The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection

Frontiers in Cardiovascular Medicine

article

Séline F. S. van der Woude¹  Friso M. Rijnberg²  Mark G. Hazekamp²  Monique R. M. Jongbloed³  Sasa Kenjeres⁴  Hildo J. Lamb⁵  Jos J. M. Westenberg⁵  Arno A. W. Roest⁶  Jolanda J. Wentzel¹ 

[1] Department of Cardiology, Biomedical Engineering, Biomechanics Laboratory;Department of Cardiothoracic Surgery, Leiden University Medical Center;Department of Anatomy, Leiden University Medical Center;Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J. M. Burgerscentrum Research School for Fluid Mechanics;Department of Radiology, Leiden University Medical Center;Department of Pediatric Cardiology, Leiden University Medical Center

关键词: Fontan;    total cavopulmonary connection;    respiration;    physiology;    flow imaging;    MRI;    hepatic veins;    blood flow;    extracardiac conduit Fontan;   

DOI  :  10.3389/fcvm.2021.683849

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Congenital heart disease is the most common birth defect and functionally univentricular heart defects represent the most severe end of this spectrum. The Fontan circulation provides an unique solution for single ventricle patients, by connecting both caval veins directly to the pulmonary arteries. As a result, the pulmonary circulation in Fontan palliated patients is characterized by a passive, low-energy circulation that depends on increased systemic venous pressure to drive blood toward the lungs. The absence of a subpulmonary ventricle led to the widely believed concept that respiration, by sucking blood to the pulmonary circulation during inspiration, is of great importance as a driving force for antegrade blood flow in Fontan patients. However, recent studies show that respiration influences pulsatility, but has a limited effect on net forward flow in the Fontan circulation. Importantly, since MRI examination is recommended every 2 years in Fontan patients, clinicians should be aware that most conventional MRI flow sequences do not capture the pulsatility of the blood flow as a result of the respiration. In this review, the unique flow dynamics influenced by the cardiac and respiratory cycle at multiple locations within the Fontan circulation is discussed. The impact of (not) incorporating respiration in different MRI flow sequences on the interpretation of clinical flow parameters will be covered. Finally, the influence of incorporating respiration in advanced computational fluid dynamic modeling will be outlined.

【 授权许可】

CC BY