Optimization of the total cavopulmonary connection using a compliant-walled computational model

Summary form only given. Each year about 1 out of every 100 children are born with complex congenital defects of the heart. About 20% of these cases take the form of a univentricular heart where only one functional ventricle has formed. In these cases, both the pulmonary and systemic circulations empty into the single ventricle causing oxygenated and unoxygenated blood to mix in the heart. This mixture is subsequently pumped to both circulations, thus impairing the right heart atriopulmonary pathway and, therefore, cardiopulmonary function. The correction for this defect is based on a palliative correction for tricuspid atresia implemented by Fontan and Baudet in 1971. Since it was first implemented, procedures to correct the atriopulmonary pathway have come to be known as Fontans. The current modification of choice, adopted for hemodynamic reasons, bypasses the right atrium (RA). Known as the total cavo-pulmonary connection (TCPC), it is carried out by transecting the superior vena cava (SVC) and attaching it to the right pulmonary artery (RPA) by an end-to-side anastomosis. Then the inferior vena cava (IVC) is attached to the left pulmonary artery (LPA) via an extra-cardiac shunt or a lateral tunnel through the RA. This research focuses on determining the optimal configuration for long-term use of the TCPC on a per-patient basis using computational methods to model arterial blood flow. Our goal is to develop a model that incorporates both the general characteristics of the pulmonary system, such as vascular compliance, and the specific geometry of each patient's anatomy. The latter can prove difficult since meshing a geometry as complex as the pulmonary tree can be an involved and time-consuming process. Our goal is to automate the process by simplifying meshing of this complex geometry and developing a physical model will produce consistently accurate and viable results for a wide range of physiologic conditions with minimal input.