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Preliminary Evaluation of Hemodynamic Effects of fontan palliation on Renal Artery Using Computational Fluid Dynamics

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Congenital Heart Disease 2023年第1期18卷 41-55页

作者： Jinlong Liu Jing Shi Weiru Luo Zhirong Tong Lefei Yang Peixuan Sun Tianyi Li Jun Du Qian Wang Institute of Pediatric Translational Medicine Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Department of Imaging Diagnosis Center Shanghai Children's Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina

Background:The assessment of renal function is important to the prognosis of patients needing fontan palliation due to the reconstructed compromised *** know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury(AKI)and the postoperative ***,the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery(RA).Methods:We reconstructed a three-dimensional(3D)vascular model of a patient requiring fontan *** technique of computational fluid dynamics(CFD)was utilized to explore the changes of RA hemodynamics under different possible blood flow *** relationship between the kidney perfusion and hemodynamic characteristics was ***:The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate *** the flow rate decreased to two-thirds of its baseline,both the pressure of left renal artery(LRA)and the pressure of right renal artery(RRA)dipped below 50%,and the pressure of RRA fell more quickly than that of *** distribution of WSS was observed on the trunk of RA,and the lowest WSS was found at the distal of *** average WSS in RA dropped to around 50%as the flow rate reached one-third of its ***:As a promising approach,CFD can be utilized to quantitatively evaluate the hemodynamic characteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function,to help realize better prognosis for the patients with fontan palliation.

关键词： Renal artery fontan palliation hemodynamics computational fluid dynamics surgical design

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Comparison of 2D and 4D Flow MRI Measurements for Hemodynamic Evaluation of the fontan palliation

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Congenital Heart Disease 2023年第6期18卷 627-638页

作者： Elisa Listo Nicola Martini Stefano Salvadori Elisa Valenti Nicola Stagnaro Gianluca Trocchio Chiara Marrone Alberto Clemente Francesca Raimondi Pierluigi Festa Lamia Ait Ali Department of Radiology IRCCS Istituto Giannina GasliniGenovaItaly U.O.C.Bioingegneria Gabriele Monasterio CNR-Tuscany FoundationPisaItaly Institute of Clinical Physiology CNR PisaItaly Cardiology Unit IRCCS Istituto Giannina GasliniGenovaItaly Pediatric Cardiology and GUCH Unit Massa Gabriele Monasterio CNR-Tuscany FoundationMassaItaly Gabriele Monasterio CNR-Tuscany Foundation PisaItaly Department of Cardiology Azienda Ospedaliero-Universitaria MeyerFlorenceItaly Institute of Clinical Physiology CNR MassaItaly

Background:The assessment of fontan circuit’sﬂow is traditionally evaluated by multiple through-plane phase-contrast MRI acquisitions(2Dﬂow),while recently,a single volumetric 4D-ﬂow MRI acquisition is emerging as a comprehensive tool for the hemodynamic evaluation in congenital heart ***:To compare 2D and 4D-ﬂow MRI measurements in patients after fontan palliation and to evaluate parameters affecting potential ***:39 patients after fontan palliation(23 males,age 22±11 years)who underwent cardiac MRI with 2D and 4D-ﬂow MRI acquisition were included in the *** all patients,bloodﬂow quantiﬁcation in the fontan circuit and aorta by 2Dﬂow and by 4Dﬂow MRI acquisition blinding to the 2D results was *** agreement between 2D and 4D-ﬂow MRI was calculated as the intraclass correlation coefﬁcient(ICC).The mean absolute differences between 4D and 2Dﬂows were analyzed using linear regression ***:4D-ﬂow MRI acquisition time was slightly lower than 2D(7.6±1.8 min vs.9.4±3.3 min,p=0.03).Flow was slightly predominant in the right pulmonary artery(58%of total pulmonaryﬂow).Conduit/tunnel-pul-monary arteriesﬂow accounted for 60%of the fontan *** between 2D and 4D was overall good-to-excellent from ICC:0.81795%CI:0.637–0.907 to 0.93295%CI:0.866–*** was no signiﬁcant inﬂu-ence of evaluated parameters on the agreement on 4D and 2Dﬂ***:4D-ﬂow MRI represents a valid tool in fontan’sﬂow quantiﬁ*** larger studies are needed to conﬁrm our results and to evaluate the impact of advanced 4D-ﬂow MRI parameters on the prognostic stratiﬁcation in patients after fontan palliation.

关键词： fontan palliation fontanﬂows 4Dﬂow MRI 2Dﬂow MRI cardiac magnetic resonance

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