Hemodynamic Effects of Additional Pulmonary Blood Flow on Glenn and Fontan Circulation

• Published in: Cardiovascular engineering and technology Vol. 11; no. 3; pp. 268 - 282
• Main Authors: Chen, Xiangyu, Yuan, Haiyun, Liu, Jiawei, Zhang, Neichuan, Zhou, Chengbin, Huang, Meiping, Jian, Qifei, Zhuang, Jian
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2020; Springer Nature B.V
• Subjects: Biomedical Engineering and Bioengineering; Biomedicine; Blood circulation; Blood flow; Cardiology; Computational fluid dynamics; Computer simulation; Datasets; Energy dissipation; Engineering; Flow distribution; Hemodynamics; Mathematical models; Original Article; Oxygen; Oxygen content; Parameter sensitivity; Pulmonary arteries; Pulsation; Shear stress; Thrombosis; Wall shear stresses; Additional pulmonary blood flow; Energy loss; Hemodynamics; Particle wash-out time; Glenn procedure
• ISSN: 1869-408X; 1869-4098
• DOI: 10.1007/s13239-020-00459-x

Purpose Additional pulmonary blood flow (APBF) can provide better pulsating blood flow and systemic arterial oxygen saturation, while low blood pulsation and low oxygen saturation are defects of the Fontan and Glenn procedure. Studying the hemodynamic effect of APBF is beneficial for clinical decisions. This study aimed to explore the effect on particle washout, as well as the differences among the sensitivities of both different hemodynamic parameters and different procedures to APBF. Methods The patient-specific clinical datasets of a patient who underwent bilateral bidirectional Glenn (BBDG) with APBF were enrolled in this study, and using these datasets, Glenn- and Fontan-type artery models were reconstructed. A series of parameters, including the total caval flow pulsatility index (TCPI), indexed energy loss (iPL), wall shear stress (WSS), systemic arterial oxygen saturation (Sat art ), particle washout time (WOT), pressure in the right superior vena cava ( P RSVC ), pulmonary flow distribution (PFD) and hepatic flow distribution (HFD), were computed from computational fluid dynamic (CFD) simulation to evaluate the hemodynamic effect of APBF. Results The result showed that APBF led to better iPL and Sat art but worse P RSVC and heart load accompanied by a great impact on HFD, making hepatic flow easier to perfuse the side without MPA and APBF. The increase in the APBF rate also effectively results in larger flow pulsation, region velocity, and wall shear stress and lower WOT, and this effect may be more effective for patients with persistent left superior vena cava (PLSVC). However, APBF might have little effect on PFD. Furthermore, APBF might affect WOT, iPL and HFD more significantly than P RSVC and has a greater improvement effect in patients with poorer iPL and WOT. Conclusions Moderate APBF is not only a measure to promote pulmonary artery growth and systemic arterial oxygen saturation but also an effective method against endothelial dysfunction and thrombosis. However, moderate APBF is patient-specific and should be determined based on hemodynamic preference that leads to desired patient outcomes, and care should be taken to prevent P RSVC and heart load from being too high as well as an imbalance in HFD.