Numerical Investigation of the Effect of Additional Pulmonary Blood Flow
on Patient-Speciﬁc Bilateral Bidirectional Glenn Hemodynamics
Department of Mechanics and Engineering Science, Fudan University, No. 220, Handan Road, Shanghai, China;
Cardiovascular Disease, General Hospital of Jinan Military Region, Jinan, China;
Institute of Computational Science and
Cardiovascular Disease, Nanjing Medical University, Nanjing, China;
Wuxi Mingci Cardiovascular Hospital, Wuxi, China; and
Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
(Received 9 April 2017; accepted 12 January 2018; published online 22 January 2018)
Associate Editor Mark Fogel and Ajit P. Yoganathan oversaw the review of this article.
Abstract—The effect of additional pulmonary blood ﬂow
(APBF) on the hemodynamics of bilateral bidirectional
Glenn (BBDG) connection was marginally discussed in
previous studies. This study assessed this effect using
patient-speciﬁc numerical simulation. A 15-year-old female
patient who underwent BBDG was enrolled in this study.
Patient-speciﬁc anatomy, ﬂow waveforms, and pressure
tracings were obtained using computed tomography, Dop-
pler ultrasound technology, and catheterization, respectively.
Computational ﬂuid dynamic simulations were performed to
assess ﬂow ﬁeld and derived hemodynamic metrics of the
BBDG connection with various APBF. APBF showed
noticeable effects on the hemodynamics of the BBDG
connection. It suppressed ﬂow mixing in the connection,
which resulted in a more antegrade ﬂow structure. Also, as
the APBF rate increases, both power loss and reﬂux in
superior venae cavae (SVCs) monotonically increases while
the ﬂow ratio of the right to the left pulmonary artery (RPA/
LPA) monotonically decreases. However, a non-monotonic
relationship was observed between the APBF rate and
indexed power loss. A high APBF rate may result in a good
ﬂow ratio of RPA/LPA but with the side effect of bad power
loss and remarkable reﬂux in SVCs, and vice versa. A
moderate APBF rate could be favourable because it leads to
an optimal indexed power loss and achieves the accept-
able ﬂow ratio of RPA/LPA without causing severe power
loss and reﬂux in SVCs. These ﬁndings suggest that patient-
speciﬁc numerical simulation should be used to assist
clinicians in determining an appropriate APBF rate based
on desired outcomes on a patient-speciﬁc basis.
Keywords—Computational ﬂuid dynamics, Single ventricle
defects, Glenn procedure, Additional pulmonary blood ﬂow.
Up to 15% of patients with single-ventricle physi-
ology may have persistent left superior vena cava
(PLSVC). Bilateral Bidirectional Glenn (BBDG) is a
surgical technique preferentially for patients with
It intends to direct blood ﬂows from right
superior vena cava (RSVC) and PLSVC to the right
and left lungs, respectively, so that a balanced lung
blood perfusion could be achieved.
Though it is
well-known as an intermediate palliation before Fon-
the BBDG was often used as a
deﬁnitive palliation particularly for patients who can-
not afford more operations.
Xu et al.
strated satisfactory long-term clinical outcomes for the
BBDG as a deﬁnitive surgery. The current practice
often preserves additional pulmonary blood ﬂow
(APBF) through the main pulmonary artery (MPA)
for the BBDG connection.
APBF sought to com-
plement blood supply to the pulmonary arteries, which
results in better systemic arterial oxygen saturation,
healthier pulmonary artery growth, and less risk of
However, some studies
pointed out that an excessive APBF rate may elevate
systemic venous pressure and aggravate ventricular
preload and afterload because of possible reﬂux of
blood ﬂow in vena cava and stubborn pleural effu-
In short, the effectiveness of APBF is still
controversial and patient-speciﬁc.
Several studies have attempted to provide direct
insight into the eﬀect of APBF on patient-speciﬁc
hemodynamics by means of computational ﬂuid dy-
namic (CFD) simulations.
CFD is a non-in-
vasive approach that can augment in vivo data with
Address correspondence to Guanghong Ding, Department of
Mechanics and Engineering Science, Fudan University, No. 220,
Handan Road, Shanghai, China. Electronic mail: email@example.com
Cardiovascular Engineering and Technology, Vol. 9, No. 2, June 2018 (
2018) pp. 193–201
2018 Biomedical Engineering Society