title: Geometric characterization of patient-specific total cavopulmonary connections and its relationship to hemodynamics.
abstract: Total cavopulmonary connection (TCPC) geometries have great variability. Geometric features, such as diameter, connection angle, and distance between vessels, are hypothesized to affect the energetics and flow dynamics within the connection. This study aimed to identify important geometric characteristics that can influence TCPC hemodynamics. Anatomies from 108 consecutive patients were reconstructed from cardiac magnetic resonance (CMR) images and analyzed for their geometric features. Vessel flow rates were computed from phase contrast CMR. Computational fluid dynamics simulations were carried out to quantify the indexed power loss and hepatic flow distribution. TCPC indexed power loss correlated inversely with minimum Fontan pathway (FP), left pulmonary artery, and right pulmonary artery diameters. Cardiac index correlated with minimum FP diameter and superior vena cava (SVC) minimum/maximum diameter ratio. Hepatic flow distribution correlated with caval offset, pulmonary flow distribution, and the angle between FP and SVC. These correlations can have important implications for future connection design and patient follow-up.
authors: School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia.
authors: Elaine
authors: E
authors: Tang
authors: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
authors: Maria
authors: M
authors: Restrepo
authors: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
authors: Christopher M
authors: CM
authors: Haggerty
authors: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
authors: Lucia
authors: L
authors: Mirabella
authors: Westat, Rockville, Maryland.
authors: James
authors: J
authors: Bethel
authors: Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Kevin K
authors: KK
authors: Whitehead
authors: Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Mark A
authors: MA
authors: Fogel
authors: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia. Electronic address: ajit.yoganathan@bme.gatech.edu.
authors: Ajit P
authors: AP
authors: Yoganathan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008102:Liver Circulation; D008279:Magnetic Resonance Imaging; D008297:Male; D008955:Models, Cardiovascular; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014683:Vena Cava, Superior / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
keywords: Fontan procedure; congenital heart defects; hemodynamics