Key result
Mathematical modeling of the Fontan circulation identified that arterial compliance and resistance strongly influence mean arterial pressure and cardiac output.
Why the study?
Fontan circulations often fail over time, but a lack of understanding of the Fontan failure cascade prevents timely identification for heart transplantation.
Mathematical modeling of the Fontan circulation identifies key hemodynamic parameters, such as arterial compliance and resistance, that strongly influence arterial pressure and cardiac output, providing a framework to understand Fontan failure.
May extend transplant-free survival in failing Fontan; leaves open whether benefits outweigh risks in larger cohorts.
Babies born with a single functioning heart ventricle instead of two require a series of surgeries during the first few years of life to redirect their blood flow, resulting in a Fontan circulation. Patients with Fontan circulations have excellent early survival; however, over time, their circulations begin to fail, ultimately resulting in their death. Currently, the only treatment for failing Fontan circulation is a heart transplant; however, many Fontan patients do not survive long enough to receive a donor heart. One of the reasons for this is a lack of understanding of the Fontan failure cascade. Often patients are identified as failing when they do not have enough time left to receive a heart transplant. The objective of this problem is to develop mathematical models of healthy and failing Fontan circulations to i) improve our understanding of Fontan failure from a hemodynamic perspective, and ii) identify physiologically-relevant ranges of parameters.
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Doyle et al. (2021) studied Fontan circulation failure. Lumped parameter mathematical modeling was evaluated. Mathematical modeling of the Fontan circulation identified that arterial compliance and resistance strongly influence mean arterial pressure and cardiac output.
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