Resmi KrishnankuttyRema, MS, Lakshmi P

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Quantitative Analysis of Extracardiac Versus Intraatrial Fontan Anatomic Geometries Resmi KrishnankuttyRema, MS, Lakshmi P. Dasi, PhD, Kerem Pekkan, PhD, Kartik Sundareswaran, MS, Mark Fogel, MD, Shiva Sharma, MD, Kirk Kanter, MD, Thomas Spray, MD, Ajit P. Yoganathan, PhD The Annals of Thoracic Surgery Volume 85, Issue 3, Pages 810-817 (March 2008) DOI: 10.1016/j.athoracsur.2007.11.082 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Flow chart representation of the skeletonization procedure. Starting with the three-dimensional (3D) reconstructed anatomic model, the flow chart shows pictures of initial and final slicing directions, converged centerlines, and the final skeleton of the geometry. The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Three-dimensional reconstructed total cavopulmonary connection anatomy with an illustration of the various vessel segments defined between the points where the vessels meet the junction (dotted lines) and the anatomic landmarks (solid lines). (IVC = inferior vena cava; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Schematic explaining the terms used for (A) curvature and (B) collinearity calculation is shown. Sample total cavopulmonary connection geometry with the skeleton of the venae cavae is shown on the left and total cavopulmonary connection junction is enlarged on the right (black box). (A) T is the tangent vector (black arrow) at the total cavopulmonary connection junction, and the red arrow indicates the direction of the space curve S(t), which is the inferior vena cava (IVC) centerline in this scenario. (B) Unit tangent vectors T̂svc and T̂ivc are shown in black arrows, and the unit displacement vector r̂ is shown in blue arrow. (SVC = superior vena cava.) The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Three-dimensional reconstructed total cavopulmonary connection anatomies with centerline curves for extracardiac (A) and intraatrial (B) geometries. The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Vessel area characteristics with mean (A) and standard deviation (B) of each vessel in the vicinity of the total cavopulmonary connection and (C) vessel area ratios between the superior and inferior venae cavae (SVC, IVC) and left and right pulmonary arteries (LPA, RPA) compared between extracardiac (white bars) and intraatrial (black bars) patient groups (n = 13 each). Gray bars represent values for normal children. (BSA = body surface area; PA = pulmonary artery; VC = venae cavae.) The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Minimum vessel area for left and right pulmonary arteries (LPA and RPA) for population groups: (A) extracardiac (white bars) and intraatrial (black bars; n = 13 each); (B) hypoplastic left heart syndrome (HLHS; white bars; n = 10) and non-HLHS (black bars; n = 16); and (C) extracardiac (EC) HLHS (white bars; n = 4), intraatrial (IA) HLHS (white bars; n = 6), extracardiac non-HLHS (black bars; n = 9), and intraatrial non-HLHS (black bars; n = 7). (BSA = body surface area.) The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Total cavopulmonary connection orientation depicted by mean collinearity (A) and mean vessel curvature (B) between the extracardiac (white bars) and intraatrial (black bars) patient groups. (IVC = inferior vena cava; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Inferior vena cava (IVC) baffle area normalized with body surface area (BSA) plotted as a function of time since Fontan. The solid line is the linear fit for extracardiac (EC), and the dashed line is for the intraatrial (IA) geometry. The Annals of Thoracic Surgery 2008 85, 810-817DOI: (10.1016/j.athoracsur.2007.11.082) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions