Hepatic blood flow distribution and performance in conventional and novel Y-graft Fontan geometries: A case series computational fluid dynamics study

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Hepatic blood flow distribution and performance in conventional and novel Y-graft Fontan geometries: A case series computational fluid dynamics study Weiguang Yang, MS, Irene E. Vignon-Clementel, PhD, Guillaume Troianowski, MS, V. Mohan Reddy, MD, Jeffrey A. Feinstein, MD, MPH, Alison L. Marsden, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 5, Pages 1086-1097 (May 2012) DOI: 10.1016/j.jtcvs.2011.06.042 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Original Glenn models and variations of Fontan geometries for 5 patients. The Y-graft includes a 20-mm trunk and two 15-mm branches. The size of the tube-shaped graft is 20 mm. Patients B and E have a stenosis in the left and right pulmonary arteries, respectively, denoted by arrows. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Visualization of the particle tracking in the model Y-graft II for patient B. Particle tracking is terminated when particles are washed from the model. LPA, Left pulmonary artery; RPA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Left, Hepatic flow distribution at rest. Right, Differences (percentage of the IVC flow) from the theoretical optima for each design at rest and exercise. Note that the theoretical optima for patient A at rest, 2×, and 3×, are 61/39, 70/30 and 72/28, respectively, and that a 50:50 split cannot be achieved in theory. IVC, Inferior vena cava; RPA, right pulmonary artery; LPA, left pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Time-averaged velocity vectors in the Y-graft and T-junction models for patients A, D, and E. In the T-junction design for patient A, the SVC jet blocks the hepatic flow entering the LPA. In patient D, most SVC flow is directed to the RPA owing to a curved SVC. In patient E, Y-graft II improves the hepatic flow distribution by having a straight proximal branch for the RPA, in which the SVC jet blocks hepatic flow going to the RPA from the right branch, compared with Y-graft I. SVC, Superior vena cava; LPA, left pulmonary artery; RPA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Hepatic flow distribution changes with variations in pulmonary flow split. Patients’ original pulmonary flow splits are marked by the arrows at the x-axis. The table shows the averaged deviations with respect to the original hepatic flow distribution for a 25% change in pulmonary flow split. IVC, Inferior vena cava; RPA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Contours of time-averaged wall shear stress (dynes/cm2) at rest for patients A and C. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Averaged differences from the theoretical optima and power losses over 5 patients. The best performing of the Y-graft and offset designs for patients B and E are used. The differences between the Y-graft and T-junction designs are statistically significant (∗P < .05). The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Based on conservation of mass, we have QRPA=QIVC·x+QSVC·y and QLPA=QIVC·(1−x)+QSVC·(1−y), where x is the fraction of hepatic flow going to the RPA and y is the fraction of SVC flow going to the RPA. SVC, Superior vena cava; IVC, inferior vena cava; RPA, right pulmonary artery; LPA, left pulmonary artery; Q, flow rate. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1086-1097DOI: (10.1016/j.jtcvs.2011.06.042) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions