Application of computational fluid dynamic simulations on the virtual Fontan operations for the patients with the functional single ventricle

Abstract

Objective To perform the virtual Fontan operations on patients who had undergone the bilateral bidirectional Glenn procedure, and to simulate the blood flow in different types of opera-tive strategies by the method of computational fluid dynamics (CFD). Methods Three-dimensional re-construction was performed with Mimics 12. 0(R) according to the results of magnetic resonance imaging (MRI). Virtual operations were performed by changing the virtual anastomotic sites of bilateral supe-rior vena cava (SVC) and pulmonary arteries (PAs), and by connecting the inferior vena cava (IVC) to different sites of PAs. Numerical simulations were established to analyze the CFD of blood flows in patients undergoing 4 different types of virtual operative strategies at different predetermined flow split distribution ratios of left pulmonary artery (LPA) to right pulmonary artery (RPA) (at 30: 70,40 : 60, 50:50,60:40 and 70:30, respectively). Results When the distance between the anastomotic sites of the bilateral SVCs to the PAs was relatively long and the anastomotic site of IVC and PAs was in the middle of the SVC-PA anastomotic sites, the control volume power loss (CVPL) was lower than any other three operative strategies at all predetermined LPA/RPA flow split distribution ratios. The CV-PL achieved a minimal value of 23.60 mW at the ratio of 50/50. Conclusions For Fontan operations, it may be the optimal operative strategy to anastomose bilateral SVCs to the homolateral PA separately and to connect the IVC in the middle of the SVC-PA anastomotic sites. Key words: Computational fluid dynamics; Fontan procedure; Virtual operation; Energy me-tabolism