The hemodynamic effects of ductus arteriosus on modified Blalock-Taussig shunt / 中华胸心血管外科杂志

ABSTRACT

Objective:To investigate hemodynamic characteristics of the modified Blalock-Taussig shunt (MBTS) with the preservation or ligation of ductus arteriosus (DA) based on computational fluid dynamics (CFD), thus to help preoperative surgery design and postoperative prediction.Methods:A patient with pulmonary atresia and patent ductus arteriosus was included. Patient-specific three-dimensional model was reconstructed and virtual surgeries of shunt insertion and ductus ligation or preservation were performed via computer-aided design (CAD). CFD was utilized to analyze hemodynamic parameters preoperatively and postoperatively based on patient-specific anatomy and physiologic data.Results:The preservation of DA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided with each other, causing large and complicated turbulence in pulmonary artery where lower wall shear stress and higher oscillatory shear index were distributed, as well as higher energy loss.Conclusion:The preservation of DA is riskier in hemodynamics which may lead to pulmonary over-perfusion, inadequate systemic perfusion and heavier cardiac burden, thus increasing the risk of heart failure and it seems to bring no benefit in terms of reducing risks of thrombosis.