title: Partial cavopulmonary assist from the inferior vena cava to the pulmonary artery improves hemodynamics in failing Fontan circulation: a theoretical analysis.
abstract: Cavopulmonary assist (CPA) for failing Fontan patients remains a challenging issue in the clinical setting. To evaluate the effectiveness of a partial CPA from the inferior vena cava (IVC) to the pulmonary artery (PA), we performed a theoretical analysis using a computational model of the Fontan circulation. Cardiac chambers and vascular systems were described as the time-varying elastance model and the modified three-element Windkessel model, respectively. A rotational pump described as a non-linear function was inserted between the IVC and the PA. When pulmonary vascular resistance index varied from 2.1 to 5.9 Wood units m(2), the partial CPA maintained cardiac index as efficiently as total CPA and markedly reduced the IVC pressure compared with total CPA. However, the partial CPA increased the superior vena cava pressure substantially. The modification from total to partial CPA is potentially an effective alternative in failing Fontan patients suffering from high IVC pressure.
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. shujismz@ri.ncvc.go.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kawada
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Une
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukumitsu
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Michael James
authors.initials: MJ
authors.lastname: Turner
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kamiya
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shishido
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Sugimachi
mesh_terms: D018729:Fontan Procedure / Q000009:adverse effects; D006321:Heart / Q000503:physiopathology; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008955:Models, Cardiovascular; D011651:Pulmonary Artery / Q000503:physiopathology*; D014682:Vena Cava, Inferior / Q000503:physiopathology*
keywords: Assist device; Cavopulmonary assist; Computational model; Fontan circulation; Inferior vena cava; Pulmonary vascular resistance