Abstract
ObjectiveThe one and a half ventricle repair (1.5VR) is a common clinical choice for patients with right heart dysfunction. Considering the influence of blood circulation failure and reoperation in urgent need, this essay aims to explore the hemodynamic effects of different pulmonary vascular resistance (PVR) values on reoperation after 1.5VR failure.MethodsThe lumped parameter model (LPM) was used to simulate the reoperation, including the return biventricular repair (2VR), ligation of azygos vein (1.5VR′) and return single ventricular repair (1.0VR). Firstly, the debugging parameters were used to simulate the hemodynamics of 2VR. Secondly, the value of PVR was changed from one to four times while the other parameters remained unchanged. Finally, 15 cardiac cycles were simulated and the 15th result was obtained. In this work, the left and right ventricular stroke work and their sum (Plv, Prv, Ptotal), the left and right ventricular ejection fraction (LVEF, RVEF), the mean Cardiac Output (mCO) and the mean pressure and flow-rate ratio of superior and inferior vena cava (mPsvc\\mPivc and mQsvc\\mQivc), respectively, were used to describe the hemodynamics of reoperation.ResultsWith the change of PVR from one to four times, the values of Plv, Prv, Ptotal, LVEF, and RVEF gradually decreased. The change rate of Plv, Ptotal and LVEF of 1.0VR were the largest in the three kinds of reoperation. The change rate of Prv of 1.5VR′ was larger than that of 2VR, but it was the opposite for their EF change rate. The mCO of 2VR, 1.5VR′, and 1.0VR decreased by 18.53%, 37.58%, and 48.07%, respectively. The mPsvc\\mPivc of 1.5VR′ increased from 3.76 to 6.77 and the mQsvc\\mQivc decreased from 0.55 to 0.36, while the mPsvc\\mPivc and mQsvc\\mQivc of 2VR and 1.0VR remained 1 and 0.67, respectively. The peak value of the tricuspid flow-rate (Qti) waveform of 2VR and 1.5VR′ changed from “E peak” to “A peak.”ConclusionThe numerical results demonstrate the highly reoperation-dependent hemodynamic consequences and their responses to variations in PVR. Comprehensive analysis of EF, mCO and ventricular stroke work indicates that PVR has a greater impact on 1.5VR′ and 1.0VR. Therefore, we suggest that the selection strategy of reoperation should focus on PVR.
Highlights
By constructing the lumped parameter models (LPM) of the reoperation after 1.5VR failure, we investigated the three kinds of surgical procedures, including the 2VR, 1.5VR, and 1.0VR
Through MATLAB simulation analysis, the hemodynamic differences among the three kinds of surgical procedures are quantitatively revealed at different Pulmonary Vascular Resistance (PVR)
We mainly focus on some values which are the ventricular stroke work, EF, Cardiac Output and pressure and flow rate of the superior and inferior vena cava, which can directly or indirectly reflect the function of the heart
Summary
The one and a half ventricle repair (1.5VR) is widely applied in the treatment of congenital heart disease with abnormal structure and function of the right ventricle like the Pulmonary Atresia with Intact Ventricular Septum (PA with IVS) (Talwar et al, 2018; Wright et al, 2019), Tetralogy of Fallot (ToF) (Talwar et al, 2018) and Ebstein’s Anomaly (EA) (Malhotra et al, 2018; Talwar et al, 2018; Akkaya et al, 2019). This phenomenon causes an increase in the right ventricular preload after 1.5VR. The circulation function after the 1.5VR surgery will deteriorate
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