The Fluid Mechanics of Truncus Arteriosus.

Truncus arteriosus (TA) is a rare, severe congenital heart disease in which the two main arteries exiting the heart fail to separate in utero resulting in one truncus and truncal valve, carrying mixed oxygenated and deoxygenated blood. About 25% of patients have a quadricuspid valve, which is prone to regurgitation and re-intervention. Despite its relevance for valve performance and mixing, fluid mechanics in TA are poorly understood. Patient-specific fluid-structure interaction simulations were performed based on CT imaging before and after TA repair. The quadricuspid valve was constructed using elasticity-based design with the patient's free edge length and geometric height extracted from echocardiography. Interaction between blood and valve was simulated with the Immersed Boundary Method. Boundary conditions were tuned to the patient's data. Mixing of oxygenated and deoxygenated blood and streaming were assessed via Lagrangian Coherent Structures (LCS) and Lagrangian Particle Tracing (LPT). Low pressures, forward flow and streamwise vortices in the one-sided pulmonary arteries (PAs) throughout the cardiac cycle affected leaflet motion, leading to asymmetric closure and regurgitation. Holodiastolic aortic flow reversal supplied PA flow and the regurgitant jet. LCS and LPT indicated favorable streaming of oxygenated blood from the LV to the aorta and deoxygenated blood from the RV to the PAs. After truncal surgery, normal hemodynamics were restored. This is the first study of fluid mechanics of TA. Using qualitative and quantitative flow analysis, we identified disrupted preoperative hemodynamics caused by one-sided PAs and showed how normal hemodynamics were re-established after repair. Favorable streaming was demonstrated aligned with patient reports. Thus, favorable streaming is plausible in total mixing lesions and patient-specific modeling may aid in its detection.