title: A new multiparameter approach to computational simulation for Fontan assessment and redesign.
abstract: BACKGROUND
  Despite an abundance of prior Fontan simulation articles, there have been relatively few clinical advances that are a direct result of computational methods. We address a few key limitations of previous Fontan simulations as a step towards increasing clinical relevance. Previous simulations have been limited in scope because they have primarily focused on a single energy loss parameter. We present a multi-parameter approach to Fontan modeling that establishes a platform for clinical decision making and comprehensive evaluation of proposed interventions.
  
  
  METHODS
  Time-dependent, 3-D blood flow simulations were performed on six patient-specific Fontan models. Key modeling advances include detailed pulmonary anatomy, catheterization-derived pressures, and MRI-derived flow with respiration. The following performance parameters were used to rank patients at rest and simulated exercise from best to worst performing: energy efficiency, inferior and superior vena cava (IVC, SVC) pressures, wall shear stress, and IVC flow distribution.
  
  
  RESULTS
  Simulated pressures were well matched to catheterization data, but low Fontan pressure did not correlate with high efficiency. Efficiency varied from 74% to 96% at rest, and from 63% to 91% with exercise. Distribution of IVC flow ranged from 88%/12% (LPA/RPA) to 53%/47%. A "transcatheter" virtual intervention demonstrates the utility of computation in evaluating interventional strategies, and is shown to result in increased energy efficiency.
  
  
  CONCLUSIONS
  A multiparameter approach demonstrates that each parameter results in a different ranking of Fontan performance. Ranking patients using energy efficiency does not correlate with the ranking using other parameters of presumed clinical importance. As such, current simulation methods that evaluate energy dissipation alone are not sufficient for a comprehensive evaluation of new Fontan designs.
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California, San Diego, CA 92093-0411, USA. amarsden@ucsd.edu
authors.forename: Alison L
authors.initials: AL
authors.lastname: Marsden
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Shadden
authors.forename: Frandics P
authors.initials: FP
authors.lastname: Chan
authors.forename: Charles A
authors.initials: CA
authors.lastname: Taylor
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Feinstein
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D015444:Exercise; D005260:Female; D018729:Fontan Procedure / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008955:Models, Cardiovascular; D011651:Pulmonary Artery; D012119:Respiration; D014057:Tomography, X-Ray Computed; D014684:Venae Cavae / Q000473:pathology; D055815:Young Adult