Effect of pulmonary conduit oversizing on hemodynamics in XXXX .

@entity1 @entity254 @entity5173 @entity1642 @entity4297
PURPOSE: Implanting the largest valved conduit possible - oversizing - to reconstruct an absent connection from the right ventricle to the pulmonary artery in certain types of @entity4297 has been suggested as a compensating measure for somatic outgrowth of the @entity1 . However, one effect that has not been investigated yet is the hemodynamic consequence. For this purpose, virtual implantation and flow simulations were conducted in this study. METHODS: To isolate the effects of conduit oversizing on the hemodynamics observed after conduit implantation and outgrowth, calculated @entity1642 ( @entity1642 ) of image-based @entity5173 ( @entity5173 ) simulations were used as indicators. Three different sizes of valved conduits (20 mm, 22 mm, and 24 mm), including the largest possible conduit size, virtually implanted in a @entity1 -sized healthy pulmonary artery and the corresponding adult-sized model were investigated. RESULTS: The @entity1 and adult models show a decrease of the mean @entity1642 (approx. 26%) in the whole domain with an increase of the conduit size. When looking at the mean @entity1642 at the @entity254 , for the @entity1 model the @entity1642 is significantly increased (approx. 40%) when oversizing (Z-score +3.21). In contrast, the stresses are decreased for the adult model (34%) when using the largest conduit (Z-score +0.25). CONCLUSIONS: Based on the results of this study, it must be considered that choosing a prosthesis size that will lead to high @entity1642 and an associated intimal reaction, possibly leading to stenosis, can defeat the benefit of having a nominally larger orifice area directly after implantation.
