Influence of antegrade pulmonary blood flow on the hemodynamic performance of bidirectional cavopulmonary anastomosis: A numerical study

The role and effect of preserved antegrade pulmonary blood flow (APBF) at the time of bidirectional cavopulmonary anastomosis (BCPA) in the management of single-ventricle physiology is controversial. We investigated the influence of APBF on the fluid dynamics of BCPA connection using computational fluid dynamics (CFD). Patient-specific, three-dimensional geometry of a BCPA connection with native pulmonary artery (PA) trunk was reconstructed and transient CFD simulations were done at four predetermined mean flow rates of PA trunk (0.5 L/min, 1 L/min, 1.5 L/min and 2 L/min). During a cardiac cycle, the flow ratio of left pulmonary artery (LPA)/right pulmonary artery (RPA) increased from 1.91 to 2.50, and average control volume power loss increased from 0.76 mW to 18.05 mW when the mean flow rate of PA trunk changed from 0.5 L/min to 2 L/min. The pulsatility of pressures in LPA, RPA and superior vena cava became more prominent as the amount of APBF increased. Local fluid structures in the connection area at four levels of APBF differed from each other.