Imaging and patient-specific simulations for the Fontan surgery: Current methodologies and clinical applications

Clinical observations together with recent modeling, imaging, and in vitro experiments have shown that the geometry of the Fontan connection plays a key role in energy losses, hepatic flow distribution, and associated strain on the cardiovascular system, all of which will in turn have an impact on the long-term clinical outcome. Recent advances in imaging and modeling of blood flow through the vascular system have the potential to improve surgical and clinical management strategies by 1) identifying the hemodynamics relevant to the initiation and progression of long-term complications, and 2) allowing bioengineers and clinicians to design optimized interventional treatments on a patient-specific basis. In this paper, we review the current state of the art in clinical imaging, experimental methods and numerical simulations as applied to the Fontan circulation, and discuss newly proposed surgical solutions and emerging methods for individualized surgical planning. Finally, we outline important challenges that remain before simulations can be used in day-to-day clinical practice for the management of single-ventricle patients.