A One Dimensional (1D) Computational Fluid Dynamics Study of Fontan-Associated Liver Disease (FALD)

TL;DR

This study uses a 1D computational fluid dynamics model to analyze hemodynamic changes in the liver of Fontan patients, revealing increased pressures and shear stress associated with FALD progression.

Contribution

It introduces a patient-specific 1D-CFD model to predict liver hemodynamics in Fontan patients and compares them with controls, providing new insights into FALD development.

Findings

Higher portal venous pressure in HLHS patient compared to DORV.

FALD progression increases portal pressure and alters shear stress.

Regions at risk for fibrosis show increased pressure and reduced flow.

Abstract

Fontan-Associated Liver Disease (FALD) is a disorder arising from hemodynamic changes and venous congestion in the liver. This disease is prominent in patients with hypoplastic left heart syndrome (HLHS). Although HLHS patients typically survive into adulthood, they have reduced cardiac output due to their univentricular physiology (i.e., a Fontan circuit). As a result, they have insufficient blood delivery to the liver. In comparison, patients with double outlet right ventricle (DORV), also having a univentricular circuit, have lower incidence of FALD. In this study, we use a patient-specific, one-dimensional computational fluid dynamics (1D-CFD) model to predict hemodynamics in the liver of an HLHS patient and compare predictions with an age- and size-matched DORV control patient. Additionally, we simulate FALD conditions in the HLHS patient to predict hemodynamic changes across various stages of disease progression. Our results show that the HLHS patient has a higher portal venous pressure compared to the DORV patient. This difference is exacerbated as FALD conditions progress. The wall shear stress (WSS) is also higher than normal for the HLHS patient, suggesting vascular remodeling. WSS decreases slightly under FALD conditions, consistent with the development of portal hypertension. Perfusion analysis gives insight into regions of liver tissue at risk for fibrosis development, showing increasing pressures and reduced flow throughout the liver tissue fed by the portal vein under FALD conditions. Our results provide insight into the specific hemodynamic changes in Fontan circulation that can cause FALD.