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Comparing Pre- and Post-operative Fontan Hemodynamic Simulations: Implications for the Reliability of Surgical Planning

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Abstract

Virtual modeling of cardiothoracic surgery is a new paradigm that allows for systematic exploration of various operative strategies and uses engineering principles to predict the optimal patient-specific plan. This study investigates the predictive accuracy of such methods for the surgical palliation of single ventricle heart defects. Computational fluid dynamics (CFD)-based surgical planning was used to model the Fontan procedure for four patients prior to surgery. The objective for each was to identify the operative strategy that best distributed hepatic blood flow to the pulmonary arteries. Post-operative magnetic resonance data were acquired to compare (via CFD) the post-operative hemodynamics with predictions. Despite variations in physiologic boundary conditions (e.g., cardiac output, venous flows) and the exact geometry of the surgical baffle, sufficient agreement was observed with respect to hepatic flow distribution (90% confidence interval—14 ± 4.3% difference). There was also good agreement of flow-normalized energetic efficiency predictions (19 ± 4.8% error). The hemodynamic outcomes of prospective patient-specific surgical planning of the Fontan procedure are described for the first time with good quantitative comparisons between preoperatively predicted and postoperative simulations. These results demonstrate that surgical planning can be a useful tool for single ventricle cardiothoracic surgery with the ability to deliver significant clinical impact.

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Acknowledgments

This study was supported by the National Heart, Lung, and Blood Institute Grants HL67622 and HL098252, and a Pre-Doctoral Fellowship Award (10PRE3720002) from the American Heart Association.

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Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA, 30332, USA

    Christopher M. Haggerty, Diane A. de Zélicourt, Maria Restrepo & Ajit P. Yoganathan

  2. College of Computing, Georgia Institute of Technology, Atlanta, GA, USA

    Jarek Rossignac

  3. Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Thomas L. Spray

  4. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Kirk R. Kanter

  5. Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Mark A. Fogel

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  1. Christopher M. Haggerty
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Correspondence to Ajit P. Yoganathan.

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Associate Editor Peter E. McHugh oversaw the review of this article.

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Haggerty, C.M., de Zélicourt, D.A., Restrepo, M. et al. Comparing Pre- and Post-operative Fontan Hemodynamic Simulations: Implications for the Reliability of Surgical Planning. Ann Biomed Eng 40, 2639–2651 (2012). https://doi.org/10.1007/s10439-012-0614-4

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  • DOI: https://doi.org/10.1007/s10439-012-0614-4

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