In Vitro Ultrasound Measurements of Powered and Unpowered Total Cavopulmonary Connection

Three-staged Fontan palliation is performed on children suffering from single ventricle congenital heart disease. The series of surgical procedures reroutes blood from the vena cavae directly to the pulmonary arteries, creating a total cavopulmonary connection (TCPC). A viscous impeller pump (VIP) is currently being developed as a cavopulmonary assist device that can modestly augment cavopulmonary flow, reduce systemic venous pressure, and improve ventricular preload. This study used ultrasound to visualize complex flow patterns in powered and unpowered in vitro mock Fontan circulations. The idealized TCPC was modeled with a silicone mold and blood analog made of water and glycerol that was seeded with 10-μm glass beads. B-mode, color Doppler, and pulsed-wave Doppler images were used to visualize complex flow patterns in the idealized TCPC with (1) no VIP, (2) static VIP, and powered VIP rotation rates of (3) 500 and (4) 2,000 rotations per minute (RPM). Pulsed-wave Doppler data showed higher mean velocities and greater variance in the outlets relative to the larger inlets. The maximum inlet velocity ± SD increased from 10.9 ± 3.53 cm/s with no VIP to 15.9 ± 1.03 when the VIP was rotating at 2,000 RPM. Likewise, the maximum outlet velocity increased from 14.9 ± 11.2 cm/s to 18.9 ± 7.25 cm/s at 2,000 RPM. The faster mean velocities with the VIP rotating suggest that the pump augments cavopulmonary flow. The results of this study suggest that measuring complex flow patterns with ultrasound in vivo could be used clinically to optimize VIP positioning and rotation rate during and after implantation

Cor triatriatum and lipomatous hypertrophy of the interatrial septum in the elderly: a case report

Cor triatriatum is a rare congenital heart defect characterized by the presence of a fibromuscular membrane dividing the left atrium into two distinct chambers. Lipomatous hypertrophy of the atrial septum is an infrequently observed benign abnormality caused by large fatty tissue deposits in the interatrial septum. An increased incidence of atrial arrhythmias is described in both pathologies, while a significant obstruction of blood flow mimicking mitral stenosis is typically manifested in cor triatriatum. We report the case of a 75-year-old woman with a previously undescribed association of the above stated abnormalities detected by both transthoracic and transeosophageal echocardiography. Diagnosis was confirmed by means of computed tomography. The singular physiologic and anatomic factors underlying survival until such a late age are described. The diagnostic, therapeutic and surgical management is discussed and a short review of the literature performed

In Vitro Ultrasound Measurements of Powered and Unpowered Total Cavopulmonary Connection

Three-staged Fontan palliation is performed on children suffering from single ventricle congenital heart disease. The series of surgical procedures reroutes blood from the vena cavae directly to the pulmonary arteries, creating a total cavopulmonary connection (TCPC). A viscous impeller pump (VIP) is currently being developed as a cavopulmonary assist device that can modestly augment cavopulmonary flow, reduce systemic venous pressure, and improve ventricular preload. This study used ultrasound to visualize complex flow patterns in powered and unpowered in vitro mock Fontan circulations. The idealized TCPC was modeled with a silicone mold and blood analog made of water and glycerol that was seeded with 10-μm glass beads. B-mode, color Doppler, and pulsed-wave Doppler images were used to visualize complex flow patterns in the idealized TCPC with (1) no VIP, (2) static VIP, and powered VIP rotation rates of (3) 500 and (4) 2,000 rotations per minute (RPM). Pulsed-wave Doppler data showed higher mean velocities and greater variance in the outlets relative to the larger inlets. The maximum inlet velocity ± SD increased from 10.9 ± 3.53 cm/s with no VIP to 15.9 ± 1.03 when the VIP was rotating at 2,000 RPM. Likewise, the maximum outlet velocity increased from 14.9 ± 11.2 cm/s to 18.9 ± 7.25 cm/s at 2,000 RPM. The faster mean velocities with the VIP rotating suggest that the pump augments cavopulmonary flow. The results of this study suggest that measuring complex flow patterns with ultrasound in vivo could be used clinically to optimize VIP positioning and rotation rate during and after implantation

Computational Fluid Dynamics Turbulence Model and Experimental Study for a Fontan Cavopulmonary Assist Device

Head-flow HQ curves for a Fontan cavopulmonary assist device (CPAD) were measured using a blood surrogate in a mock circulatory loop and simulated with various computational fluid dynamics (CFD) models. The tests benchmarked the CFD tools for further enhancement of the CPAD design. Recommended Reynolds-Averaged Navier-Stokes (RANS) CFD approaches for the development of conventional ventricular assist devices (VAD) were found to have shortcomings when applied to the Fontan CPAD, which is designed to neutralize off-condition obstruction risks that could contribute to a major adverse event. The no-obstruction condition is achieved with a von Karman pump, utilizing large clearances and small blade heights, which challenge conventional VAD RANS-based CFD hemodynamic simulations. High-fidelity large eddy simulation (LES) is always recommended; however, this may be cost-inhibitive for optimization studies in commercial settings, thus the reliance on RANS models. This study compares head and power predictions of various RANS turbulence models, employing experimental measurements and LES results as a basis for comparison. The models include standard k-ϵ, re-normalization group k-ϵ, realizable k-ϵ, shear stress transport (SST) k-ω, SST with transitional turbulence, and Generalized k-ω. For the pressure head predictions, it was observed that the standard k-ϵ model provided far better agreement with experiment. For the rotor torque, k-ϵ predictions were 30% lower than LES, while the SST and LES torque values were near identical. For the Fontan CPAD, the findings support using LES for the final design simulations, k-ϵ model for head and general flow simulation, and SST for power, shear stress, hemolysis, and thrombogenicity predictions