Evaluation of a novel extra-cardiac Fontan procedure with implantation of a biocompatible membrane

Abstract

Fontan operation is a final palliative surgical treatment for patients with a single ventricle (SV) physiology. One of the common disadvantages of Fontan operation is to generate a non-pulsatile flow instead of the normal pulsatile flow produced by contraction of the ventricle. Theoretically, in SV patients, maintaining the antegrade flow through pulmonary valve can produce flow pulsatility in the right and left pulmonary arteries. However, it not only increases the energy loss in the Fontan of total cavopulmonary pathway (TCPC), but also imposes an extra load on pulmonary arteries as well as the ventricle.In this study, the potential capability of pulmonary valve of the patient that can be used to increase the pulsatility of blood flow in pulmonary arteries, as a novel concept, is introduced and evaluated by using numerical simulation. In this approach, the main pulmonary artery of the patient is repaired and a flexible membrane is constructed by sewing the leaflets of pulmonary valve (three cups) together, through Fontan surgery. This membrane would fluctuate by high gradient pressure that is imposed from univentricular heart in each cardiac cycle. Alternatively, more dilatable materials, as flexible artificial membranes, are also considered to examine the effect of membrane's compliance on blood flow in pulmonary arteries. In this work, we have used the flow solid interaction (FSI) simulation to investigate the effect of mechanical properties of the membrane material on the pulsatility of velocity profiles.