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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00196

PHYSIOLOGICAL FONTAN PROCEDURE

 Antonio F. Corno1, 2*, Matt J. Owen3,  Andrea Cangiani4, Edward J. Hall4 and Aldo Rona3
  • 1Pediatric Cardiac Surgery, University of Leicester, United Kingdom
  • 2University Hospitals of Leicester NHS Trust, United Kingdom
  • 3University of Leicester, United Kingdom
  • 4University of Nottingham, United Kingdom

Objective: The conventional Fontan circulation deviates the superior vena cava (SVC=1/3 of the systemic venous return) towards the right lung (3/5 of total lung volume) and the inferior vena cava (IVC=2/3 of the systemic venous return) towards the left lung (2/5 of total lung volume). A “physiological” Fontan deviating the SVC towards the left lung and the IVC towards the right lung was compared with the conventional setting by computational fluid dynamics, studying if this setting achieves a more favorable hemodynamic than the conventional Fontan circulation.
Materials and Methods: An in-silico 3D parametric model of the Fontan procedure was developed using idealized vascular geometries with invariant sizes of SVC, IVC, right pulmonary artery (RPA), and left pulmonary artery (LPA), steady inflow velocities at IVC and SVC, and constant equal outflow pressures at RPA and LPA. These parameters were set to perform finite-volume incompressible steady flow simulations, assuming a single-phase, Newtonian, isothermal, laminar blood flow. Numerically converged finite-volume mass and momentum flow balances determined the inlet pressures and the outflow rates. Closed-path numerical integration of energy fluxes across domain boundaries determined the flow energy loss through the Fontan circulation. The comparison evaluated: 1) mean IVC pressure; 2) energy loss rate; 3) kinetic energy maximum value throughout the domain volume.
Results: The comparison of the physiological versus conventional Fontan provided these results: 1) mean IVC pressure 13.9mmHg versus 14.1mmHg (= 0.2mmHg reduction); 2) energy loss rate 5.55mW versus 6.61mW (= 16% reduction); 3) kinetic energy 283J/m3 versus 396J/m3 (= 29% reduction).
Conclusions: A more physiological flow distribution is accompanied by a reduction of mean IVC pressure and by substantial reductions of energy loss rate, and peak kinetic energy. The potential clinical impact of these hemodynamic changes in reducing the incidence and severity of the adverse long-term effects of the Fontan circulation, in particular liver failure and protein-losing enteropathy, still remains to be assessed and will be the subject of future work.

Keywords: congenital heart defects, congenital heart surgery, Fontan Procedure, flow modeling, computational fluid dynamics

Received: 04 Mar 2019; Accepted: 29 Apr 2019.

Edited by:

Giovanni Biglino, University of Bristol, United Kingdom

Reviewed by:

Alejandro J. Lopez-Magallon, Children’s National Health System, United States
Gianluca Trocchio, Istituto Giannina Gaslini (IRCCS), Italy  

Copyright: © 2019 Corno, Owen, Cangiani, Hall and Rona. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Antonio F. Corno, University of Leicester, Pediatric Cardiac Surgery, Leicester, United Kingdom, tonycorno2@gmail.com