Abstract
PurposePatients with a functionally univentricular heart represent one of the most common severe cardiac lesions with a prevalence of 3 per 10,000 live births. Hemodynamics of the singular ventricle is a major research topic in cardiology and there exists a relationship between fluid dynamical features and cardiac behavior in health and disease. The aim of the present work was to compare intraventricular flow in single right ventricle (SRV) patients and subjects with healthy left hearts (LV) through patient-specific CFD simulations.MethodsThree-dimensional real-time echocardiographic images were obtained for five SRV patients and two healthy subjects and CFD simulations with a moving mesh methodology were performed. Intraventricular vortex formation and vortex formation time (VFT) as well as the turbulent kinetic energy (TKE) and ventricular washout were evaluated.ResultsThe results show significantly lower values for the VFT and the TKE in SRV patients compared with healthy LV subjects. Furthermore, vortex formation does not progress to the apex in SRV patients. These findings were confirmed by a significantly lower washout in SRV patients.ConclusionsThe study pinpoints the intriguing role of intraventricular flows to characterize performance of SRVs that goes beyond standard clinical metrics such as ejection fraction.
Highlights
The treatment of severe congenital heart defects (CHD) in newborns is an important medical challenge of our time
If a severe hypoplasia of the left ventricle is present in functional Univentricular heart (UVH), it is referred to as hypoplastic left heart syndrome
Time-discrete ventricular volumes of five patients with single right ventricle (SRV) circulation and two subjects with healthy left ventricle (LV) were acquired from transthoraxic real-time 3D-echocardiography measurements performed at the University Hospital Bonn (UKB)
Summary
The treatment of severe congenital heart defects (CHD) in newborns is an important medical challenge of our time. The term functional UVH is used for heart defects in which only one ventricle is functioning and the other is absent or hypoplastic. Biventricular repair of this pathology is not possible.[28, 29]. Only one functional right ventricle is present and is described as singular right ventricle (SRV) This anomaly must be treated within the first days after birth with palliative measures by adjusting the blood supply to the lungs. Afterwards, during the first four years of the patient’s life, the socalled Fontan circulation is achieved by means of several surgical interventions. Only oxygenated blood is pumped into the body through the one functional ventricle.[4, 15]
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