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COMPUTATIONAL INVESTIGATION OF PATIENT-SPECIFIC SELF-POWERED FONTAN CIRCULATIONS

Marcus W. Ni
Department of Mechanical Engineering, Embry-Riddle Aeronautical University, 600 S Clyde Morris Blvd, Daytona Beach, Florida, USA

Ray Prather
Arnold Palmer Hospital for Children

Kyle Beggs
Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, Florida, USA

Giovanna Rodriguez
Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, Florida, USA

Rachel Quinn
College of Medicine, University of Central Florida, 4000 Central Florida Blvd, Orlando, Florida, USA

Eduardo Divo
Department of Mechanical Engineering, Embry-Riddle Aeronautical University, 600 S Clyde Morris Blvd, Daytona Beach, Florida, USA

Mark Fogel
The Perelman School of Medicine at The University of Pennsylvania and The Children's Hospital of Philadelphia, Division of Cardiology/Department of Pediatrics and the Department of Radiology, 3401 Civic Center Blvd, Philadelphia, Pennsylvania, USA

Alain J. Kassab
Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, Florida, USA

William M. DeCampli
The Heart Center at Arnold Palmer Hospital for Children, 92 W Miller St, Orlando, Florida, USA; College of Medicine, University of Central Florida, 4000 Central Florida Blvd, Orlando, Florida, USA

DOI: 10.1615/TFEC2018.bio.024756
pages 1087-1101


KEY WORDS: CFD, Cardiovascular, Fontan

Abstract

Children born with anatomic or functional "single ventricle" must progress through two or more major operations to sustain life. This management sequence culminates in the total cavopulmonary connection (TCPC), or "Fontan" operation. A consequence of the "Fontan circulation", however, is elevated central venous pressure and inadequate ventricular preload, which contribute to continued morbidity[1][2][3][4]. We propose a solution to these problems by increasing pulmonary blood flow using an "injection jet shunt" (IJS) in which the source of blood flow and energy is the ventricle itself. The IJS has the unique property of lowering venous pressure while enhancing pulmonary blood flow and ventricular preload. We report preliminary results of an analysis of this circulation using a tightly-coupled, multi-scale, patient-specific, computational fluid dynamics model. Two patient-specific models (10 and 24-year-old) were developed using de-identified MRI data provided by Children's Hospital of Philadelphia. Our calculations show that, constraining the excess volume load to the ventricle at 50% (pulmonary to systemic flow ratio of 1.5), an optimally configured IJS can lower venous pressure while increasing systemic oxygen delivery for these 2 patient-specific models. The IJS in these patient-specific models proved to be less efficient then the IJS results reported in our previous results for a synthetic model of a 2-year-old Fontan[5][6]. These findings suggest that the cardiac output, and geometry of a specific patient will greatly affect the efficiency of IJS configurations.

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