Intraventricular hemodynamics in pediatric patients with single right ventricles reveal deteriorated washout and low vortex for-mation times: An in silico study

Abstract

The congenital heart disease univentricular heart (UVH) occurs with an incidence of 0.04-0.5% in newborns and is often treated with the Fontan procedure. In this intervention, the cardiac circulation is transformed into a singular circulation with only one ventricular chamber pumping. Hemodynamics the singular ventricle is a major research topic in cardiology and there exists a relationship between fluid dynamical features and cardiac behavior in health and disease. By visualizing the flow using Computational Fluid Dynamics (CFD) models, an option is created to investigate the flow in patient-specific geometries. CFD simulation of the pathological single right ventricle in contrast to the healthy left ventricle is the research object of the present work. The aim is the numerical comparison of the intraventricular flow within the ventricles. Based on this, flow formation in different anatomies of the ventricles is investigated. Patient-specific measurements of ventricles from three-dimensional real-time echocardiographic images served as the basis for the simulations with five single right ventricle (SRV) patients and two subjects with healthy left hearts (LV) investigated. Interpolation of these data reproduced the shape and continuous motion of the heart during a cardiac cycle. This motion was implemented into a CFD model with a moving mesh methodology. For comparison of the ventricles, the vortex formation as well as the occurring turbulent kinetic energy (TKE) and washout were evaluated. Vortex formation was assessed using the dimensionless vortex formation time (VFT). The results show significantly lower values for the VFT and the TKE in SRV patients than for the compared LV Patients. Furthermore, vortex formation does not progress to the apex in SRV patients. These findings were confirmed by a significantly lower washout in SRV patients. Flow simulation within the moving ventricle provides the possibility of more detailed analysis of the ventricular function. Simulation results show altered vortex formation and reduced washout of SRV in comparison to healthy LV. This information could provide important information for the planning and treatment of Fontan patients.