Haemodynamic performance of 16-20-mm extracardiac Goretex conduits in adolescent Fontan patients at rest and during simulated exercise

• Published in: European journal of cardio-thoracic surgery 2022-12, Vol.63 (1)
• Main Authors: Rijnberg, Friso M, van 't Hul, Luca C, Hazekamp, Mark G, van den Boogaard, Pieter J, Juffermans, Joe F, Lamb, Hildo J, Terol Espinosa de Los Monteros, Covadonga, Kroft, Lucia J M, Kenjeres, Sasa, le Cessie, Saskia, Jongbloed, Monique R M, Westenberg, Jos J M, Roest, Arno A W, Wentzel, Jolanda J
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Congenital; Fontan Procedure; Heart Defects, Congenital - surgery; Hemodynamics; Humans; Oxygen; Pulmonary Artery - surgery; Vena Cava, Superior - surgery
• ISSN: 1873-734X; 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezac522

To date, it is not known if 16-20-mm extracardiac conduits are outgrown during somatic growth from childhood to adolescence. This study aims to determine total cavopulmonary connection (TCPC) haemodynamics in adolescent Fontan patients at rest and during simulated exercise and to assess the relationship between conduit size and haemodynamics. Patient-specific, magnetic resonance imaging-based computational fluid dynamic models of the TCPC were performed in 51 extracardiac Fontan patients with 16-20-mm conduits. Power loss, pressure gradient and normalized resistance were quantified in rest and during simulated exercise. The cross-sectional area (CSA) (mean and minimum) of the vessels of the TCPC was determined and normalized for flow rate (mm2/l/min). Peak (predicted) oxygen uptake was assessed. The median age was 16.2 years (Q1-Q3 14.0-18.2). The normalized mean conduit CSA was 35-73% smaller compared to the inferior and superior vena cava, hepatic veins and left/right pulmonary artery (all P