HEPATIC VENOUS BLOOD FLOW DISTRIBUTION IN THE TOTAL CAVOPULMONARY CONNECTION: PATIENT-SPECIFIC ANATOMICAL MODELS

摘要

CFD modeling of the anatomical pathways (TCPC) created by the palliative single-ventricle heart defect surgeries is an area studied by several research groups [1-5]. To the best of our knowledge except Walker et al. (in idealized experimental models) [6], all studies focused on the prediction of hydrodynamic power losses or dissipation function and ignored venous hepatic flow distribution to the left and right lungs. Hepatic flow coming from the inferior vena cava (IVC) transports essential growth factors that are required for normal lung growth. Inadequate IVC blood distribution also cause protein loosing enteropathy [7], a serious complex pathology leading to total failure of the surgically created single-ventricle circulation system. Early TCPC configurations distributing the hepatic flow unidirectionaly to one of the lungs [8] were promptly discontinued from the operating rooms and replaced with "+" shaped connections for these reasons, Fig 1. The objective of this study is to quantify the distribution of hepatic flow returning from the IVC to each of the lungs through a Lagrangian analysis of CFD simulations of a large number of patient specific TCPCs. This study for the first time provides insight into the influence of different surgical approaches such as extra-cardiac and intra-atrial connections on the hepatic distribution to the lungs.