Abstract
A central shunt (CS) was an important surgery of systemic-to-pulmonary shunt (SPS) for the treatment of complex congenital heart diseases with decreased pulmonary blood flow (CCHDs-DPBF). There was no clear conclusion on how to deal with unclosed patent ductus arteriosus (PDA) during CS surgery. This study expanded the knowledge base on PDA by exploring the influence of the closing process of the PDA on the hemodynamic parameters for the CS model. The initial three-dimensional (3D) geometry was reconstructed based on the patient's computed tomography (CT) data. Then, a CS configuration with three typical pulmonary artery (PA) dysplasia structures and different sizes of PDA was established. The three-element windkessel (3WK) multiscale coupling model was used to define boundary conditions for transient simulation through computational fluid dynamics (CFD). The results showed that the larger size of PDA led to a greater systemic-to-pulmonary shunt ratio (QS/A), and the flow ratio of the left pulmonary artery (LPA) to right pulmonary artery (RPA) (QL/R) was more close to 1, while both the proportion of high wall shear stress (WSS) areas and power loss decreased. The case of PDA nonclosure demonstrates that the aortic oxygen saturation (Sao2) increased, while the systemic oxygen delivery (Do2) decreased. In general, for the CS model with three typical PA dysplasia, the changing trends of hemodynamic parameters during the spontaneous closing process of PDA were roughly identical, and nonclosure of PDA had a series of hemodynamic advantages, but a larger PDA may cause excessive PA perfusion and was not conducive to reducing cyanosis symptoms.
Highlights
For infants with congenital heart disease and insufficient pulmonary blood flow, the systemic-to-pulmonary shunt (SPS) is the most commonly used clinical palliative surgical method, which mainly includes modified the BlalockTaussig shunt (MBTS) and central shunt (CS) [1, 2]
The simulation results show that the nonclosure of patent ductus arteriosus (PDA) in CS surgery may associate with a better hemodynamic environment, which is similar to the result of the previous study for PDA management during the MBTS [11]
Our study demonstrates that nonclosure of PDA tends to result in lower power loss and indexed power loss (iPL) of the CS model with three typical pulmonary artery (PA) dysplasia structures, and retaining the initial PDA reduces the power loss of the CS model by more than 30% compared with the PDA closed
Summary
For infants with congenital heart disease and insufficient pulmonary blood flow, the systemic-to-pulmonary shunt (SPS) is the most commonly used clinical palliative surgical method, which mainly includes modified the BlalockTaussig shunt (MBTS) and central shunt (CS) [1, 2]. Several studies have compared the postoperative data of the PDA stenting and the SPS surgery for different infants and found that the PDA stenting group is associated with fewer complications, shorter stay in the intensive care unit, and better development of PA, but there was no significant difference in mortality between the two groups [8, 9]. These studies have shown that unclosed PDA has some benefits in the palliative treatment of patients with insufficient pulmonary blood flow, the PDA stents may cause a series of problems. We abandoned the previous steady simulation method, and the transient simulation can get more meaningful data [13]
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