A central shunt (CS) was an important surgery of systemic-to-pulmonary shunt (SPS) for the treatment of complex congenital heart diseases with decreased pulmonary blood flow (CCHDs-DPBF). There was no clear conclusion on how to deal with unclosed patent ductus arteriosus (PDA) during CS surgery. This study expanded the knowledge base on PDA by exploring the influence of the closing process of the PDA on the hemodynamic parameters for the CS model. The initial three-dimensional (3D) geometry was reconstructed based on the patient’s computed tomography (CT) data. Then, a CS configuration with three typical pulmonary artery (PA) dysplasia structures and different sizes of PDA was established. The three-element windkessel (3WK) multiscale coupling model was used to define boundary conditions for transient simulation through computational fluid dynamics (CFD). The results showed that the larger size of PDA led to a greater systemic-to-pulmonary shunt ratio (), and the flow ratio of the left pulmonary artery (LPA) to right pulmonary artery (RPA) () was more close to 1, while both the proportion of high wall shear stress (WSS) areas and power loss decreased. The case of PDA nonclosure demonstrates that the aortic oxygen saturation (Sao₂) increased, while the systemic oxygen delivery (Do₂) decreased. In general, for the CS model with three typical PA dysplasia, the changing trends of hemodynamic parameters during the spontaneous closing process of PDA were roughly identical, and nonclosure of PDA had a series of hemodynamic advantages, but a larger PDA may cause excessive PA perfusion and was not conducive to reducing cyanosis symptoms.

中文翻译：

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中央分流术后患者动脉导管未闭的血流动力学

中央分流术（CS）是体肺分流术（SPS）的一项重要手术，用于治疗肺血流量减少的复杂先天性心脏病（CCHDs-DPBF）。CS手术中如何处理未闭合的动脉导管未闭（PDA）尚无明确结论。本研究通过探索 PDA 关闭过程对 CS 模型血液动力学参数的影响，扩展了 PDA 的知识库。根据患者的计算机断层扫描 (CT) 数据重建初始三维 (3D) 几何结构。然后，建立了具有三个典型肺动脉 (PA) 发育不良结构和不同大小的 PDA 的 CS 配置。三元素windkessel (3WK) 多尺度耦合模型用于通过计算流体动力学(CFD) 定义瞬态模拟的边界条件。结果表明，PDA越大，体肺分流比越大。)，左肺动脉 (LPA) 与右肺动脉 (RPA) ( )的流量比更接近于 1，而高壁剪应力 (WSS) 区域和功率损失的比例均下降。PDA 不闭合的情况表明主动脉氧饱和度 (Sao ₂ ) 增加，而全身氧输送 (Do ₂ ) 减少。总的来说，对于具有三种典型PA发育不良的CS模型，PDA自发闭合过程中血流动力学参数的变化趋势大致相同，不闭合PDA具有一系列血流动力学优势，但较大的PDA可能导致PA灌注过多且不利于减轻紫绀症状。