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Original research article
Computational fluid dynamics in Fontan patients to evaluate power loss during simulated exercise
  1. Sjoerd S M Bossers1,2,
  2. Merih Cibis3,
  3. Frank J Gijsen3,
  4. Michiel Schokking4,
  5. Jan L M Strengers5,
  6. René F Verhaart3,
  7. Adriaan Moelker2,
  8. Jolanda J Wentzel3,
  9. Willem A Helbing1,2
  1. 1Department of Paediatrics, Division of Cardiology, Erasmus Medical Centre—Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
  3. 3Department of Biomedical Engineering, Division of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
  4. 4Department of Paediatrics, Division of Cardiology, St. Radboud University Medical Center, Nijmegen, The Netherlands
  5. 5Department of Paediatrics, Division of Cardiology, University Medical Centre Utrecht—Wilhelmina Children's Hospital, Utrecht, The Netherlands
  1. Correspondence to Professor WA Helbing, Erasmus Medical Centre — Sophia Children's Hospital, Department of Paediatric Cardiology, Sp-2429, PO Box 2060, Rotterdam 3000 CB, The Netherlands; w.a.helbing{at}


Objective Exercise intolerance is common in total cavopulmonary connection (TCPC) patients. It has been suggested that power loss (Ploss) inside the TCPC plays a role in reduced exercise performance. Our objective is to establish the role of Ploss inside the TCPC during increased flow, simulating exercise in a patient-specific way.

Methods Cardiac MRI (CMR) was used to obtain flow rates from the caval veins during rest and increased flow, simulating exercise with dobutamine. A 3D reconstruction of the TCPC was created using CMR data. Computational fluid dynamics (CFD) simulations were performed to calculate Ploss inside the TCPC structure for rest and stress conditions. To reflect the flow distribution during exercise, a condition where inferior caval vein (IVC) flow was increased twofold compared with rest was added.

29 TCPC patients (15 intra-atrial lateral tunnel (ILT) and 14 extracardiac conduit (ECC)) were included.

Results Mean Ploss at rest was 1.36±0.94 (ILT) and 3.20±1.26 (ECC) mW/m2 (p<0.001), 2.84±1.95 (ILT) and 8.41±3.77 (ECC) mW/m2 (p<0.001) during dobutamine and 5.21±3.50 (ILT) and 15.28±8.30 (ECC) mW/m2 (p=0.001) with twofold IVC flow. The correlation between cardiac index and Ploss was exponential (ILT: R2=0.811, p<0.001; ECC: R2=0.690, p<0.001).

Conclusions Ploss inside the TCPC structure is limited but increases with simulated exercise. This relates to the anatomy of TCPC and the surgical technique used. In all flow conditions, ILT patients have lower Ploss than ECC patients. We did not find a relationship between Ploss and exercise capacity.

  • Fontan Procedure
  • Total Cavopulmonary Connection
  • Computational Fluid Dynamics
  • Single Ventricle
  • Congenital

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