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Effects of Exercise and Respiration on Hemodynamic Efficiency in CFD Simulations of the Total Cavopulmonary Connection

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Abstract

Congenital heart defects with a single functional ventricle, such as hypoplastic left heart syndrome and tricuspid atresia, require a staged surgical approach to separate the systemic and pulmonary circulations. Ultimately, the venous or pulmonary side of the heart is bypassed by directly connecting the vena cava to the pulmonary arteries with a modified t-shaped junction. The Fontan procedure (total cavopulmonary connection, TCPC) completes this process of separation. To date, computational fluid dynamics (CFD) simulations in this low pressure, passive flow, intrathoracic system have neglected the presumed important effects of respiration on physiology and higher “stress” states such as with exercise have never been considered. We hypothesize that incorporating effects of respiration and exercise would provide more realistic estimates of TCPC performance. Time-dependent, 3D blood flow simulations are performed by a custom finite element solver for two patient-specific Fontan models with a novel respiration model, developed to generate physiologic time-varying flow conditions. Blood flow features, pressure, and energy efficiency are analyzed at rest and with increasing flow rates to simulate exercise conditions. The simulations produce realistic pressure and flow data, comparable to that measured by catheterization and echocardiography, and demonstrate substantial increases in energy dissipation (i.e. decreased performance) with exercise and respiration due to increasing intensity of small scale vortices in the flow. As would be expected, these changes are highly dependent on patient-specific anatomy and Fontan geometry. We propose that respiration and exercise should be incorporated into TCPC CFD simulations to provide increasingly realistic evaluations of TCPC performance.

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Acknowledgments

This work was supported by the National Science Foundation under grant number 0205741 and the Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University. Alison Marsden was also supported by a Stanford University Medical School Dean’s Fellowship. Irene Vignon-Clementel was supported by an American Heart Association predoctoral fellowship. The authors wish to thank Dr. David Rosenthal for assistance with echocardiography, Adam J. Bernstein for geometric model construction and cardiac surgeons Dr. Frank Hanley and Dr. Mohan Reddy for sharing their expertise on Fontan surgical procedures.

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Authors and Affiliations

  1. Pediatrics Department, Stanford University, Clark Center E350, Stanford, CA, 94305, USA

    Alison L. Marsden & Jeffrey A. Feinstein

  2. Mechanical Engineering Department, Stanford University, Stanford, CA, USA

    Irene E. Vignon-Clementel

  3. Radiology Department, Stanford University, Stanford, CA, USA

    Frandics P. Chan

  4. Bioengineering Department, Stanford University, Stanford, CA, USA

    Charles A. Taylor

Authors
  1. Alison L. Marsden
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  2. Irene E. Vignon-Clementel
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  3. Frandics P. Chan
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  4. Jeffrey A. Feinstein
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  5. Charles A. Taylor
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Correspondence to Alison L. Marsden.

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Marsden, A.L., Vignon-Clementel, I.E., Chan, F.P. et al. Effects of Exercise and Respiration on Hemodynamic Efficiency in CFD Simulations of the Total Cavopulmonary Connection. Ann Biomed Eng 35, 250–263 (2007). https://doi.org/10.1007/s10439-006-9224-3

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  • DOI: https://doi.org/10.1007/s10439-006-9224-3

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