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Computational Fluid Dynamics Investigation of A Novel Hybrid Comprehensive Stage II Operation For Single Ventricle Palliation

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Date Issued:
2019
Abstract/Description:
Single ventricle (SV) anomalies account for one(&)#226;€"fourth of all cases of congenital heart disease. The existingthree hybrid staged surgical approach serving as a palliative treatment for this anomaly entails multiple complicationsand achieves a survival rate of only 50%. To reduce trauma associated with the second stage of the hybrid procedure,the hybrid comprehensive stage 2 (HCS2) operation was introduced in 2014 at Arnold Palmer Hospital in Orlando as anovel palliation alternative for a select subset of SV patients with adequate antegrade aortic flow. It avoids dissection ofthe pulmonary arteries by introducing a stented intrapulmonary baffle and avoids reconstruction of the aortic arch bymaintaining patency of the ductus arteriosus. This dissertation aims to provide better insight on the post-operativehemodynamics of HCS2 patients. A multi-scale Computational Fluid Dynamics (CFD) analysis of a synthetic,patient-derived HCS2 geometry based on unsteady laminar flow conditions and a non(&)#226;€"Newtonian blood model isutilized to quantify the resultant hemodynamics. The 3D CFD model is coupled to a 0D lumped parameter modelof the peripheral circulation that supplies the boundary conditions necessary to run the CFD analyses of the HCS2. Based on clinical parameters suggesting the baffle related narrowing to be at minimum 10mm and the pressuregradient not surpassing 20mmHg, hemodynamic analysis reveals that for even a 7.23mm narrowing the averagepressure drop across the baffle is 0.53mmHg. A peak pressure drop of 2.96mmHg was computed over the investigatedrange of clearances over the pulmonary baffle. Vortex shedding presents no concerns as the distance between the baffleand the aortic arch is much smaller compared to the length required for full vortices to form. Uneven contour distributionof the wall shear stress was observed due to the bend presented by the baffle that strongly affects the velocity profile inthe lumen across the pulmonary trunk and into the ductus arteriosus. Moreover, an oxygen transport model was derived,and the results showed consistency with the published data of Glenn patients. Particle residence time was also reported toidentify any blood recirculation or flow stagnation that may lead to platelet activation leading to clot formation rate.The study provides a range of main pulmonary artery geometries that, following multi-scale CFD analysis, present noconcerns regarding excessive pressure gradients or vortex formation. Moreover, the model identifies locations ofpotentially problematic hemodynamics that could be mitigated by shape optimization of the reconstruction.
Title: Computational Fluid Dynamics Investigation of A Novel Hybrid Comprehensive Stage II Operation For Single Ventricle Palliation.
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Name(s): Hameed, Marwan, Author
Kassab, Alain, Committee Chair
DeCampli, William, Committee Member
Chow, Louis, Committee Member
Mansy, Hansen, Committee Member
Divo, Eduardo, Committee Member
University of Central Florida, Degree Grantor
Type of Resource: text
Date Issued: 2019
Publisher: University of Central Florida
Language(s): English
Abstract/Description: Single ventricle (SV) anomalies account for one(&)#226;€"fourth of all cases of congenital heart disease. The existingthree hybrid staged surgical approach serving as a palliative treatment for this anomaly entails multiple complicationsand achieves a survival rate of only 50%. To reduce trauma associated with the second stage of the hybrid procedure,the hybrid comprehensive stage 2 (HCS2) operation was introduced in 2014 at Arnold Palmer Hospital in Orlando as anovel palliation alternative for a select subset of SV patients with adequate antegrade aortic flow. It avoids dissection ofthe pulmonary arteries by introducing a stented intrapulmonary baffle and avoids reconstruction of the aortic arch bymaintaining patency of the ductus arteriosus. This dissertation aims to provide better insight on the post-operativehemodynamics of HCS2 patients. A multi-scale Computational Fluid Dynamics (CFD) analysis of a synthetic,patient-derived HCS2 geometry based on unsteady laminar flow conditions and a non(&)#226;€"Newtonian blood model isutilized to quantify the resultant hemodynamics. The 3D CFD model is coupled to a 0D lumped parameter modelof the peripheral circulation that supplies the boundary conditions necessary to run the CFD analyses of the HCS2. Based on clinical parameters suggesting the baffle related narrowing to be at minimum 10mm and the pressuregradient not surpassing 20mmHg, hemodynamic analysis reveals that for even a 7.23mm narrowing the averagepressure drop across the baffle is 0.53mmHg. A peak pressure drop of 2.96mmHg was computed over the investigatedrange of clearances over the pulmonary baffle. Vortex shedding presents no concerns as the distance between the baffleand the aortic arch is much smaller compared to the length required for full vortices to form. Uneven contour distributionof the wall shear stress was observed due to the bend presented by the baffle that strongly affects the velocity profile inthe lumen across the pulmonary trunk and into the ductus arteriosus. Moreover, an oxygen transport model was derived,and the results showed consistency with the published data of Glenn patients. Particle residence time was also reported toidentify any blood recirculation or flow stagnation that may lead to platelet activation leading to clot formation rate.The study provides a range of main pulmonary artery geometries that, following multi-scale CFD analysis, present noconcerns regarding excessive pressure gradients or vortex formation. Moreover, the model identifies locations ofpotentially problematic hemodynamics that could be mitigated by shape optimization of the reconstruction.
Identifier: CFE0007813 (IID), ucf:52340 (fedora)
Note(s): 2019-12-01
Ph.D.
Engineering and Computer Science, Mechanical and Aerospace Engineering
Doctoral
This record was generated from author submitted information.
Subject(s): Conginital -- VSD -- LPM -- CFD -- Pulsatile -- HCS2 -- coupling -- pateint specific
Persistent Link to This Record: http://purl.flvc.org/ucf/fd/CFE0007813
Restrictions on Access: campus 2020-12-15
Host Institution: UCF

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