Management of a Stenotic Right Ventricle-Pulmonary Artery Shunt Early After the Norwood Procedure Tain-Yen Hsia, MD, Francesco Migliavacca, PhD, Giancarlo.

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Management of a Stenotic Right Ventricle-Pulmonary Artery Shunt Early After the Norwood Procedure Tain-Yen Hsia, MD, Francesco Migliavacca, PhD, Giancarlo Pennati, PhD, Rossella Balossino, PhD, Gabriele Dubini, PhD, Marc R. de Leval, MD, Scott M. Bradley, MD, Edward L. Bove, MD The Annals of Thoracic Surgery Volume 88, Issue 3, Pages 830-838 (September 2009) DOI: 10.1016/j.athoracsur.2009.05.051 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schematics of the multiscale model of a 5-mm right ventricle to pulmonary artery shunt Norwood circulation that couples a 3-dimensional computational fluid dynamics model to the lumped parameter network of the entire circulation. (AO = aorta; ASD = atrial septal defect; CA1 = coronary artery 1; CA2 = coronary artery 2; CB = coronary bed; CV = coronary vein; LA = left atrium; LBA = lower body arteries; LBB = lower body bed; LVB = lower body veins; NEOAO = neoaorta; PAB = pulmonary arterial bed; PVB = pulmonary venous bed; RA = right atrium; SVP = single ventricle physiology; TRIC = tricuspid valve; UBA = upper body arteries; UBB = upper body bed; UBV = upper body veins.) The Annals of Thoracic Surgery 2009 88, 830-838DOI: (10.1016/j.athoracsur.2009.05.051) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Three-dimensional computational fluid dynamics models of the various shunt configurations: (A) 5-mm right ventricular-pulmonary artery (RV-PA) shunt, (B) 5-mm RV-PA shunt with proximal stenosis, (C) 3-mm modified Blalock-Taussig shunt added to the stenotic RV-PA shunt, and (D) 3.5-mm Blalock-Taussig shunt only. The Annals of Thoracic Surgery 2009 88, 830-838DOI: (10.1016/j.athoracsur.2009.05.051) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Systemic oxygen delivery and (B) diastolic regurgitant flow through the right-ventricular-pulmonary artery (RV-PA) shunt as percentage of pulmonary blood flow (Qp) for 4 models: 5-mm RV-PA shunt, 5-mm RV-PA shunt with a 3-mm proximal stenosis, 3-mm modified Blalock-Taussig shunt added to the stenotic RV-PA shunt, and 3.5-mm modified Blalock-Taussig shunt only. The Annals of Thoracic Surgery 2009 88, 830-838DOI: (10.1016/j.athoracsur.2009.05.051) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Simulated right ventricular pressure-volume loops for 3 models: 3-mm modified Blalock-Taussig (mBT) shunt added to a 5-mm right-ventricular-pulmonary artery (RV-PA) shunt with a 2-mm proximal stenosis, a 3-mm mBT shunt added to a 5-mm RV-PA shunt with 3-mm proximal stenosis, and a 3.5-mm mBT shunt only. The Annals of Thoracic Surgery 2009 88, 830-838DOI: (10.1016/j.athoracsur.2009.05.051) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions