Pediatric Cardiology and Cardiac Surgery
Vol.26 No.1 2010 (39-48)
Keiichi Itatani,1 Kagami Miyaji,1 Kuniyoshi Ohara,1 and Masahiro Ishii2)
Departments of 1)Cardiovascular Surgery and 2) Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Long-term results and exercise tolerance after the Fontan operation depend largely on the hemodynamic efficiency of its pulmonary circulation without a functional ventricle. Thus, there have been many previous reports about the hemodynamics of Fontan circulation, and CFD (computational fluid dynamics) is one of the most efficient methods. There have been 19 reports of the Fontan CFD model, since 1995. With progress in computer technology and commercially packaged software, precise methods of geometric creation and mesh generation, as well as calculation algorithm have been fully discussed and become well established. Precise evaluation in the preoperative or postoperative period, virtual operation by computer, and definition of the optimal surgical strategies are possible using current technology. However, creation of more physiological models including the effects of respiration, exercise, pulmonary artery impedance, and atrial wall compliance warrants further study, and calculations reflecting multi-factorial systems and long-term predictions including patients’ growth and/or vessel degeneration retain many difficulties even today. Also, energy loss, which was used to evaluate the hemodynamic efficiency in most of the studies, has difficulties in clinical application. More convenient parameters reflecting low-pressure and a low-energy Fontan system should be established.