studies have relied either on idealized models or a single patient-specific model. The objective of this study is to comprehensively compare the hemodynamic performance and hepatic blood flow distribution of the Y-graft Fontan baffle with 2 current designs using multiple patient-specific models. METHODS: Y-shaped and tube-shaped grafts were virtually implanted into 5 patient-specific Glenn models forming 3 types of Fontan geometries: Y-graft, T-junction, and offset. Unsteady flow simulations were performed at rest and at varying exercise conditions. The hepatic flow distribution between the right and left lungs was carefully quantified using a particle tracking method. Other physiologically relevant parameters such as energy dissipation, superior vena cava pressure, and wall shear stress were evaluated. RESULTS: The Fontan geometry significantly influences the hepatic flow distribution. The Y-graft design improves the hepatic flow distribution effectively in 4 of 5 patients, whereas the T-junction and offset designs may skew as much as 97% of hepatic flow to 1 lung in 2 cases. Sensitivity studies show that changes in pulmonary flow split can affect the hepatic flow distribution dramatically but that some Y-graft and T-junction designs are relatively less sensitive than offset designs. The Y-graft design offers moderate improvements over the traditional designs in power loss and superior vena cava pressure in all patients. CONCLUSIONS: The Y-graft Fontan design achieves overall superior hemodynamic performance compared with traditional designs. However, the results emphasize that no one-size-fits-all solution is available that will universally benefit all patients and that designs should be customized for individual patients before clinical application.
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Journal of Thoracic and Cardiovascular Surgery, Elsevier, 2012, 143 (5), pp.1086-1097. 〈10.1016/j.jtcvs.2011.06.042〉
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Contributeur : Irene Vignon-Clementel <>
Soumis le : vendredi 9 décembre 2011 - 10:58:04
Dernière modification le : mardi 17 avril 2018 - 11:32:56

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Weiguang Yang, Irene Vignon-Clementel, Guillaume Troianowski, V Mohan Reddy, Jeffrey Feinstein, et al.. Hepatic blood flow distribution and performance in conventional and novel Y-graft Fontan geometries: A case series computational fluid dynamics study.. Journal of Thoracic and Cardiovascular Surgery, Elsevier, 2012, 143 (5), pp.1086-1097. 〈10.1016/j.jtcvs.2011.06.042〉. 〈hal-00649953〉

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