Computational Analysis of Hybrid Norwood Circulation With Distal Aortic Arch Obstruction and Reverse Blalock-Taussig Shunt Andres Ceballos, MS, I. Ricardo.

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Computational Analysis of Hybrid Norwood Circulation With Distal Aortic Arch Obstruction and Reverse Blalock-Taussig Shunt Andres Ceballos, MS, I. Ricardo Argueta-Morales, MD, Eduardo Divo, PhD, Ruben Osorio, BS, Christopher A. Caldarone, MD, Alain J. Kassab, PhD, William M. DeCampli, MD, PhD The Annals of Thoracic Surgery Volume 94, Issue 5, Pages 1540-1550 (November 2012) DOI: 10.1016/j.athoracsur.2012.06.043 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Three-dimensional models are shown of the hybrid Norwood. (B) Detailed view of the transverse aortic arch with stenosis highlighted in red. (DA = descending aorta; LCA = left carotid artery; LcorA = left coronary artery; LPA = left pulmonary artery; LSA = left subclavian artery; Nom = nominal anatomy; RCA = right carotid artery; RBTS = reverse Blalock-Taussig shunt; RcorA = right coronary artery; RSA = right subclavian artery; RPA = right pulmonary artery; Sten = stenosis anatomy.) The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Dimensions are shown for (A) stenotic (Sten) and (B) nominal reverse Blalock-Taussig shunt (RBTS) models. (C) Sten-RBTS model computational domain mesh. Measurements are in millimeters. (Ø = diameter.) The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Multiscale model of the hybrid Norwood. (A) Three-dimensional model coupled with lumped parameter model. (B) Coupling scheme. The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Ventricular and descending aorta pressures produced by the (A and C) multiscale model and from the (B and D) typical hybrid Norwood patient. (DA = descending aorta.) The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Composite plots: (A) ventricular, atrial, and pulmonary root pressure (left scale) with cardiac output (right scale). (B) Pressure traces of all arteries. (DA = descending aorta; LCA = left carotid artery; LcorA = left coronary artery; LPA = left pulmonary artery; LSA = left subclavian artery; Nom = nominal anatomy; P.Root = pulmonary root; RBTS = reverse Blalock-Taussig shunt; RCA = right carotid artery, RcorA = right coronary artery; RSA = right subclavian artery, RPA = right pulmonary artery; Sten= stenosis anatomy.) The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Flow-rates and pressures over a cardiac cycle: (A) coronaries, (B) carotids, (C) subclavians, (D) pulmonary, (E) descending aorta (DA), and (F) reverse Blalock-Taussig shunt (RBTS). The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Streamlines at selected times in the cardiac cycle (1 = peak systole; 2 = early diastole; 3 = middle diastole; 4 = late diastole) for (A) nominal (Nom) and (B) Nom-reverse Blalock-Taussig shunt (RBTS) models. The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Streamlines at selected times in the cardiac cycle (1 = peak systole; 2 = early diastole; 3 = middle diastole; 4 = late diastole are shown for (A) stenotic (Sten) and (B) Sten-reverse Blalock-Taussig shunt (RBTS) models. The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 9 Streamline details at selected times in the cardiac cycle (1 = peak systole; 2 = early diastole; 3 = middle diastole; 4 = late diastole) are shown for (A) nominal reverse Blalock-Taussig shunt (Nom-RBTS, (B) and stenotic (Sten)-RBTS models). The Annals of Thoracic Surgery 2012 94, 1540-1550DOI: (10.1016/j.athoracsur.2012.06.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions