A numerical model of neonatal pulmonary atresia with intact ventricular septum and RV-dependent coronary flow

作者：Mynard J P^*; Davidson M R; Penny D J; Smolich J J

来源：International Journal for Numerical Methods in Biomedical Engineering, 2010, 26(7): 843-861.

DOI：10.1002/cnm.1384

• congenital heart disease
• pulmonary atresia
• collateral flow
• one-dimensional modelling

We developed a numerical model of the neonatal arterial and coronary circulations in the context of pulmonary atresia with intact ventricular septum (PAIVS). PAIVS is a congenital heart defect characterized by a blocked pulmonary valve orifice and elevated right ventricular (RV) pressure, and is often associated with an abnormal connection (fistula) between the RV cavity and a coronary artery (e.g. the left anterior descending artery, LAD). A proximal coronary stenosis is also common and can result in RV-dependent coronary flow, where decompression of the RV by surgical repair of the atresia leads to compromised coronary flow (ischaemia). Using a combined one-dimensional and lumped parameter model, we simulated PAWS to investigate the effects of an RV-LAD fistula, LAD stenosis and RV decompression on coronary haemodynamics. We also simulated coronary collaterals, which develop in response to inadequate blood flow, and found that these may provide little protection against ischaemia in the setting of PAIVS with RV-LAD fistula and LAD stenosis if collateral flow is preferentially directed to the low-resistance fistula. While the focus of this study was PAWS, the techniques presented may be applied to a variety of complex congenital heart defects that include abnormal vascular connections and unusual coronary anatomy.

• 出版日期2010-7