title: Haemodynamic impact of stent implantation for lateral tunnel Fontan stenosis: a patient-specific computational assessment.
abstract: BACKGROUND
  The physiological importance of the lateral tunnel stenosis in the Fontan pathway for children with single ventricle physiology can be difficult to determine. The impact of the stenosis and stent implantation on total cavopulmonary connection resistance has not been characterized, and there are no clear guidelines for intervention. Methods and results A computational framework for haemodynamic assessment of stent implantation in patients with lateral tunnel stenosis was developed. Cardiac magnetic resonances images were reconstructed to obtain total cavopulmonary connection anatomies before stent implantation. Stents with 2-mm diameter increments were virtually implanted in each patient to understand the impact of stent diameter. Numerical simulations were performed in all geometries with patient-specific flow rates. Exercise conditions were simulated by doubling and tripling the lateral tunnel flow rate. The resulting total cavopulmonary connection vascular resistances were computed. A total of six patients (age: 14.4 ± 3.1 years) with lateral tunnel stenosis were included for preliminary analysis. The mean baseline resistance was 1.54 ± 1.08 WU · m(2) and dependent on the stenosis diameter. It was further exacerbated during exercise. It was observed that utilising a stent with a larger diameter lowered the resistance, but the resistance reduction diminished at larger diameters.
  
  
  CONCLUSIONS
  Using a computational framework to assess the severity of lateral tunnel stenosis and the haemodynamic impact of stent implantation, it was observed that stenosis in the lateral tunnel pathway was associated with higher total cavopulmonary connection resistance than unobstructed pathways, which was exacerbated during exercise. Stent implantation could reduce the resistance, but the improvement was specific to the minimum diameter.
authors.affiliation: 1School of Chemical and Biomolecular Engineering,Georgia Institute of Technology,Atlanta,GA,United States of America.
authors.forename: Elaine
authors.initials: E
authors.lastname: Tang
authors.affiliation: 2Department of Cardiology,Boston Children's Hospital,Harvard Medical School,Boston,MA,United States of America.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: 3The Wallace H. Coulter Department of Biomedical Engineering,Georgia Institute of Technology & Emory University,Atlanta,Georgia,United States of America.
authors.forename: Maria
authors.initials: M
authors.lastname: Restrepo
authors.affiliation: 2Department of Cardiology,Boston Children's Hospital,Harvard Medical School,Boston,MA,United States of America.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Valente
authors.affiliation: 3The Wallace H. Coulter Department of Biomedical Engineering,Georgia Institute of Technology & Emory University,Atlanta,Georgia,United States of America.
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Yoganathan
mesh_terms: D000293:Adolescent; D002648:Child; D003251:Constriction, Pathologic; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D066230:Patient-Specific Modeling; D011183:Postoperative Complications / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult
keywords: Congenital heart disease; Fontan procedure; computational modelling; magnetic resonance imaging