Computational fluid dynamics, congenital heart diseases, Fontan hemodynamics, medical imaging
Single ventricle (SV) congenital heart defects are present in two of every 1000 live births in the US. In this condition the systemic and pulmonary blood flow mix in the functional ventricle, resulting in insufficient blood oxygen saturation for sustaining life. This is corrected in a series of palliative surgical procedures that results in the total cavopulmonary connection (TCPC), where the venous returns are directed to the pulmonary arteries bypassing the right heart. Even though this procedure has improved life expectancy, there are still numerous long term complications. To improve patient quality of life, several studies have aimed to understand the interplay between the complex TCPC geometry and hemodynamic performance. More recently, surgical planning tools have been used to predict and improve the hemodynamics in the most complex cases prior to surgery. However, these tools still need to be enhanced in order to be able to accurately predict the patient response to the surgical connection, and also to account for the small changes of the surgical implementation.
The proposed work aims to investigate the accuracy of the prediction and the effectiveness of the surgical planning paradigm for SV patients. For this purpose, a coupled geometrical multiscale computational methodology will be implemented to fully characterize the hemodynamic impact of surgical planning designs. This coupled solver will be able to model the interaction of the local (TCPC) and the global (SV circulation) hemodynamics. This will be used to help elucidate the changes that take place in the adaptation going from pre- to a post-operative stage, and its impact on the surgical planning decision making process. In addition, the robustness of the surgical options will be evaluated, in order to take into account the small variations that can occur during the actual surgical implementation. The work to be developed in this thesis will provide an enhanced surgical planning tool for SV patients, that seeks to give a better prediction of the patient outcome and provide more guidelines that will aid in the decision making process.