The lower limit of the pulmonary artery index for the extracardiac Fontan circulation Keiichi Itatani, MD, Kagami Miyaji, MD, Yayoi Nakahata, MD, Kuniyoshi.

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Presentation transcript:

The lower limit of the pulmonary artery index for the extracardiac Fontan circulation Keiichi Itatani, MD, Kagami Miyaji, MD, Yayoi Nakahata, MD, Kuniyoshi Ohara, MD, Shinichi Takamoto, MD, Masahiro Ishii, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 1, Pages 127-135 (July 2011) DOI: 10.1016/j.jtcvs.2010.11.033 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Geometry of extracardiac Fontan operation. Mean values of 17 patients were used to create geometry. Right and left pulmonary arteries were assumed to be same diameter and varied so that pulmonary artery index (PAI, Nakata index) ranged from 50 mm2/m2 to 200 mm2/m2 with every 10-mm2/m2 increase. Average values of bilateral pulmonary artery (PA) diameters were used, with 9.6-mm diameter equivalent to pulmonary artery index (Nakata index) of 273. Radius of conduits was 16 mm. Conduits were anastomosed to pulmonary artery at a distance equal to 1 superior vena cava (SVC) radius from center of Glenn anastomosis site. Conduit curve was determined as though middle level of conduit deviated 6.6 mm from axis of inferior vena cava (IVC). B., Time varying function of boundary conditions. Superior and inferior vena caval flows were given in previously reported magnetic resonance imaging flow study.12 Pressures of bilateral pulmonary arteries were given so that pulmonary arterial resistances were 1.2, 2.0, and 2.6 Um2. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 127-135DOI: (10.1016/j.jtcvs.2010.11.033) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Flow features of pulmonary artery index (PAI) model areas at rest at pulmonary arterial resistance (Rp) of 1.2 Um2. Direction of arrows indicates flow direction, and colors indicate flow velocity magnitudes. Flow acceleration was detected in small models with small pulmonary artery index in both expiratory and inspiratory phases. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 127-135DOI: (10.1016/j.jtcvs.2010.11.033) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Pressure distributions at rest at pulmonary arterial resistance (Rp) of 1.2 Um2. Pressure gradients are demonstrated with color gradients. Central venous pressures were prominently high in models with small pulmonary artery index (PAI) in both expiratory and inspiratory phases. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 127-135DOI: (10.1016/j.jtcvs.2010.11.033) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Flow features of pulmonary artery index (PAI) model areas during 1.0-W/kg exercise at pulmonary arterial resistance (Rp) of 1.2 Um2. Inferior vena caval flow was increased. Flow acceleration was more prominent during exercise than in models at rest, especially in models with small pulmonary artery index, in both expiratory and inspiratory phases. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 127-135DOI: (10.1016/j.jtcvs.2010.11.033) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Energy loss and mean inferior vena caval (IVC) pressure on various pulmonary artery index (PAI) models under various boundary conditions. AvPAI indicates average pulmonary artery index of the 17 patients with Fontan circulations in our hospital. A, Energy loss and pulmonary artery index at rest and on 2 exercise levels. B, Mean inferior vena caval pressure and pulmonary arterial index at rest and on 2 exercise levels. C, Mean inferior vena caval pressure and pulmonary artery index at 3 pulmonary arterial resistance (Rp) levels. D, Sketches of all model geometries with different pulmonary artery indices. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 127-135DOI: (10.1016/j.jtcvs.2010.11.033) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions