Kannojiya Vikas, Sahni Akshita, Eickhoff Emily, Zacharia Neha, St Clair Nicole, Schulz Noah, Hammer Peter E, Del Nido Pedro J, Rathod Rahul H, Hoganson David M, Govindarajan Vijay
Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts, United States.
Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States.
Am J Physiol Heart Circ Physiol. 2025 Jul 1;329(1):H124-H134. doi: 10.1152/ajpheart.00072.2025. Epub 2025 May 5.
Patients with interrupted inferior vena cava (I-IVC) and azygos continuation who undergo Fontan completion via hepatoazygos shunting exhibit unique hemodynamic challenges. This study evaluates age-related shifts in systemic venous return dominance, hepatic flow distribution (HFD), power loss (PL), and flow disturbances using patient-specific computational fluid dynamics (CFD). Data analysis from 95 patients with I-IVC showed a nonlinear shift in upper-to-lower body systemic flow dominance with ratios of 2, 1, and 0.5 (correlating to ages ∼3, ∼10, and ∼20, respectively). CFD simulations for 17 selected patients revealed a trend of increasing HFD toward the right pulmonary artery, with median splits of 45%-49%, 48%-52%, and 40%-60% for the respective flow ratios. Power loss increased significantly with lower-body flow dominance. Median values for absolute PL were 4.75 mW (ratio 2), 16.5 mW (ratio 1), and 33.7 mW (ratio 0.5). Indexed PL showed a similar trend, rising from 0.04 mW/m to 0.11 mW/m across the flow ratios. Vorticity and viscous dissipation rates, key metrics of flow disturbances, also increased with lower-body flow dominance, showing strong correlations with PL ( = 0.58-0.76). Kruskal-Wallis-based statistical analysis identified significant statistical differences in absolute PL ( = 0.0045) and flow disturbances ( < 0.001), emphasizing the impact of age-related flow dynamics on Fontan efficiency. Our findings emphasize the need for targeted interventions in patients with I-IVC with azygos continuation to mitigate evolving hemodynamic inefficiencies and optimize Fontan outcomes during critical growth periods. Evaluate how age-driven changes in patients with interrupted inferior vena cava impact Fontan efficiency. Using patient-specific computational fluid dynamics, our study reveals nonlinear flow dynamics, increasing power loss, and evolving hepatic flow distribution, emphasizing the need for tailored interventions to optimize outcomes.
患有下腔静脉中断（I-IVC）且奇静脉延续并通过肝奇静脉分流完成Fontan手术的患者面临独特的血流动力学挑战。本研究使用患者特异性计算流体动力学（CFD）评估了全身静脉回流优势、肝血流分布（HFD）、功率损失（PL）和血流紊乱随年龄的变化。对95例I-IVC患者的数据分析显示，上下半身全身血流优势呈非线性变化，比例分别为2、1和0.5（分别对应年龄约3岁、约10岁和约20岁）。对17例选定患者的CFD模拟显示，HFD向右肺动脉增加的趋势，各血流比例的中位数分流分别为45%-49%、48%-52%和40%-60%。功率损失随下半身血流优势显著增加。绝对PL的中位数分别为4.75 mW（比例2）、16.5 mW（比例1）和33.7 mW（比例0.5）。指数PL显示出类似趋势，在各血流比例中从0.04 mW/m上升至0.11 mW/m。作为血流紊乱关键指标的涡度和粘性耗散率也随下半身血流优势增加，与PL显示出强相关性（=0.58-0.76）。基于Kruskal-Wallis的统计分析确定了绝对PL（=0.0045）和血流紊乱（<0.001）存在显著统计学差异，强调了年龄相关血流动力学对Fontan效率的影响。我们的研究结果强调，对于奇静脉延续的I-IVC患者，需要进行有针对性的干预，以减轻不断演变的血流动力学低效情况，并在关键生长阶段优化Fontan手术结果。评估下腔静脉中断患者年龄驱动的变化如何影响Fontan效率。通过患者特异性计算流体动力学，我们的研究揭示了非线性血流动力学、增加的功率损失和不断演变的肝血流分布，强调了需要进行量身定制的干预以优化结果。
