Fontan Circulation

Team: Alyssa Taylor-LaPole & Mette Olufsen

Collaborators: Charles Puelz & Justin Weigand

Overview:

A Fontan circulation is a univentricular circulation that is a result of a series of reconstructive surgeries. A group of patients that undergo these surgeries to obtain a Fontan circulation are Hypoplastic Left Heart Syndrome (HLHS) patients born with one functioning ventricle. This study uses fluid dynamics modeling to compare vascular perfusion to the gut and brain for two groups of HLHS patients. One group include patients born with a non-functional left ventricle, as part of their circuit reconstruction the aorta is moved from the non-functional left ventricle to the right ventricle. Another group (the control group) are double outlet right ventricle patients. This patient group also has one functioning ventricle, but these patients have both the aorta and main pulmonary arteries leaving the right ventricle and therefore do not require aortic reconstruction.  This project uses computational modeling to study if patients with aortic reconstruction experience excessive aortic remodeling impacting perfusion of the brain and vital organs. To answer this question, we collaborate with Drs. Weigand and Puelz at Baylor College of Medicine and Texas Children’s Hospital. Using 4D MRI images and MRI angiograms we are able to set up systemic arterial network and using a 0D heart model, a 3D-FSI aortic model, and a 1D model of the peripheral vasculature we generate patient-specific predictions of ventricular afterload, wave-propagation, wave-intensity, and energy loss. We are also able to obtain qualitative measures such as pressure maps, shear stress, wall distensibility, and peripheral perfusion. The latter is important as it allows us to predict perfusion of the brain and gut. Patients with a Fontan circuit typically have inadequate cerebral perfusion which can lead to stroke. Fontan circuits can also have decreased perfusion in the gut; this can lead to Fontan-associated liver disease which subsequently causes several other detrimental issues such as liver cirrhosis.

 

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