The Fontan operation is one in which the right heart is bypassed leaving the left ventricle to drive the blood through both the capillaries and the lungs, making it important to design an operation which is hemodynamically efficient. The object here was to relate the pressure in Fontan connections to its geometry with the aim of increasing the hemodynamically efficiency. From CT or magnetic resonance images, glass models were made of realistic atrio-pulmonary (AP) and cavo-pulmonary (CP) connections in which the right atrium and/or ventricle are bypassed. The glass models were connected to a steady flow loop and flow visualization, pressure and 3 component LDA measurements made. In the AP model the large atrium and curvature of the conduit created swirling patterns, the magnitude of which was similar to the axial velocity. This led to an inefficient flow and a subsequent large pressure loss (780 Pa). In contrast, the CP connection with a small intra-atrial chamber had reduced swirling and a significantly smaller pressure loss (400 Pa at 8 l.min) and was therefore a more efficient connection. There were, however, still pressure losses and it was found that these occurred where there was a large bending of the flow, such as from the superior vena cava to the MPA and from the MPA to the right pulmonary artery.

1.
Agarwal
K. C.
,
Edwards
W. D.
,
Feldt
R. H.
,
Danielson
G. K.
,
Puga
F. J.
, and
McGoon
D. C.
,
1981
, “
Clinicopathological Correlates of Obstructed Right-Sided Porcine-Valved Extracardiac Conduits
,”
J Thorac Cardiovasc Surg
, Vol.
81
, pp.
591
601
.
2.
Bjork
V. O.
,
Olin
C. L.
,
Bjarke
B. B.
,
Thoren
C. A.
,
1979
, “
Right Atrial-Right Ventricular Anastomosis for Correction of Tricuspid Atresia
,”
J Thorac Cardiovasc Surg
, Vol.
77
, pp.
452
459
.
3.
De Leval
M. R.
,
Kilner
P.
,
Gewillig
M.
,
Bull
C.
,
1988
, “
Total Cavopulmonary Connection: A Logical Alternative to Atriopulmonary Connection for Complex Fontan Operations
,”
J Thorac Cardiovasc Surg
, Vol.
96
, pp.
682
695
.
4.
Dobell
A. R.
,
Trusler
G. A.
,
Smallhorn
J. F.
, and
Williams
W. G.
,
1986
, “
Atrial Thrombi After the Fontan Operation
,”
Ann Thorac Surg
, Vol.
42
, pp.
664
667
.
5.
Fontan
F.
, and
Baudet
E.
,
1971
, “
Surgical Repair of Tricuspid Atresia
,”
Thorax
, Vol.
26
, pp.
240
248
.
6.
Fyfe
D. A.
,
Kline
C. H.
,
Sade
R. M.
, and
Gillette
P. C.
,
1991
, “
Transesophageal Echocardiography Detects Thrombus Formation not Identified by Transthoracic Echocardiography after the Fontan Operation
,”
JACC
, Vol.
18
, pp.
1733
1737
.
7.
Gale
A. W.
,
Danielson
D. C.
,
McGoon
D. C.
, and
Mair
D. D.
,
1979
, “
Modified Operation for Univentricular Heart and Complicated Congenital Lesions
,”
J Thorac Cardiovasc Surg
, Vol.
78
, pp.
831
838
.
8.
Hoffman, J. I. E., 1987, Incidence. In Anderson, R. H., Macartney, F. J., Shinebourne, E. A., and Tynan, M. (eds.). Pediatric Cardiology, Vol. 1. London: Churchill Livingstone, p. 4.
9.
Hopkins
R. A.
,
Armstrong
B. E.
,
Serwer
G. A.
,
Peterson
R. J.
, and
Oldham
H. N.
,
1985
, “
Physiological Rationale for a Bidirectional Cavopulmonary Shunt: A Versatile Complement to the Fontan Principle
,”
J Thorac Cardiovasc Surg
, Vol.
90
, pp.
391
398
.
10.
Kreutzer
G.
,
Galindez
E.
,
Bono
H.
,
de Palma
C.
, and
Laura
J. P.
,
1973
, “
An Operation for the Correction of Tricuspid Atresia
,”
J Thorac Cardiovasc Surg.
, Vol.
66
, pp.
613
621
.
11.
Low
H. T.
,
Chew
Y. T.
, and
Lee
C. N.
,
1993
, “
Flow Studies on Atriopulmonary and Cavopulmonary Connections of the Fontan Operations for Congenital Heart Defects
,”
J Biomed Eng
, Vol.
15
, pp.
303
307
.
12.
Muster
A. J.
,
Zales
V. R.
,
Ilbawi
M. N.
,
Backer
C. L.
,
Duffy
C. E.
,
Mavroudis
C.
,
1993
, “
Biventricular Repair of Hypoplastic Right Ventricle Assisted by Pulsatile Bidirectional Cavopulmonary Anastomosis
,”
Circ
Vol.
105
, pp.
112
119
.
13.
Pearl, J., Haas, G., Laks, H., and Drinkwater, D., 1991, Management of Complications of Extracardac Conduits. In Waldhausen, J. A., and Orringer, M. B., eds., Complications in Cardiothoracic Surgery, St. Louis. Mosby, pp. 212–223.
14.
Pearl
J. M.
,
Laks
H.
,
Stein
D. G.
,
Drinkwater
D. C.
,
George
B. L.
, and
Williams
R. G.
,
1991
, “
Total Cavopulmonary Anastomosis Versus Conventional Modified Fontan Procedure
,
Ann Thorac Surg.
, Vol.
52
, pp.
180
196
.
15.
Shannon
F. L.
,
Campell
D. N.
, and
Clarke
D. R.
,
1986
, “
Right Atrial Thrombosis: Rare Complication of the Modified Fontan
,”
Pediatr Cardiol
, Vol.
7
, pp.
209
212
.
16.
Shemin
R. J.
,
Merrill
W. H.
,
Pfeifer
J. S.
,
Conkle
D. M.
, and
Morrow
A. G.
,
1979
, “
Evaluation of Right Atrial-Pulmonary Artery Conduits for Tricuspid Atresia
,
J. Thorac Cardio. Vasc. Surg.
, Vol.
78
, pp.
685
690
.
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