Abstract

Transcatheter palliation using fenestrated Modified Micro Vascular Plugs (MVP) has emerged as a promising, minimally invasive alternative to surgical pulmonary artery banding (PAB) for high-risk neonates with single-ventricle physiology. However, clinical applications are currently limited by the difficulty in predicting the resulting pulmonary-to-systemic flow ratio () and the lack of a standardized approach for selecting the optimal fenestration size. This study utilizes patient-specific computational fluid dynamics (CFD) to quantitatively evaluate the impact of varying fenestration diameters on circulatory balance. Patient-specific 3D models of the pulmonary artery (PA) were reconstructed from imaging data for two clinical cases using SimVascular. Transient CFD simulations were performed using a finite element method. Three-element Windkessel (RCR) boundary conditions were applied at the outlets and tuned to match patient-specific clinical measurements. MVP deployment was simulated by modifying PA outlet diameters (1 mm, 2 mm, and 3 mm for patient 1; 2 mm for patient 2) and compared with baseline (no-device) models. The simulations demonstrated significant flow redistribution based on fenestration size. At baseline, both patients exhibited severe pulmonary over-circulation (Patient 1  = 14.1; Patient 2  = 38.3). For Patient 1, reducing the fenestration diameter decreased the  ratio to 9.83 (3 mm), 4.17 (2 mm), and 0.56 (1 mm). For Patient 2, the 2 mm fenestration redirected flow toward the systemic circulation, increasing aortic flow from 0.021 L/min to 0.0978 L/min and reducing the  to 7.44. Additionally, the device improved flow symmetry between the left and right pulmonary arteries and captured characteristic diastolic retrograde flow through the arterial duct. Patient-specific CFD modeling successfully quantified the hemodynamic impact of MVP fenestration size. The results indicate that reducing fenestration diameter effectively increases systemic perfusion and mitigates pulmonary over-circulation. For the studied cases, a fenestration size between 1.0 mm and 2.0 mm is suggested as ideal for achieving circulatory balance. This predictive tool offers a valuable method for individualized pre-procedural planning in single-ventricle palliation.

Committee Chair

Fanwei Kong

Committee Members

Guy Genin, David Peters, Jessica Wagenseil

Degree

Master of Science (MS)

Author's Department

Mechanical Engineering & Materials Science

Author's School

McKelvey School of Engineering

Document Type

Thesis

Date of Award

Spring 5-2026

Language

English (en)

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Engineering Commons

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