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The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

¹Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; ²Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh; ³Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ⁴Pediatric Cardiology Services, Atlanta; and ⁵Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia

Submitted 15 June 2008 ; accepted in final form 11 October 2008

Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96 ± 0.80 WU) and systemic vascular resistances (18.4 ± 7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39 ± 0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI (n = 16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output (CO) dependence on TCPC resistance was negligible (sensitivity = –0.064 l·min^–1·WU^–1) but not for the SV circulation (sensitivity = –0.88 l·min^–1·WU^–1). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (+35%) and decreased preload (–12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology.

mathematical modeling; cardiac function; congenital heart defects; magnetic resonance imaging

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