Transient Hemodynamic Changes upon Changing a BCPA into a TCPC in Staged Fontan Operation: A Computational Model Study

<table>Simulated changes in transpulmonary flow rate (<svg height="18.4" id="M160" style="vertical-align:-5.03984pt" version="1.1" viewbox="0 0 29.299999 18.4" width="29.299999" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
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<g transform="matrix(.012,-0,0,-.012,13.113,15.475)"><path d="M169 380l92 53q26 16 49 16q80 0 128.5 -56t48.5 -133q0 -108 -72.5 -180.5t-176.5 -91.5q-38 1 -69 18v-131q0 -57 13 -70t71 -18v-27h-236v27q49 5 61 17t12 61v452q0 48 -9.5 58.5t-56.5 16.5v24q66 11 145 43v-79zM169 346v-270q37 -39 94 -39q63 0 101.5 50
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</svg> (a)) and venous pressure (<svg height="15.4" id="M161" style="vertical-align:-3.25792pt" version="1.1" viewbox="0 0 25.112499 15.4" width="25.112499" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
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<g transform="matrix(.012,-0,0,-.012,10.875,15.187)"><path d="M135 536q-20 0 -35 15.5t-15 35.5q0 22 15 37t36 15t35.5 -15t14.5 -37q0 -21 -15 -36t-36 -15zM252 0h-220v26q48 5 59 17t11 63v206q0 47 -9 58t-54 18v24q78 12 142 39v-345q0 -51 11.5 -63t59.5 -17v-26z" id="x69"></path></g><g transform="matrix(.012,-0,0,-.012,13.981,15.187)"><path d="M478 437v-26q-39 -5 -53 -17.5t-35 -57.5q-68 -149 -142 -347h-28q-47 128 -138 350q-17 43 -30.5 54.5t-53.5 17.5v26h205v-26q-40 -4 -46.5 -14.5t6.5 -42.5q41 -115 95 -247q43 101 89 238q12 36 3.5 48.5t-50.5 17.5v26h178z" id="x76"></path></g><g transform="matrix(.012,-0,0,-.012,19.395,15.187)"><path d="M390 111l17 -21q-34 -45 -80 -73.5t-89 -28.5q-91 0 -146 62t-55 147q0 118 101 195q74 57 149 57h1q59 0 90 -27q16 -14 16 -30q0 -15 -12 -29t-21 -14q-8 0 -19 11q-44 41 -101 41q-52 0 -87.5 -42.5t-35.5 -117.5q0 -49 15 -87t39 -58t49 -30t48 -10q33 0 60.5 12
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</svg> (b)) under various cardiovascular conditions upon the change of a BCPA into a TCPC. The results are expressed as percentage changes relative to the pre-TCPC values. <svg height="18.112499" id="M162" style="vertical-align:-5.03984pt" version="1.1" viewbox="0 0 27.1875 18.112499" width="27.1875" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path d="M627 18l-10 -26q-79 6 -116 27t-69 76q-41 71 -71 138q-13 29 -27.5 39t-42.5 10h-46l-27 -145q-13 -74 -2.5 -88.5t78.5 -20.5l-6 -28h-271l5 28q66 6 82.5 21.5t30.5 87.5l71 387q12 66 2 78.5t-77 19.5l8 28h233q102 0 147 -29q65 -43 65 -129q0 -69 -45.5 -117
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</svg>: pulmonary vascular resistance; <svg height="16.737499" id="M163" style="vertical-align:-4.23227pt" version="1.1" viewbox="0 0 33.9375 16.737499" width="33.9375" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
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<g transform="matrix(.012,-0,0,-.012,11.013,15.187)"><path d="M433 39l-85 -51q-27 0 -47 20q-16 16 -24 44q-5 -3 -24 -16.5t-27 -18.5t-23 -13.5t-25 -12t-19 -3.5q-52 0 -86 36.5t-34 85.5q0 71 81 99q128 43 155 65v17q0 54 -23 83.5t-62 29.5q-28 0 -45 -19t-29 -66q-7 -23 -29 -23q-15 0 -29 13t-14 30t31 40q25 19 68.5 40.5
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</svg>: lower-body arteriolar resistance; <svg height="15.4" id="M164" style="vertical-align:-3.25792pt" version="1.1" viewbox="0 0 24.25 15.4" width="24.25" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path d="M609 650l-19 -162l-30 -2q2 69 -14 94q-9 18 -28.5 26t-74.5 8h-88q-30 0 -37 -6.5t-12 -36.5l-41 -212h103q48 0 69 5.5t32 19t26 50.5h29l-40 -198h-30q2 58 -11.5 70.5t-85.5 12.5h-99l-30 -167q-17 -87 3 -101q18 -15 111 -15q59 0 89 7t54 27q8 7 15.5 16t16 21.5
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<g transform="matrix(.012,-0,0,-.012,10.8,15.187)"><path d="M319 325l-25 -7q-33 99 -103 99q-29 0 -47 -19.5t-18 -49.5t22 -49.5t62 -36.5q63 -26 95 -57t32 -79q0 -64 -50 -101t-115 -37q-35 0 -67.5 10.5t-46.5 23.5q-5 11 -11 51t-6 67l27 5q14 -53 46.5 -88.5t75.5 -35.5q29 0 50 19.5t21 50.5t-19.5 51.5t-59.5 39.5
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</svg>: maximum active elastance of the left ventricle in systole; <svg height="15.4" id="M165" style="vertical-align:-3.25792pt" version="1.1" viewbox="0 0 26.275 15.4" width="26.275" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path d="M609 650l-19 -162l-30 -2q2 69 -14 94q-9 18 -28.5 26t-74.5 8h-88q-30 0 -37 -6.5t-12 -36.5l-41 -212h103q48 0 69 5.5t32 19t26 50.5h29l-40 -198h-30q2 58 -11.5 70.5t-85.5 12.5h-99l-30 -167q-17 -87 3 -101q18 -15 111 -15q59 0 89 7t54 27q8 7 15.5 16t16 21.5
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<g transform="matrix(.012,-0,0,-.012,10.8,15.187)"><path d="M517 51v-25q-101 -18 -155 -38v65l-61 -36q-50 -29 -78 -29q-68 0 -126.5 58t-58.5 155q0 103 77 175.5t180 72.5q36 0 67 -12v143q0 48 -11.5 58.5t-65.5 14.5v25q79 9 156 34v-597q0 -38 7.5 -48t36.5 -13zM362 85v275q-35 51 -103 51q-20 0 -40.5 -8.5t-42 -28
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</svg>: baseline passive elastance of the left ventricle in diastole.</table>

The Scientific World Journal

fig5

Figure 5

Figure 5: Transient Hemodynamic Changes upon Changing a BCPA into a TCPC in Staged Fontan Operation: A Computational Model Study 