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S1047951111001491a



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Cardiology in the Young 2011 Page 1 of 12 r Cambridge University Press 2011 doi 10 1017 S1047951111001491 Original Article Pulsatile venous waveform quality affects the conduit performance in functional and failing Fontan circulations Onur Dur 1 Ergin Kocyildirim 2 Ozlem Soran 3 Peter D Wearden 2 Victor O Morell 2 Curt G DeGroff 4 Kerem Pekkan1 5 Department of Biomedical Engineering Carnegie Mellon University 2Section of Pediatric Cardiothoracic Surgery of the Heart Lung and Esophageal Surgical Institute University of Pittsburgh Medical School Children s Hospital of Pittsburgh 3Cardiovascular Institute University of Pittsburgh Pittsburgh Pennsylvania 4Congenital Heart Center University of Florida Gainesville Florida 5Department of Mechanical Engineering Carnegie Mellon University Pittsburgh Pennsylvania United States of America 1 Abstract Objective To investigate the effect of pulsatility of venous flow waveform in the inferior and superior caval vessels on the performance of functional and failing Fontan patients based on two primary performance measures the conduit power loss and the distribution of inferior caval flow hepatic factors to the lungs Methods Doppler angiography flows were acquired from two typical extra cardiac conduit failing Fontan patients aged 13 and 25 years with ventricle dysfunction Using computational fluid dynamics haemodynamic efficiencies of failing functional and in vitro generated mechanically assisted venous flow waveforms were evaluated inside an idealised total cavopulmonary connection with a caval offset To investigate the effect of venous pulsatility alone cardiac output was normalised to 3 litres per minute in all cases To quantify the pulsatile behaviour of venous flows two new performance indices were suggested Results Variations in the pulsatile content of venous waveforms altered the conduit efficiency notably Highfrequency and low amplitude oscillations lowered the pulsatile component of the power losses in failing Fontan flow



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