Multiscale modeling of the cardiovascular system: application to the study of pulmonary and coronary perfusions in the univentricular circulation.
The objective of this study is to compare the coronary and pulmonary blood flow dynamics resulting from two configurations of systemic-to-pulmonary artery shunts currently utilized during the Norwood procedure: the central (CS) and modified Blalock Taussig (MBTS) shunts. A lumped parameter model of the neonatal cardiovascular circulation and detailed 3-D models of the shunt based on the finite volume method were constructed. Shunt sizes of 3, 3.5 and 4 mm were considered. A multiscale approach was adopted to prescribe appropriate and realistic boundary conditions for the 3-D models of the Norwood circulation. Results showed that the average shunt flow rate is higher for the CS option than for the MBTS and that pulmonary flow increases with shunt size for both options. Cardiac output is higher for the CS option for all shunt sizes. Flow distribution between the left and the right pulmonary arteries is not completely balanced, although for the CS option the discrepancy is low (50-51% of the pulmonary flow to the right lung) while for the MBTS it is more pronounced with larger shunt sizes (51-54% to the left lung). The CS option favors perfusion to the right lung while the MBTS favors the left. In the CS option, a smaller percentage of aortic flow is distributed to the coronary circulation, while that percentage rises for the MBTS. These findings may have important implications for coronary blood flow and ventricular function.
Laganà
Katia
K
Laboratory of Biological Structure Mechanics, Bioengineering Department, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy.
Balossino
Rossella
R
Migliavacca
Francesco
F
Pennati
Giancarlo
G
Bove
Edward L
EL
de Leval
Marc R
MR
Dubini
Gabriele
G
D001783:Blood Flow Velocity; D001794:Blood Pressure; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D003198:Computer Simulation; D003326:Coronary Circulation; D018610:Heart Bypass, Right / Q000295:instrumentation / Q000379:methods*; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology* / Q000601:surgery*; D008955:Models, Cardiovascular; D011652:Pulmonary Circulation; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome