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Total Cavopulmonary Connection Efficiency: Importance of Pulmonary Artery Diameter
K. R. Kanter1, R. KrishnankuttyRema2, L. P. Dasi2, H. D. Kitajima2, K. Pekkan2, M. Fogel3, K. Whitehead3, S. Sharma4, A. P. Yoganathan2. 1Emory University School of Medicine, Atlanta, GA, 2Georgia Institute of Technology, Atlanta, GA, 3Children's Hospital of Philadelphia, Philadelphia, PA, 4Pediatric Cardiology Services, Lawrenceville, GA,
BACKGROUND:
Large geometric variability exists among total cavopulmonary connections (TCPC) due to patient specificity and the chosen surgical procedure. We examined the geometric and hemodynamic characteristics of extra cardiac (EC) and intra atrial (IA) Fontan surgical options and correlated the anatomic characteristics with their hemodynamic efficiency and patient cardiac index (CI).
METHODS:
The study was conducted retrospectively on 22 Fontan patients (11 ECs and 11 IAs). TCPC geometric parameters such as vessel areas, curvature, and offsets were quantified using a skeletonization method. Energy loss at the TCPC junction was available from previous in vitro experiments and computational flow dynamic simulations for five and nine patients respectively. CI data were available for all patients.
RESULTS:
There was no significant difference between the mean cross sectional areas of all the vessels or minimum PA areas for EC and IA TCPCs as shown in Fig. 1a. The indexed energy dissipation within the TCPC was predominantly a function of the minimum cross-sectional area of the pulmonary arteries (PA) while all other geometric features had lesser influence (R2-value of 0.898 and P<0.0002) as shown in Fig. 1b. As shown in Fig1c, CI is strongly dependent on the minimum PA area (P=0.006) suggesting that TCPC energy loss has a significant impact on cardiac output.
CONCLUSIONS:
The anatomy of TCPC plays a significant role in determining the TCPC performance and the cardiac output irrespective of whether it is EC or IA connection. In particular, the efficiency of TCPC is predominantly a function of the size of the PAs. 
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