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Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions

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Abstract

The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.

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Abbreviations

AZ:

Azygous

CFD:

Computational fluid dynamics

CHD:

Congenital heart defect

CMR:

Cardiac magnetic resonance

ECC:

Extracardiac conduit

HFD:

Hepatic flow distribution

IVC:

Inferior vena cava

LPA:

Left pulmonary artery

LPN:

Lumped parameter network

LSVC:

Left superior vena cava

PAVM:

Pulmonary arteriovenous malformation

PCMRI:

Phase-contrast magnetic resonance imaging

RPA:

Right pulmonary artery

SSFP:

Steady-state free precession

SVC:

Superior vena cava

TCPC:

Total cavopulmonary connections

VENC:

Velocity encoding

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Funding

This work was funded by the NHLBI Grants HL67622 and HL098252 as well as an American Heart Association Predoctoral fellowship 17PRE33630117.

Author information

Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA

    Phillip M. Trusty, Zhenglun Alan Wei & Ajit P. Yoganathan

  2. Department of Pediatrics, Division of Cardiology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

    Timothy C. Slesnick

  3. School of Life Science, Fudan University, Shanghai, China

    Zhenglun Alan Wei

  4. School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA

    Jarek Rossignac

  5. Division of Cardiothoracic Surgery, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

    Kirk R. Kanter

  6. Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Mark A. Fogel

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  1. Phillip M. Trusty
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  2. Timothy C. Slesnick
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  3. Zhenglun Alan Wei
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  7. Ajit P. Yoganathan
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Corresponding author

Correspondence to Ajit P. Yoganathan.

Ethics declarations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. No animal studies were carried out by any of the authors for this article.

Conflict of Interest

Phillip Trusty, Timothy Slesnick, Alan Wei, Jarek Rossignac, Kirk Kanter, and Ajit Yoganathan declare that they have no conflict of interest. Mark Fogel received a research grant.

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Associate Editor Jeffrey W. Holmes oversaw the review of this article

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Trusty, P.M., Slesnick, T.C., Wei, Z.A. et al. Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions. J. of Cardiovasc. Trans. Res. 11, 133–144 (2018). https://doi.org/10.1007/s12265-018-9786-0

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