Assisted Fontan procedure: animal and in vitro models and computational fluid dynamics study

作者：Corno Antonio F^*; Vergara Christian; Subramanian Chellappan; Johnson Robert A; Passerini Tiziano; Veneziani Alessandro; Formaggia Luca; Alphonso Nelson; Quarteroni Alfio; Jarvis Jonathan C

来源：Interactive Cardiovascular and Thoracic Surgery, 2010, 10(5): 679-683.

DOI：10.1510/icvts.2009.223024

• Animal model
• Computational fluid dynamics
• Fontan operation
• Latissimus dorsi muscle
• Mathematical model
• Pulmonary vascular resistance

Fontan connection with intermittent compression by wrapped latissimus dorsi (LD) was tested in vivo, in vitro and by means of computational fluid dynamics (CFD). Experimental study: LD was conditioned in four pigs for three weeks before Fontan connection by valved conduit wrapped with LD. Mock circuit: Inflatable cuff wrapped around valved conduit provided intermittent external compression, with pressure and flow measured at driving pressure of 8 or 16 mmHg. CFD study: A circuit was tested for possible increase above basal flow (4 l/min) with intermittent external compression. Experimental study: Intermittent conduit compression by LD provided mean 7% decrease of baseline PA pressure, with simultaneous flow increase of 2%. Mock circuit: By raising the driving pressure from 8 to 16 mmHg, the flow increased with baseline PVR (56%) and with elevated PVR (80%). Total pulmonary flow was reduced during intermittent external compression with both baseline and elevated PVR. CFD study: Compression with 13.0 mmHg provided 4.9% increase of total pulmonary flow with substantial increase of the peak flow (92%). In vivo and in vitro, the increased flow produced by compressing a conduit was confounded by the inevitable intermittent flow restriction. Mathematical model using lower pressure for intermittent external compression showed potential for increase in pulmonary flow.

• 出版日期2010-5