EFFECT OF GEOMETRY, RESPIRATION AND VESSEL DEFORMABILITY ON FONTAN HEMODYNAMICS: A NUMERICAL INVESTIGATION

Abstract

Single ventricle (SV) congenital heart defects occur in 2 of every 1000 live births in the US. The Fontan procedure, the common palliation of single ventricle heart defect patients, results in the bypass the right ventricle, completing the total cavopulmonary connection (TCPC). Even though this procedure results in favorable short-term outcomes, Fontan patients are subjected to a series of long-term complications, including reduced exercise capacity and life expectancy. The exact causes of these long-term complications are not clear, but some are attributed to the unfavorable hemodynamics in the TCPC. In this thesis, the impact of geometry, respiration-driven flow, and vessel wall deformability on TCPC hemodynamics was evaluated and compared. First, the impact of patient specific geometry was studied by characterizing the patient specific anatomic features of a large patient cohort of TCPCs obtained from cardiac magnetic resonance (CMR) images. Second, the influence of respiratory-driven flow was investigated by comparing TCPC hemodynamics simulated using a vessel flow waveform obtained from both free-breathing and breath-held phase-contrast CMR acquisitions. Third, the effect of wall deformability was studied by comparing TCPC hemodynamics under rigid wall and compliant wall conditions. At the end of this thesis, the impact of patient specific geometry, flow pulsatility, respiration, and wall compliance on TCPC hemodynamics was discussed.