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Pulmonary Circulatory Mechanical Assist As A Strategy To Support The Norwood Circulation-Computational Fluid Dynamics Study
Syed M. Peer, MD1, Canberk Yildrim, MS2, Manan Desai1, Karthik Ramakrishnan, MD1, Pranava Sinha, MD1, Richard Jonas, MD1, Can Yerebakan, MD1, Kerem Pekkan, MD3.
1Children's National Hospital, Washington, DC, USA, 2Istanbul Bilgi University, Istanbul, Turkey, 3Koc University, Istanbul, Turkey.

Objective: We hypothesize that mechanical assistance of the pulmonary blood flow (aQP) in a Norwood circulation (Figure 1A) can increase systemic cardiac output and oxygen delivery. The hemodynamics of an unassisted Norwood BT shunt (NBTS) circulation were compared with an aQp based NBTS circulation using a lumped parameter computational (LMP) model.
Methods: A LMP model (Figure 1B) was developed to simulate a NBTS circulation with a 3.5mm shunt in a 3.5 kg neonate. A roller pump circulatory assist device with an inflow bladder was incorporated into the NBTS circulation to mechanically support the pulmonary blood flow. The hemodynamics of the unassisted NBTS and aQp based NBTS circulation were simulated. Assisted and unassisted models with normal ejection fraction (EF) (56%) and reduced EF (30%) were compared.
Results: The simulated hemodynamics of the unassisted NBTS circulation were comparable to published clinical data. Compared to the unassisted NBTS circulation (EF-56% and EF-30%) the cardiac index in the aQp based NBTS circulation increased by 18% (EF-56%) and 29% (EF-30%), the central venous pressure decreased by up to 3 mm Hg (EF-56% and EF-30%) at a max aQp flow of 800ml/min. Initiation of aQp increased the arterial oxygen saturation by upto 15% and mixed venous saturation by upto 20%. Conclusions: An aQp based NBTS circulation has higher cardiac index and oxygen delivery compared to a standard NBTS circulation.


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