title: Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study.
abstract: The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patient-specific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.
authors: Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China; fuyouliang@sjtu.edu.cn.
authors: Fuyou
authors: F
authors: Liang
authors: Department of Pediatrics and Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan;
authors: Hideaki
authors: H
authors: Senzaki
authors: Department of Pediatrics and Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan;
authors: Clara
authors: C
authors: Kurishima
authors: Department of Cardiac Surgery, Royal Children's Hospital, Parkville, Victoria, Australia;
authors: Koichi
authors: K
authors: Sughimoto
authors: Pediatrics, University Hospital University of Tokyo, Tokyo, Japan; and.
authors: Ryo
authors: R
authors: Inuzuka
authors: Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China; Graduate School of Engineering, Chiba University, Inage, Chiba, Japan.
authors: Hao
authors: H
authors: Liu
mesh_terms: D003326:Coronary Circulation; D018729:Fontan Procedure; D006439:Hemodynamics; D006801:Humans; D008955:Models, Cardiovascular
keywords: Fontan circulation; cardiac output; cardiovascular properties; central venous pressure; computational model