Non-uniform mixing of hepatic venous flow and inferior vena cava flow in the Fontan conduit
| Autor: | Sasa Kenjeres, Hans C. van Assen, Jos J.M. Westenberg, Joe F. Juffermans, Mark G. Hazekamp, Jolanda J. Wentzel, Hildo J. Lamb, Monique R.M. Jongbloed, Friso M Rijnberg, Arno A.W. Roest, Séline F S van der Woude |
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| Přispěvatelé: | Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Heart Defects
Congenital Inferior vena caval medicine.medical_specialty Biomedical Engineering Biophysics hepatic flow distribution hepatic venous Vena Cava Inferior Bioengineering computational fluid dynamics Hepatic Veins Pulmonary Artery 030204 cardiovascular system & hematology Fontan Procedure Biochemistry Inferior vena cava Venous flow 030218 nuclear medicine & medical imaging Biomaterials 03 medical and health sciences 0302 clinical medicine Electrical conduit Internal medicine Humans Medicine mixing cardiovascular diseases Life Sciences–Engineering interface Research Articles business.industry digestive oral and skin physiology Hemodynamics nutritional and metabolic diseases Blood flow surgical procedures operative Dynamic models Flow (mathematics) medicine.vein flow Arteriovenous Fistula Cardiology Conduit flow cardiovascular system business Biotechnology Fontan |
| Zdroj: | Journal of the Royal Society Interface, 18(177):1027. The Royal Society Journal of the Royal Society Interface, 18(177) Journal of the Royal Society. Interface, 18(177). ROYAL SOC Journal of the Royal Society, Interface Journal of the Royal Society Interface |
| ISSN: | 1742-5689 |
| Popis: | Fontan patients require a balanced hepatic blood flow distribution (HFD) to prevent pulmonary arteriovenous malformations. Currently, HFD is quantified by tracking Fontan conduit flow, assuming hepatic venous (HV) flow to be uniformly distributed within the Fontan conduit. However, this assumption may be unvalid leading to inaccuracies in HFD quantification with potential clinical impact. The aim of this study was to (i) assess the mixing of HV flow and inferior vena caval (IVC) flow within the Fontan conduit and (ii) quantify HFD by directly tracking HV flow and quantitatively comparing results with the conventional approach. Patient-specific, time-resolved computational fluid dynamic models of 15 total cavopulmonary connections were generated, including the HV and subhepatic IVC. Mixing of HV and IVC flow, on a scale between 0 (no mixing) and 1 (perfect mixing), was assessed at the caudal and cranial Fontan conduit. HFD was quantified by tracking particles from the caudal (HFD caudal conduit ) and cranial (HFD cranial conduit ) conduit and from the hepatic veins (HFD HV ). HV flow was non-uniformly distributed at both the caudal (mean mixing 0.66 ± 0.13) and cranial (mean 0.79 ± 0.11) level within the Fontan conduit. On a cohort level, differences in HFD between methods were significant but small; HFD HV (51.0 ± 20.6%) versus HFD caudal conduit (48.2 ± 21.9%, p = 0.033) or HFD cranial conduit (48.0 ± 21.9%, p = 0.044). However, individual absolute differences of 8.2–14.9% in HFD were observed in 4/15 patients. HV flow is non-uniformly distributed within the Fontan conduit. Substantial individual inaccuracies in HFD quantification were observed in a subset of patients with potential clinical impact. |
| Databáze: | OpenAIRE |
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