In Vitro Flow Analysis of a Patient-Specific Intraatrial Total Cavopulmonary Connection Diane A. de Zélicourt, MS, Kerem Pekkan, PhD, Lisa Wills, BS,

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In Vitro Flow Analysis of a Patient-Specific Intraatrial Total Cavopulmonary Connection Diane A. de Zélicourt, MS, Kerem Pekkan, PhD, Lisa Wills, BS, Kirk Kanter, MD, Joseph Forbess, MD, Shiva Sharma, MD, Mark Fogel, MD, Ajit P. Yoganathan, PhD The Annals of Thoracic Surgery Volume 79, Issue 6, Pages 2094-2102 (June 2005) DOI: 10.1016/j.athoracsur.2004.12.052 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The anatomic intraatrial model reconstructed from magnetic resonance imaging (A) and the two simplified glass models (B and C). (IVC = inferior vena cava; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava; Ø = diameter.) The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Flow visualization of the simplified glass models at 4 L/min for model 1 (a, b) and 1 L/min for model 2 (c, d); inflow split, 60/40 inferior vena cava (IVC) to superior vena cava (SVC); outflow split, 50/50 left pulmonary artery (LPA) to right pulmonary artery (RPA). Dye injected from the superior vena cava (top) and inferior vena cava (bottom). The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Control volume power losses in model 1, at 1, 2, 3, and 4 L/min, with a 60/40 inferior vena cava to superior vena cava flow split. (Rlung = lung resistance; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Control volume power losses in model 2, at 1, 2 and 3 L/min, with a 60/40 inferior vena cava to superior vena cava flow split. (Rlung = lung resistance; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Flow visualization of the intraatrial model at 1 L/min. (IVC = inferior vena cava; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Quantitative assessment of the flow field using digital particle image velocimetry (PIV) and computational fluid dynamic (CFD) methods. Flow conditions: 3 L/min, 60/40 inferior vena cava to superior vena cava, and 50/50 left pulmonary artery to right pulmonary artery. The sagittal velocity maps are indexed from the most anterior plane (A) to the most posterior plane (D). The location of the sagittal planes is shown in Figure 7(1). The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Assessment of the total velocity using computational fluid dynamic methods; at 3 L/min, 60/40 inferior vena cava to superior vena cava, and 50/50 left pulmonary artery to right pulmonary artery. The location of the sagittal (A to D), coronal (E), and axial (F) planes is shown in schematics 1 and 2. The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Schematic of the flow structure in the intraatrial model at 1 L/min, 60/40 inferior vena cava to superior vena cava, and 70/30 left pulmonary artery to right pulmonary artery. (IVC = inferior vena cava; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 9 Control volume power losses in the anatomic intraatrial model. At 3 L/min, fully developed turbulence took place in the left pulmonary artery (LPA) below 50% right pulmonary artery (RPA) and in the left pulmonary artery above 60% right pulmonary artery. (IVC = inferior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 10 Pressure distribution in the anatomical intraatrial model at 1 L/min; inlet flow split: 60/40 inferior vena cava to superior vena cava; outlet flow split: 70/30 left pulmonary artery to right pulmonary artery. Pressures are given in millimeters of mercury. Inferior vena cava pressure was chosen as the reference (Ref.). The Annals of Thoracic Surgery 2005 79, 2094-2102DOI: (10.1016/j.athoracsur.2004.12.052) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions