title: In vitro flow experiments for determination of optimal geometry of total cavopulmonary connection for surgical repair of children with functional single ventricle.
abstract: OBJECTIVE
  This study sought to evaluate the effect of offsetting cavopulmonary connections at varying pulmonary flow ratios to determine the optimal geometry of the connection.
  
  
  BACKGROUND
  Previous investigators have demonstrated energy conservation within the streamlined contours of the total cavopulmonary connection compared with that of the atriopulmonary connection. However, their surgical design of connecting the two cavae directly opposite each other may result in high energy losses. Others have introduced a unidirectional connection with some advantages but with concerns about the formation of arteriovenous malformation in the lung excluded from hepatic venous return. Thus, an optimal surgical design has not been determined.
  
  
  METHODS
  In the present models, the caval connections were offset through a range of 0.0 to 2.0 diameters by 0.5 superior cava diameter increments. Flow ratios were fixed for superior and inferior cavae and varied for right and left pulmonary arteries as 70:30, 60:40, 50:50, 40:60 and 30:70 to stimulate varying lung resistance. Pressure measurements and flow visualization were done at steady flows of 2, 4 and 6 liters/min to stimulate rest and exercise.
  
  
  RESULTS
  Our data show that the energy losses at the 0.0-diameter offset were double the losses of the 1.0 and 1.5 diameters, which had minimal energy losses. This result was attributable to chaotic patterns seen on flow visualization in the 0.0-diameters offset. Energy savings were more evident at the 50:50 right/left pulmonary artery ratio. Energy losses increased with increased total flow rates.
  
  
  CONCLUSIONS
  The results strongly suggest the incorporation of caval offsets in future total cavopulmonary connections.
authors.affiliation: Children's Heart Center, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Goudy
authors.forename: P
authors.initials: P
authors.lastname: Walker
authors.forename: S
authors.initials: S
authors.lastname: Panchal
authors.forename: A
authors.initials: A
authors.lastname: Ensley
authors.forename: K
authors.initials: K
authors.lastname: Kanter
authors.forename: V
authors.initials: V
authors.lastname: Tam
authors.forename: D
authors.initials: D
authors.lastname: Fyfe
authors.forename: A
authors.initials: A
authors.lastname: Yoganathan
mesh_terms: D002648:Child; D002675:Child, Preschool; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008962:Models, Theoretical; D012039:Regional Blood Flow