ArticleInteractive cardiovascular and thoracic surgery2022
A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation.
Article in Interactive cardiovascular and thoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 9 citations in OpenAlex.
- Evaluation of neo-innominate connection in bilateral bidirectional Glenn patients using computational flow modeling.JTCVS structural and endovascular · 2026Article
- Evolving hemodynamics in Fontan circulation: age-driven insights in patients with interrupted inferior vena cava and hepatoazygos shunt.American journal of physiology. Heart and circulatory physiology · 2025Article
- Applications of Computational Fluid Dynamics in Congenital Heart Disease: A Review.Journal of cardiovascular development and disease · 2025Review
- Evaluation of the total hydrodynamic energy loss using 4D flow MRI in a case with Fontan failure.Heliyon · 2024Article
- In vitro hemodynamic performance of a blood pump for self-powered venous assist in univentricular hearts.Scientific reports · 2024Article
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Authors and funding
12 authors at 5 institutions in 1 country.
Funding
Abstract
objectivesTo evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure.
methodsFor 9 patients, aged 2 to18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments.
resultsThe proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up.
conclusionsThe new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development. DATE AND NUMBER OF IRB APPROVAL: 25 October 2019, 280011928-604.01.01.
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