Faculty, Staff and Student Publications

Language

English

Publication Date

7-1-2025

Journal

American Journal of Physiology-Heart and Circulatory Physiology

DOI

10.1152/ajpheart.00072.2025

PMID

40323666

PMCID

PMC12165781

PubMedCentral® Posted Date

7-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Patients with interrupted inferior vena cava (I-IVC) and azygos continuation who undergo Fontan completion via hepatoazygos shunting exhibit unique hemodynamic challenges. This study evaluates age-related shifts in systemic venous return dominance, hepatic flow distribution (HFD), power loss (PL), and flow disturbances using patient-specific computational fluid dynamics (CFD). Data analysis from 95 patients with I-IVC showed a nonlinear shift in upper-to-lower body systemic flow dominance with ratios of 2, 1, and 0.5 (correlating to ages ∼3, ∼10, and ∼20, respectively). CFD simulations for 17 selected patients revealed a trend of increasing HFD toward the right pulmonary artery, with median splits of 45%–49%, 48%–52%, and 40%–60% for the respective flow ratios. Power loss increased significantly with lower-body flow dominance. Median values for absolute PL were 4.75 mW (ratio 2), 16.5 mW (ratio 1), and 33.7 mW (ratio 0.5). Indexed PL showed a similar trend, rising from 0.04 mW/m2 to 0.11 mW/m2 across the flow ratios. Vorticity and viscous dissipation rates, key metrics of flow disturbances, also increased with lower-body flow dominance, showing strong correlations with PL (R = 0.58–0.76). Kruskal–Wallis-based statistical analysis identified significant statistical differences in absolute PL (P = 0.0045) and flow disturbances (P < 0.001), emphasizing the impact of age-related flow dynamics on Fontan efficiency. Our findings emphasize the need for targeted interventions in patients with I-IVC with azygos continuation to mitigate evolving hemodynamic inefficiencies and optimize Fontan outcomes during critical growth periods.   NEW & NOTEWORTHY Evaluate how age-driven changes in patients with interrupted inferior vena cava impact Fontan efficiency. Using patient-specific computational fluid dynamics, our study reveals nonlinear flow dynamics, increasing power loss, and evolving hepatic flow distribution, emphasizing the need for tailored interventions to optimize outcomes.

Keywords

Humans, Fontan Procedure, Vena Cava, Inferior, Hemodynamics, Azygos Vein, Adolescent, Male, Female, Child, Child, Preschool, Age Factors, Heart Defects, Congenital, Models, Cardiovascular, Young Adult, Adult, Infant, Liver Circulation, Patient-Specific Modeling

Published Open-Access

yes

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