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Article Outline

 



Since its first description, the Fontan operation has undergone several modifications geared toward the goal of energy preservation. Total extracardiac cavopulmonary connection (TECPC) is an established procedure, but the best spatial arrangement preserving a better energy efficiency remains controversial. An in vitro qualitative and quantitative analysis of flow fields showed that TECPC with left-sided diversion of the inferior vena caval conduit anastomosis is characterized by a central vortex that regulates the caval flow partitioning and provides a more favorable energy-saving pattern than is seen with the TECPC with directly opposed cavopulmonary anastomoses. As visualized in the figure,¹ obtained by means of a laser light sheet, in facing cavopulmonary anastomoses the collision of the converging caval flows generates circular swirling patterns, secondary flows, and areas of stagnations characterized by low velocity. In this model, collision and interaction of caval flows results in kinetic energy losses and viscous dissipation that decrease fluid dynamic efficiency.

Antonio Amodeo, MD

Reference

1.Amodeo A, Grigioni M, Oppido G, Daniele C, D'Avenio G, Pedrizzetti G, et al. The beneficial vortex and best spatial arrangement in total extracardiac cavopulmonary connection. J Thorac Cardiovasc Surg. 2002;124:471-8.