Effects of pulmonary afterload on the hemodynamics after the hemi-Fontan procedure.

A computational fluid dynamics study based on the application of the finite volume method has been performed to investigate the effects of the pulmonary afterload on the hemodynamics after the hemi-Fontan procedure. This operation is generally used as part of a series of staged procedures to treat complex congenital malformations of the heart. It consists of re-directing the superior vena caval flow from the right atrium into the pulmonary arteries, by-passing the right ventricle while excluding the inferior caval flow from the lungs. To reproduce correctly the pulmonary afterload conditions, a simplified lumped-parameter mechanical model of the pulmonary circulation has been developed and linked to the finite volume solver. In addition, the effect of a stenosis in the left pulmonary artery was also examined. In this paper the adopted methodology is presented, together with some of the preliminary results. The model has been used to simulate the local fluid dynamics for different values of the pulmonary arteriolar resistance and lung resistances, allowing a quantitative evaluation of the dissipated energy and the flow distribution into the lungs. The results show that both flow distribution into the lungs and energy dissipation after the hemi-Fontan procedure are only minimally affected by the pulmonary arteriolar resistance.