Interactive pre-surgical design of optimal extra-cardiac Fontan connections starting with cardiac MRI reconstructions of the Glenn anastomosis
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KeywordsVascular Model Lateral Tunnel Average Pressure Gradient Increase Energy Loss Caval Flow
Pre-surgical planning for Fontan procedures involves time-consuming patient-specific vascular segmentation and non-intuitive virtual surgical modeling which has encumbered utility in the clinic by surgeons. We present an interactive platform to design virtual surgical options and visualize pericardial enlargement strategy for Fontan connections, starting with patient-specific vascular templates.
The ideal tested EC connection anastomosis was offset toward the RPA (see Figure 1B,C) and resulted in a favorable 58% LPA flow split, as opposed to an equitable (~50:50, unfavorable) outflow split between LPA & RPA in the LT case which is known to correlate with increased energy loss due to collision of caval inflow streams. Figures 1D & E compare the inflow / outflow waveforms and the LPA outflow split % in the ideal EC case, with the original LT and the virtual Glenn model. The ideal EC connection had a 38% lower average pressure gradient between IVC and PAs, compared with the original LT connection.
We demonstrate the feasibility of a novel virtual surgery tool to retrospectively create and hemodynamically evaluate a range of feasible patient-specific EC Fontan connections starting with a virtual Glenn anatomosis model. This presented methodology may be applied to prospective surgical planning starting with pre-Fontan CMR imaging of the Glenn anatomosis.
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