Liang Fuyou, Senzaki Hideaki, Yin Zhaofang, Fan Yuqi, Sughimoto Koichi, Liu Hao
SJTU-CU International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.
ScientificWorldJournal. 2013 Nov 10;2013:486815. doi: 10.1155/2013/486815. eCollection 2013.
The clinical benefits of the Fontan operation in treating single-ventricle defects have been well documented. However, perioperative mortality or morbidity remains a critical problem. The purpose of the present study was to identify the cardiovascular factors that dominate the transient hemodynamic changes upon the change of a bidirectional cavopulmonary (Glenn) anastomosis (BCPA) into a total cavopulmonary connection (TCPC). For this purpose, two computational models were constructed to represent, respectively, a single-ventricle circulation with a BCPA and that with a TCPC. A series of model-based simulations were carried out to quantify the perioperative hemodynamic changes under various cardiovascular conditions. Obtained results indicated that the presence of a low pulmonary vascular resistance and/or a low lower-body vascular resistance is beneficial to the increase in transpulmonary flow upon the BCPA to TCPC change. Moreover, it was found that ventricular diastolic dysfunction and mitral valve regurgitation, despite being well-known risk factors for poor postoperative outcomes, do not cause a considerable perioperative reduction in transpulmonary flow. The findings may help physicians to assess the perioperative risk of the TCPC surgery based on preoperative measurement of cardiovascular function.
Fontan手术治疗单心室缺损的临床益处已有充分记录。然而，围手术期死亡率或发病率仍然是一个关键问题。本研究的目的是确定在双向腔肺（Glenn）吻合术（BCPA）转变为全腔肺连接（TCPC）时主导短暂血流动力学变化的心血管因素。为此，构建了两个计算模型，分别代表具有BCPA的单心室循环和具有TCPC的单心室循环。进行了一系列基于模型的模拟，以量化各种心血管条件下的围手术期血流动力学变化。获得的结果表明，低肺血管阻力和/或低体循环血管阻力的存在有利于在BCPA转变为TCPC时肺血流量的增加。此外，研究发现，尽管心室舒张功能障碍和二尖瓣反流是术后不良结局的众所周知的危险因素，但它们不会导致围手术期肺血流量显著减少。这些发现可能有助于医生根据术前心血管功能测量评估TCPC手术的围手术期风险。
