Purpose

Additional pulmonary blood flow (APBF) can provide better pulsating blood flow and systemic arterial oxygen saturation, while low blood pulsation and low oxygen saturation are defects of the Fontan and Glenn procedure. Studying the hemodynamic effect of APBF is beneficial for clinical decisions. This study aimed to explore the effect on particle washout, as well as the differences among the sensitivities of both different hemodynamic parameters and different procedures to APBF.

Methods

The patient-specific clinical datasets of a patient who underwent bilateral bidirectional Glenn (BBDG) with APBF were enrolled in this study, and using these datasets, Glenn- and Fontan-type artery models were reconstructed. A series of parameters, including the total caval flow pulsatility index (TCPI), indexed energy loss (iPL), wall shear stress (WSS), systemic arterial oxygen saturation (Sat_art), particle washout time (WOT), pressure in the right superior vena cava (P_RSVC), pulmonary flow distribution (PFD) and hepatic flow distribution (HFD), were computed from computational fluid dynamic (CFD) simulation to evaluate the hemodynamic effect of APBF.

Results

The result showed that APBF led to better iPL and Sat_art but worse P_RSVC and heart load accompanied by a great impact on HFD, making hepatic flow easier to perfuse the side without MPA and APBF. The increase in the APBF rate also effectively results in larger flow pulsation, region velocity, and wall shear stress and lower WOT, and this effect may be more effective for patients with persistent left superior vena cava (PLSVC). However, APBF might have little effect on PFD. Furthermore, APBF might affect WOT, iPL and HFD more significantly than P_RSVC and has a greater improvement effect in patients with poorer iPL and WOT.

Conclusions

Moderate APBF is not only a measure to promote pulmonary artery growth and systemic arterial oxygen saturation but also an effective method against endothelial dysfunction and thrombosis. However, moderate APBF is patient-specific and should be determined based on hemodynamic preference that leads to desired patient outcomes, and care should be taken to prevent P_RSVC and heart load from being too high as well as an imbalance in HFD.

中文翻译：

---

额外的肺血流对Glenn和Fontan循环的血流动力学影响。

目的

额外的肺血流量（APBF）可以提供更好的脉动血流量和全身动脉血氧饱和度，而低血脉动和低血氧饱和度则是Fontan和Glenn手术的缺陷。研究APBF的血液动力学效应对临床决策是有益的。这项研究旨在探讨对颗粒冲洗的影响，以及不同血液动力学参数和不同程序对APBF的敏感性之间的差异。

方法

本研究招募了接受APBF双向双向Glenn（BBDG）治疗的患者的患者特定临床数据集，并使用这些数据集重建了Glenn型和Fontan型动脉模型。一系列参数，包括总腔流量脉动指数（TCPI），指数能量损失（iPL），壁切应力（WSS），全身动脉血氧饱和度（Sat _art），颗粒冲洗时间（WOT），右侧压力通过计算流体动力学（CFD）模拟计算上腔静脉（P _RSVC），肺血流分布（PFD）和肝血流分布（HFD），以评估APBF的血流动力学效应。

结果

结果表明，APBF导致更好的iPL和Sat_技术，但差的P _RSVC和心脏负荷对HFD产生巨大影响，使肝血流更容易灌注无MPA和APBF的一侧。APBF速率的增加还有效地导致更大的血流脉动，区域速度和壁切应力以及更低的WOT，并且这种效果对于持续左上腔静脉（PLSVC）的患者可能更有效。但是，APBF对PFD的影响可能很小。此外，APBF可能比P _RSVC对WOT，iPL和HFD的影响更大，并且对iPL和WOT较差的患者具有更大的改善作用。

结论

适度的APBF不仅是促进肺动脉生长和全身动脉血氧饱和度的一种措施，而且还是对抗内皮功能障碍和血栓形成的有效方法。但是，中度APBF是因患者而异，应根据导致所需患者预后的血流动力学偏好确定，并应注意防止P _RSVC和心脏负荷过高以及HFD失衡。