Zhang Yong, Fang Minhua, Wang Zengwei, Liu Yu, Zhang Chunzhen, Wang Zhenlong, Wang Huishan
Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Front Physiol. 2022 Nov 24;13:1078140. doi: 10.3389/fphys.2022.1078140. eCollection 2022.
This study applied preoperative computed tomography angiography (CTA) and computational fluid dynamics (CFD) simulation to predicte and verify the outcome of Y-shaped extracardiac conduits Fontan for functional single ventricle. Based on the preoperative CTA data of functional single ventricle (FSV), 4 types of spatial structures of extracardiac conduits were designed for 4 experimental groups: Group A, a traditional TCPC group (20 mm); Group B, a diameter-preserving Y-shaped TCPC (YCPC) group (branch 10 mm); Group C, YCPC group (branch 12 mm); and Group D, an area-preserving YCPC group (branch14 mm). Four indicators including flow velocity, pressure gradient (PG), energy efficiency and inferior vena cava (IVC) blood flow distribution were compared. The optimal procedure was applied. The radionuclide lung perfusion, CTA, echocardiography, cardiovascular angiography and catheterization were performed postoperatively. There were the lowest PG, the lowest flow velocity of branches, the highest energy efficiency, and a relatively balanced and stable distribution of IVC flow for group D. Subsequently, the group D, a handcrafted Y-shaped conduit (14 mm) was used for the YCPC procedure. There was no postoperative PG between the conduit and pulmonary artery with normal pressure and resistance. IVC flow was distributed uniformly. CTA-based CFD provided more guidance for the clinical application of TCPC. A comprehensive surgical design could bring good postoperative outcome. Area-preserving YCPC has more advantages than TCPC and the diameter-preserving YCPC. The study effectively improved the feasibility of clinical applications of YCPC.
本研究应用术前计算机断层血管造影（CTA）和计算流体动力学（CFD）模拟来预测和验证Y形心外管道Fontan手术治疗功能性单心室的结果。基于功能性单心室（FSV）的术前CTA数据，为4个实验组设计了4种心外管道的空间结构：A组，传统全腔静脉-肺动脉连接术（TCPC）组（20mm）；B组，保留直径的Y形TCPC（YCPC）组（分支10mm）；C组，YCPC组（分支12mm）；D组，保留面积的YCPC组（分支14mm）。比较了包括流速、压力梯度（PG）、能量效率和下腔静脉（IVC）血流分布在内的4项指标。采用了最佳手术方案。术后进行了放射性核素肺灌注、CTA、超声心动图、心血管造影和心导管检查。D组的PG最低，分支流速最低，能量效率最高，IVC血流分布相对平衡稳定。随后，D组采用手工制作的Y形管道（14mm）进行YCPC手术。管道与肺动脉之间术后PG正常，压力和阻力正常。IVC血流分布均匀。基于CTA的CFD为TCPC的临床应用提供了更多指导。综合手术设计可带来良好的术后效果。保留面积的YCPC比TCPC和保留直径的YCPC具有更多优势。本研究有效提高了YCPC临床应用的可行性。
