Comparison of Fontan surgical options for patients with apicocaval juxtaposition
| Autor: | Camille Johnson, Brijesh P Kottayil, Ajit P. Yoganathan, Zhenglun Alan Wei, Gopalraj S. Sunil, Wenjun Wu, Morgan Stephens, Mahesh Kappanayil, Phillip M. Trusty, Ritchie Sharon, Balaji Srimurugan, Mark A. Fogel |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Heart Defects
Congenital Male medicine.medical_specialty Adolescent Flow distribution Heart Ventricles Hemodynamics 030204 cardiovascular system & hematology Pulmonary Artery Fontan Procedure Article 03 medical and health sciences 0302 clinical medicine medicine Humans cardiovascular diseases Child Power loss medicine.diagnostic_test business.industry Magnetic resonance imaging Vascular surgery Magnetic Resonance Imaging Cardiac surgery Surgery surgical procedures operative 030228 respiratory system Cardiac mass Case-Control Studies Pediatrics Perinatology and Child Health cardiovascular system Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Pediatr Cardiol |
| Popis: | Apicocaval juxtaposition (ACJ) is a rare form of viscerocardiac malpositions in association with single-ventricle congenital heart defects. The Fontan surgery is the common palliation, and possible surgical options include ipsilateral, contralateral, and intra-atrial conduits. Concerns include lower hemodynamic performances or risks of conduit compression by the cardiac mass. This study investigates the hemodynamics and clinical outcomes of ACJ patients and potential surgical improvements. Ten consecutive ACJ patients were included, along with a reference cohort of ten non-ACJ patients. Magnetic resonance images were acquired at 6±0.6 year follow-up for anatomical analysis and hemodynamic assessments using computational fluid dynamics. Metrics of interest are deformation index (DI), indexed power loss (iPL), and hepatic flow distribution (HFD(off)). A “virtual” surgery was performed to explore potential hemodynamic improvements using a straightened conduit. DI for ACJ patients fell within the DI range of non-ACJ patients. Contralateral conduits had insignificantly higher iPL (0.070 [0.032,0.137]) than ipsilateral conduits (0.041 [0.013,0.095]) and non-ACJ conduits (0.034 [0.011,0.061]). HFD(off) was similar for the ipsilateral (21 [12,35]), contralateral (26 [7,41]), and non-ACJ Fontan conduits (17 [0,48]). Virtual surgery demonstrated that a straightened conduit reduced HFD(off) and iPL for the contralateral and ipsilateral conduits, potentially leading to improved clinical outcomes. In this limited sample, the hemodynamic performance of ACJ patients was not significantly different from their non-ACJ counterparts. The use of a straightened conduit option could potentially improve patient outcomes. Additionally, the fear of significant compression of conduits for ACJ patients was unsupported. |
| Databáze: | OpenAIRE |
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