ArticleComputers in biology and medicine2024
Biomechanics and clinical implications of Fontan upsizing.
Article in Computers in biology and medicine, 2024. 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.
- Altered caval flow and wall shear stress in single ventricle circulation: insights from ferumoxytol-enhanced 4D flow MRI.European heart journal. Imaging methods and practice · 2026Article
- Evaluation of neo-innominate connection in bilateral bidirectional Glenn patients using computational flow modeling.JTCVS structural and endovascular · 2026Article
- Outcomes of a Physiology-driven Extracardiac Fontan Strategy Incorporating Computational Fluid Dynamics: A Multicentre Study.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 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
- Constrained optimization of scaffold behavior for improving tissue engineered vascular grafts.Journal of biomechanics · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundThe Fontan operation, a palliative procedure for single ventricle patients, has evolved to improve outcomes and reduce complications. While extracardiac conduit (ECC) is favored for its simplicity and potential hemodynamic benefits, concerns arise about conduit size adequacy over time. Undersized ECC conduits may cause hemodynamic inefficiencies and long-term complications, while oversizing can lead to flow disturbances, stagnation, and thrombosis, necessitating surgical revision or upsizing to optimize hemodynamics.
objectivesThe study aimed to predict the impact of upsizing by developing a patient-specific workflow using cardiac magnetic resonance-based imaging and computational fluid dynamics to assess Fontan hemodynamic changes and determine the most optimal conduit size.
methodsWe simulated upsizing in patient-specific models, computing reduction in power loss (PL), and analyzed pressure gradients, wall shear stress (WSS), and other local flow dynamic parameters such as vorticity and viscous dissipation that influence PL in a Fontan. Additionally, we quantified the impact of upsizing on hepatic flow distribution (HFD).
resultsAcross the patient cohort, upsizing resulted in a PL reduction of 16 %-63 %, with the greatest reduction observed in patients with the smallest pre-existing conduit sizes (14 mm). The optimal conduit size for minimizing PL was highly patient-specific. For instance, a 20 mm conduit reduced PL by 63 % in one patient, while another patient showed 16 % reduction with upsizing. Pressure gradients decreased by 15 %-35 %, correlating with the reduction in PL, while WSS decreased consistently with upsizing. Vorticity and viscous dissipation exhibited more variability but followed the overall trend of reduced PL. HFD changes were modest with a maximum variation of 30 %.
conclusionsOur findings underscore the importance of individualized approaches in Fontan conduit upsizing. CFD-based quantitative evaluations of PL, pressure gradients, HFD, and WSS can guide optimal conduit sizing, improving long-term outcomes for patients.
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