Flow simulations and validation for the first cohort of patients undergoing the Y-graft Fontan procedure

J Thorac Cardiovasc Surg. 2015 Jan;149(1):247-55. doi: 10.1016/j.jtcvs.2014.08.069. Epub 2014 Sep 21.


Objectives: In this study, with the use of computational fluid dynamics, we evaluate the postoperative hemodynamic performance of the first cohort of patients undergoing a handcrafted Y-graft Fontan procedure and validate simulation predictions of hepatic blood flow distribution against in vivo clinical data.

Methods: An 18-12 × 2-mm handcrafted Y-graft modification of the Fontan procedure was performed in 6 patients. Early (at the time of discharge) and 6-month postoperative 3-dimensional magnetic resonance imaging data were collected. Patient-specific models were constructed for flow simulations.

Results: Hepatic blood flow distribution varied among patients. Lung perfusion data (n = 3) showed good agreement with simulations. Postoperative asymmetry in hepatic blood flow distribution was reduced 6 months postoperatively. In 1 patient, low wall shear stress was found in the left limb of the Y-graft, corresponding to the location of subsequent thrombosis in the patient.

Conclusions: The credibility and accuracy of simulation-based predictions of postoperative hepatic flow distribution for the Fontan surgery have been validated by in vivo lung perfusion data. The performance of the Y-graft design is highly patient-specific. The anastomosis location is likely the most important factor influencing hepatic blood flow distribution. Although the development of thrombosis is multifactorial, the occurrence in 1 patient suggests that simulations should not solely consider the hepatic blood flow distribution but also aim to avoid low wall shear stress in the limbs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Validation Study

MeSH terms

  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis Implantation / methods
  • Blood Vessel Prosthesis*
  • Computer Simulation*
  • Fontan Procedure / adverse effects
  • Fontan Procedure / instrumentation*
  • Fontan Procedure / methods
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Hemodynamics
  • Humans
  • Liver Circulation
  • Magnetic Resonance Imaging
  • Models, Cardiovascular*
  • Prosthesis Design
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / physiopathology
  • Pulmonary Artery / surgery*
  • Pulmonary Circulation
  • Radiography
  • Regional Blood Flow
  • Time Factors
  • Treatment Outcome
  • Vena Cava, Inferior / diagnostic imaging
  • Vena Cava, Inferior / physiopathology
  • Vena Cava, Inferior / surgery*