Impact of aortopulmonary collateral flow and single ventricle morphology on longitudinal hemodynamics in Fontan patients: A serial CMR study
| Autor: | Christian Jux, Pia Kruppa, Inga Voges, Lucas Hofmann, Bettina Reich, Christian Apitz, Kerstin Gummel, Heiner Latus, Markus Khalil, Dietmar Schranz |
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| Rok vydání: | 2020 |
| Předmět: |
Heart Defects
Congenital medicine.medical_specialty Vena Cava Superior Volume overload Magnetic Resonance Imaging Cine Hemodynamics 030204 cardiovascular system & hematology Fontan Procedure Univentricular Heart Inferior vena cava 03 medical and health sciences 0302 clinical medicine Superior vena cava medicine.artery Internal medicine Ascending aorta Humans Medicine cardiovascular diseases 030212 general & internal medicine Ejection fraction business.industry Blood flow Magnetic Resonance Imaging medicine.anatomical_structure medicine.vein Ventricle cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | International Journal of Cardiology. 311:28-34 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2020.01.065 |
| Popis: | Background Single ventricle (SV) patients with a Fontan circulation are at risk for functional deterioration. The aim of this study was to assess longitudinal Fontan hemodynamics using serial cardiovascular magnetic resonance (CMR) data and to study the impact of aortopulmonary collateral (APC) flow and type of SV morphology. Methods Forty-one Fontan patients (age at first CMR 13.4 ± 6.0 years) with two CMR examinations within a time interval of at least 4 years (follow-up 5.3 ± 0.9 years) were included. The protocol consisted of short-axis cine volumetry and 2-dimensional blood flow measurements in the inferior vena cava (IVC), superior vena cava (SVC) and ascending aorta (Ao). APC flow was calculated as Ao – (SVC + IVC). Myocardial strain/strain rate was assessed using feature tracking technique. Results SV end-diastolic volume (p = 0.14) and ejection fraction (p = 0.70) remained constant. No significant changes in CMR derived myocardial strain/strain rate values were observed. Ao flow decreased (p = 0.01), IVC flow remained unchanged (p = 0.52), while SVC flow (p = 0.003) and APC flow (p = 0.006) decreased significantly. Patients with a systemic right ventricle (RV) showed unchanged APC flow and a further increase in SV size over time compared to patients with a systemic left ventricle. Conclusions Longitudinal CMR data in a cohort of clinically stable Fontan patients revealed no significant changes in SV dimensions and myocardial performance while APC flow decreased spontaneously. Patients with a systemic RV seem to be at risk for permanent SV volume overload through APCs and might therefore benefit from consequent interventional APC embolization. |
| Databáze: | OpenAIRE |
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