Abstract
For children born with single ventricle heart defects, the Fontan procedure (right heart bypass via connection of caval veins to pulmonary arteries) is the palliative procedure of choice. Previous research has demonstrated strong coupling between the geometric characteristics of the surgical construct and the resulting patient-specific hemodynamics, which may relate to the numerous chronic morbidities seen in these patients. The combination of medical imaging, computer graphics and computational fluid simulations has introduced a powerful new paradigm for these procedures: providing the means to model the various options and evaluate the resulting characteristics. This paper details these methodologies, their application to planning interventions, and their contributions to generalizable knowledge of Fontan hemodynamics.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
de Leval MR, Kilner P, Gewillig M, Bull C (1988) Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 96:682–695
de Leval MR, Dubini G, Migliavacca F, Jalali H, Camporini G, Redington A, Pietrabissa R (1996) Use of computational fluid dynamics in the design of surgical procedures: application to the study of competitive flows in cavopulmonary connections. J Thorac Cardiovasc Surg 111:502–513
de Zélicourt DA, Pekkan K, Wills L, Kanter KR, Forbess J, Sharma S, Fogel MA, Yoganathan AP (2005) In vitro flow analysis of a patient-specific intraatrial total cavopulmonary connection. Ann Thorac Surg 79:2094–2102
de Zélicourt DA, Ge L, Wang C, Sotiropoulos F, Gilmanov A, Yoganathan AP (2009) Flow simulations in arbitrarily complex cardiovascular anatomies—an unstructured Cartesian grid approach. Comput & Fluids 38:1749–1762
de Zélicourt DA, Haggerty CM, Sundareswaran KS, Whited BS, Rossignac JR, Kanter KR, Gaynor JW, Spray TL, Sotiropoulos F, Fogel MA, Yoganathan AP (2011) Individualized computer-based surgical planning to address pulmonary arteriovenous malformations in patients with a single ventricle with an interrupted inferior vena cava and azygous continuation. J Thorac Cardiovasc Surg 141:1170–1177
Duncan BW, Desai S (2003) Pulmonary arteriovenous malformations after cavopulmonary anastomosis. Ann Thorac Surg 76:1759–1766
Fogel MA, Weinberg PM, Chin AJ, Fellows KE, Hoffman EA (1996) Late ventricular geometry and performance changes of functional single ventricle throughout staged Fontan reconstruction assessed by magnetic resonance imaging. J Am Coll Cardiol 28:212–221
Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248
Frakes DH, Conrad CP, Healy TM, Monaco JW, Fogel MA, Sharma S, Smith MJ, Yoganathan AP (2003) Application of an adaptive control grid interpolation technique to morphological vascular reconstruction. IEEE Trans Biomed Eng 50:197–206
Frakes DH, Smith MJ, Parks WJ, Sharma S, Fogel MA, Yoganathan AP (2005) New techniques for the reconstruction of complex vascular anatomies from MRI images. J Cardiovasc Magn Reson 7:425–432
Gersony DR, Gersony WM (2003) Management of the postoperative Fontan patient. Prog Ped Cardiol 17:73–79
Gilmanov A, Sotiropoulos F (2005) A hybrid Cartesian/immersed boundary method for simulating flows with 3D, geometrically complex, moving bodies. J Comput Phys 207:457–492
Kim HJ, Vignon-Clementel IE, Figueroa CA, LaDisa JF, Jansen KE, Feinstein JA, Taylor CA (2009) On coupling a lumped parameter heart model and a three-dimensional finite element aorta model. Ann Biomed Eng 37:2153–2169
Laganà K, Balossino R, Migliavacca F, Pennati G, Bove EL, de Leval MR, Dubini G (2005) Multiscale modeling of the cardiovascular system: application to the study of pulmonary and coronary perfusions in the univentricular circulation. J Biomech 38:1129–1141
Mair DD, Puga FJ, Danielson GK (2001) The Fontan procedure for tricuspid atresia: early and late results of a 25-year experience with 216 patients. J Am Coll Cardiol 37:933–939
Markl M, Geiger J, Kilner PJ, Foll D, Stiller B, Beyersdorf F, Arnold R, Frydrychowicz A (2011) Time-resolved three-dimensional magnetic resonance velocity mapping of cardiovascular flow paths in volunteers and patients with Fontan circulation. Eur J Cardiothorac Surg 39:206–212
Migliavacca F, Dubini G, Bove E, de Leval MR (2003) Computational fluid dynamics simulations in realistic 3-D geometries of the total cavopulmonary anastomosis: the influence of the inferior caval anastomosis. J Biomech Eng 125:803–813
Migliavacca F, Balossino R, Pennati G, Dubini G, Hsia TY, de Leval MR, Bove E (2006) Multiscale modelling in biofluidynamics: application to reconstructive paediatric cardiac surgery. J Biomech 39:1010–1020
Pekkan K, Whited B, Kanter KR, Sharma S, de Zélicourt DA, Sundareswaran KS, Frakes DH, Rossignac J, Yoganathan AP (2008) Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM). Med Biol Eng Comput 46:1139–1152
Pennati G, Corsini C, Cosentino D, Hsia TY, Luisi VS, Dubini G, Migliavacca F (2011) Boundary conditions of patient-specific fluid dynamics modelling of cavopulmonary connections: possible adaptation of pulmonary resistances is a critical issue for virtual surgical planning. Interface Focus 1:297–307
Sharma S, Goudy S, Walker P, Panchal S, Ensley A, Kanter KR, Tam V, Fyfe D, Yoganathan AP (1996) In vitro flow experiments for determination of optimal geometry of total cavopulmonary connection for surgical repair of children with functional single ventricle. J Am Coll Cardiol 27:1264–1269
Sundareswaran KS, de Zélicourt DA, Sharma S, Kanter KR, Spray TL, Rossignac J, Sotiropoulos F, Fogel MA, Yoganathan AP (2009a) Correction of pulmonary arteriovenous malformation using image-based surgical planning. JACC Cardiovasc Imaging 2:1024–1030
Sundareswaran KS, Frakes DH, Fogel MA, Soerensen D, Oshinski JN, Yoganathan AP (2009b) Optimum fuzzy filters for phase-contrast magnetic resonance imaging segmentation. J Magn Reson Imaging 29:155–165
Sundareswaran KS, Haggerty CM, de Zélicourt DA, Dasi LP, Pekkan K, Frakes DH, Powell AJ, Kanter KR, Fogel MA, Yoganathan AP (2012) Visualization of flow structures in Fontan patients using three-dimensional phase contrast magnetic resonance imaging. J Thorac Cardiovasc Surg 143:1108–1116
Acknowledgements
This work was supported by the National Heart, Lung, and Blood Institute through Grants HL67622 and HL098252, and through American Heart Association Pre-Doctoral Fellowships.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media Dordrecht
About this paper
Cite this paper
Haggerty, C.M. et al. (2013). Patient-Specific Surgery Planning for the Fontan Procedure. In: Holzapfel, G., Kuhl, E. (eds) Computer Models in Biomechanics. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5464-5_16
Download citation
DOI: https://doi.org/10.1007/978-94-007-5464-5_16
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-5463-8
Online ISBN: 978-94-007-5464-5
eBook Packages: EngineeringEngineering (R0)