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Wang J, Dong S, Yan J. Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage. CONGENIT HEART DIS 2021. [DOI: 10.32604/chd.2021.015016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Wei ZA, Johnson C, Trusty P, Stephens M, Wu W, Sharon R, Srimurugan B, Kottayil BP, Sunil GS, Fogel MA, Yoganathan AP, Kappanayil M. Comparison of Fontan Surgical Options for Patients with Apicocaval Juxtaposition. Pediatr Cardiol 2020; 41:1021-1030. [PMID: 32377893 PMCID: PMC7325867 DOI: 10.1007/s00246-020-02353-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
Apicocaval juxtaposition (ACJ) is a rare form of viscerocardiac malpositions in association with single-ventricle congenital heart defects. The Fontan surgery is the common palliation, and possible surgical options include ipsilateral, contralateral, and intra-atrial conduits. Concerns include lower hemodynamic performances or risks of conduit compression by the cardiac mass. This study investigates the hemodynamics and clinical outcomes of ACJ patients and potential surgical improvements. Ten consecutive ACJ patients were included, along with a reference cohort of ten non-ACJ patients. Magnetic resonance images were acquired at 6 ± 0.6 year follow-up for anatomical analysis and hemodynamic assessments using computational fluid dynamics. Metrics of interest are deformation index (DI), indexed power loss (iPL), and hepatic flow distribution (HFDoff). A "virtual" surgery was performed to explore potential hemodynamic improvements using a straightened conduit. DI for ACJ patients fell within the DI range of non-ACJ patients. Contralateral conduits had insignificantly higher iPL (0.070 [0.032,0.137]) than ipsilateral conduits (0.041 [0.013,0.095]) and non-ACJ conduits (0.034 [0.011,0.061]). HFDoff was similar for the ipsilateral (21 [12,35]), contralateral (26 [7,41]), and non-ACJ Fontan conduits (17 [0,48]). Virtual surgery demonstrated that a straightened conduit reduced HFDoff and iPL for the contralateral and ipsilateral conduits, potentially leading to improved clinical outcomes. In this limited sample, the hemodynamic performance of ACJ patients was not significantly different from their non-ACJ counterparts. The use of a straightened conduit option could potentially improve patient outcomes. Additionally, the fear of significant compression of conduits for ACJ patients was unsupported.
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Affiliation(s)
- Zhenglun Alan Wei
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Camille Johnson
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Phillip Trusty
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Morgan Stephens
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Wenjun Wu
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Ritchie Sharon
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Balaji Srimurugan
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | | | - G S Sunil
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Mark A Fogel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
| | - Mahesh Kappanayil
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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