Patient-Specific Multiscale Computational Fluid Dynamics Assessment Of Embolization Rates In The Hybrid Norwood: Effects of Size and Placement of the Reverse Blalock-Taussig Shunt

The hybrid Norwood operation is performed to treat hypoplastic left heart syndrome. Distal arch obstruction may compromise flow to the brain. In a variant of this procedure, a synthetic graft (RBTS) is placed between the pulmonary trunk and innominate artery to improve upper torso blood flow. Thrombi originating in the graft may embolize to the brain. In this study we used computational fluid dynamics (CFD) and particle tracking to investigate the patterns of particle embolization as a function of the anatomic position of the RBTS. The degree of distal arch obstruction as well as position of particle origin influence embolization probabilities to the cerebral arteries. Cerebral embolization probabilities can be reduced by as much as 20% by optimizing graft position, for a given arch geometry, degree of distal arch obstruction and particle origin. There is a tradeoff, however, between cerebral pulmonary and coronary embolization probabilities.