Norwood with right ventricle-to-pulmonary artery conduit is more effective than Norwood with Blalock-Taussig shunt for hypoplastic left heart syndrome: mathematic modeling of hemodynamics

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
Tomasz MroczekJanusz Skalski

Abstract

The introduction of right ventricle to pulmonary artery (RV-PA) conduit in the Norwood procedure for hypoplastic left heart syndrome resulted in a higher survival rate in many centers. A higher diastolic aortic pressure and a higher mean coronary perfusion pressure were suggested as the hemodynamic advantage of this source of pulmonary blood flow. The main objective of this study was the comparison of two models of Norwood physiology with different types of pulmonary blood flow sources and their hemodynamics. Based on anatomic details obtained from echocardiographic assessment and angiographic studies, two three-dimensional computer models of post-Norwood physiology were developed. The finite-element method was applied for computational hemodynamic simulations. Norwood physiology with RV-PA 5-mm conduit and Blalock-Taussig shunt (BTS) 3.5-mm shunt were compared. Right ventricle work, wall stress, flow velocity, shear rate stress, energy loss and turbulence eddy dissipation were analyzed in both models. The total work of the right ventricle after Norwood procedure with the 5-mm RV-PA conduit was lower in comparison to the 3.5-mm BTS while establishing an identical systemic blood flow. The Qp/Qs ratio was higher in the BTS group....Continue Reading

References

Sep 1, 1981·The Annals of Thoracic Surgery·D M Behrendt, A Rocchini
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May 20, 2003·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Edward MalecTomasz Mroczek
Jun 28, 2003·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Christian Pizarro, William I Norwood
Aug 21, 2003·The Journal of Thoracic and Cardiovascular Surgery·Shunji SanoShin-ichi Ohtsuki
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May 18, 2005·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Katarzyna JanuszewskaEdward Malec
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May 28, 2010·The New England Journal of Medicine·Richard G OhyeUNKNOWN Pediatric Heart Network Investigators

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Citations

Feb 13, 2013·The Journal of Thoracic and Cardiovascular Surgery·Katja M GistJames Jaggers
Jun 25, 2014·Journal of the American Heart Association·Phillip T BurchUNKNOWN Pediatric Heart Network Investigators

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