Pulsatile Efficiency and Pediatric Venous Assist Options in Failing Fontan Patients

摘要

Our findings at this stage are limited to computational modeling but highlighted the significance of venous flow pulsatility on the energy efficiency inside the single ventricle circulation and the feasibility of venous flow waveform optimization [7], Quantification of the energy efficiency of the failing waveform via clinically meaningful indices may provide a rational to correlate hemodynamics with cardiac malfunction and postoperative complications. Efforts to develop a hybrid theoretical-numerical framework described in this contribution yielded an analytical expression that allowed estimating the pulsatile power loss changes based on frequency content and amplitude fluctuations of the caval flow waveforms. Incorporating patient-specific Doppler angiography venous flows from failing Fontan patients predictive capability of this relation was demonstrated. Our analysis indicated that due to the higher frequency content and lower amplitude fluctuations, Failing Fontan patients had lower pulsatile energy dissipation, in turn higher hemodynamic efficiency compared to the healthy patients.Venous flow assist through EECP in the Fontan circulation can non-invasively result in flow augmentation, facilitate vascular remodeling and introduce various control options in order to aid patient management. Executing CFD simulations with the EECP-generated venous flows, low energy efficiency (-60%) was evaluated for the EECP-assisted SV circuit. This provides the motivation to tune the EECP therapy in order to optimize the unsteady venous flow dynamics of the Fontan circuit and improve the effectiveness of the therapy.Future efforts will expand the real-time flow data through additional clinical studies to gain improved understanding throughout the disease timeline. We plan to extend our pulsatility analysis to patient-specific settings and communicate during the meeting.