Abstract
For complex congenital heart disease (CHD) involving a single functioning ventricle, the Fontan operation is performed which results in a circulation where deoxygenated venous blood passively flows into the pulmonary arteries without a ventricular pump. However, conventional Fontan graft designs may result in suboptimal cardiovascular hemodynamics leading to post-surgical complications. Patient-specific designs are thus promising in the Fontan operation. This paper reports the virtual simulation and designs of patient-specific Fontan grafts with the aid of computational fluid dynamics (CFD). CFD parameters including meshing, wall layers, and solver choices were studied to bolster accuracy while minimizing computational time. CFD simulations of original Fontan design were performed to evaluate three hemodynamic parameters: indexed power loss (iPL), hepatic flow distribution (HFD), and percentage of the non-physiological wall shear stress (%WSS, a novel surrogate marker for clot risk). New designs were then created to target these parameters with iterative optimization technique. This overall approach was utilized to redesign the Fontan grafts of patients (n = 2). The re-designed Fontan grafts showed significant improvements in all three hemodynamic parameters when compared to the original designs. Our unique integration of surgical design and flow simulation has the potential to enable cardiac surgeons to effectively simulate patient specific designs for the Fontan operation, potentially improving the surgical outcomes of patients with complex CHD.
This work is supported by the National Institutes of Health under award numbers R01HL143468 and R21HD090671. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.
The authors acknowledge the University of Maryland supercomputing resources (http://hpcc.umd.edu) made available for conducting the research reported in this paper.
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Kim, B. et al. (2019). Virtual Cardiac Surgical Planning Through Hemodynamics Simulation and Design Optimization of Fontan Grafts. In: Shen, D., et al. Medical Image Computing and Computer Assisted Intervention – MICCAI 2019. MICCAI 2019. Lecture Notes in Computer Science(), vol 11768. Springer, Cham. https://doi.org/10.1007/978-3-030-32254-0_23
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DOI: https://doi.org/10.1007/978-3-030-32254-0_23
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