{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T06:41:32Z","timestamp":1775889692185,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2005,11,22]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            In our multicenter study of the total cavopulmonary connection (TCPC), a cohort of patients with long-segment left pulmonary artery (LPA) stenosis was observed (35%). The clinically recognized detrimental effects of LPA stenosis motivated a computational fluid dynamic simulation study within 3-dimensional patient-specific and idealized TCPC pathways. The goal of this study was to quantify and evaluate the hemodynamic impact of LPA stenosis and to judge interventional strategies aimed at treating it.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            Simulations were conducted at equal vascular lung resistance, modeling both discrete stenosis (DS) and diffuse long-segment hypoplasia with varying degrees of obstruction (0% to 80%). Models having fenestrations of 2 to 6 mm and atrium pressures of 4 to 14 mm Hg were explored. A patient-specific, extracardiac TCPC with 85% DS was studied in its original configuration and after virtual surgery that dilated the LPA to 0% stenosis in the computer medium. Performance indices improved exponentially (\n            <jats:italic>R<\/jats:italic>\n            <jats:sup>2<\/jats:sup>\n            &gt;0.99) with decreasing obstruction. Diffuse long-segment hypoplasia was \u224850% more severe with regard to lung perfusion and cardiac energy loss than DS. Virtual angioplasty performed on the 3-dimensional Fontan anatomy exhibiting an 85% DS stenosis produced a 61% increase in left lung perfusion and a 50% decrease in cardiac energy dissipation. After 4-mm fenestration, TCPC baffle pressure dropped by \u224810% and left lung perfusion decreased by \u22488% compared with the 80% DS case.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            DS &lt;60% and diffuse long-segment hypoplasia &lt;40% could be considered tolerable because both resulted in only a 12% decrease in left lung perfusion. In contrast to angioplasty, a fenestration (right-to-left shunt) reduced TCPC pressure at the cost of decreased left and right lung perfusion. These results suggest that pre-Fontan computational fluid dynamic simulation may be valuable for determining both the hemodynamic significance of LPA stenosis and the potential benefits of intervention.\n          <\/jats:p>","DOI":"10.1161\/circulationaha.104.530931","type":"journal-article","created":{"date-parts":[[2005,11,15]],"date-time":"2005-11-15T01:25:56Z","timestamp":1132017956000},"page":"3264-3271","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":70,"title":["Total Cavopulmonary Connection Flow With Functional Left Pulmonary Artery Stenosis"],"prefix":"10.1161","volume":"112","author":[{"given":"Kerem","family":"Pekkan","sequence":"first","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroumi D.","family":"Kitajima","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"de Zelicourt","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph M.","family":"Forbess","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. James","family":"Parks","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Fogel","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiva","family":"Sharma","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirk R.","family":"Kanter","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Frakes","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajit P.","family":"Yoganathan","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Fluid Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta (K.P., H.D.K., D.d.Z., D.F., A.P.Y.); Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga (J.M.F., K.R.K.); Department of Cardiology, Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Ga (W.J.P.); Division of Cardiology, Children\u2019s Hospital of Philadelphia, Philadelphia..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)35174-8"},{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(03)00186-6"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.102.17.2094"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000129273.50975.f4"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(03)00411-9"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002469900146"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(96)00111-8"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000087406.27922.6b"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(97)00112-7"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.92.5.1217"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002469900195"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.10.051"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00055-9"},{"key":"e_1_3_3_14_2","first-page":"II-85","volume":"86","year":"1992","unstructured":"Mavroudis C, Zales VR, Backer CL, Muster AJ, Latson LA. 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