HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kirk Kanter Mark Fogel Ajit P. Yoganathan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Zélicourt, D. A. Articles by Yoganathan, A. P. Search for Related Content PubMed PubMed Citation Articles by de Zélicourt, D. A. Articles by Yoganathan, A. P. Related Collections Cardiac - other Congenital - acyanotic

J Thorac Cardiovasc Surg 2006;131:785-791
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Flow study of an extracardiac connection with persistent left superior vena cava

^a Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
^b Pediatric Cardiology, Emory University, Atlanta, Ga
^c Department of Surgery, Emory University, Atlanta, Ga
^d Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa

Received for publication August 25, 2005; revisions received October 17, 2005; accepted for publication November 8, 2005.

^_* Address for reprints: Ajit P. Yoganathan, PhD, Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology & Emory University, Room 2119, U. A. Whitaker Building, 313 Ferst Dr, Atlanta, GA 30332-0535 (Email: ajit.yoganathan{at}bme.gatech.edu).

BACKGROUND: Numerous studies have sought to optimize the design of total cavopulmonary connections with a single superior vena cava. This study was directed to the 2% to 4.5% of the population with dual superior venae cavae, investigating the flow fields associated with such total cavopulmonary connection anatomies. Additionally, it demonstrates the potential use of computational designs and simulations as surgical planning tools.

METHODS: A 3-dimensional model of a total cavopulmonary connection with bilateral superior venae cavae was reconstructed from a patient's magnetic resonance images and investigated experimentally and numerically to assess the power losses and flow structures within the connection. On the basis of these results, a virtual operation was performed in the computer to improve the original connection design. The modified anatomy was studied numerically.

RESULTS: Because of a smooth connection with an extracardiac conduit and no major dimension mismatch between the baffle and the connecting vessels, the original anatomy yielded smooth flow fields, low power losses, and few disturbances. However, a large offset between the inferior vena cava and the left superior vena cava resulted in flow stasis and unbalanced hepatic flow distribution. Shifting the inferior vena cava and positioning it between the 2 superior venae cavae resulted in a 7% decrease in power losses and eliminated the associated flow stasis regions in the main pulmonary artery segment.

CONCLUSIONS: This study demonstrates the potential use of computer-aided design and numeric simulations for surgical planning. It shows that locating the inferior vena cava between the superior venae cavae may lead to better-balanced lung perfusion. This may require suturing the right and left superior venae cavae closer to each other during the hemi-Fontan or Glenn stage.

This article has been cited by other articles:

				Y. Nakamura, T. Yagihara, K. Kagisaki, I. Hagino, and J. Kobayashi Pulmonary arteriovenous malformations after a Fontan operation in the left isomerism and absent inferior vena cava Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 69 - 76. [Abstract] [Full Text] [PDF]

				K. S. Sundareswaran, K. Pekkan, L. P. Dasi, K. Whitehead, S. Sharma, K. R. Kanter, M. A. Fogel, and A. P. Yoganathan The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise Am J Physiol Heart Circ Physiol, December 1, 2008; 295(6): H2427 - H2435. [Abstract] [Full Text] [PDF]

				K. K. Whitehead, K. Pekkan, H. D. Kitajima, S. M. Paridon, A. P. Yoganathan, and M. A. Fogel Nonlinear Power Loss During Exercise in Single-Ventricle Patients After the Fontan: Insights From Computational Fluid Dynamics Circulation, September 11, 2007; 116(11_suppl): I-165 - I-171. [Abstract] [Full Text] [PDF]

				D. D. Soerensen, K. Pekkan, D. de Zelicourt, S. Sharma, K. Kanter, M. Fogel, and A. P. Yoganathan Introduction of a New Optimized Total Cavopulmonary Connection Ann. Thorac. Surg., June 1, 2007; 83(6): 2182 - 2190. [Abstract] [Full Text] [PDF]