Journal of Cardiovascular Imaging

  • 제30권2호
  • /
  • Pages.99-108
  • /
  • 2022
  • /
  • 2586-7210(pISSN)
  • /
  • 2586-7296(eISSN)
한국심초음파학회 (Korean Society of Echocardiography)
권호 표지
DOI QR코드

DOI QR Code

Pulsatility Index in Different Modifications of Fontan Palliation: An Echocardiographic Assessment

  • Reza Shabanian (Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences) ;
  • Parvin Akbari Asbagh (Department of Pediatric Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences) ;
  • Abdullah Sedaghat (Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences) ;
  • Minoo Dadkhah (Department of Pediatric Cardiology, Baharloo Hospital, Tehran University of Medical Sciences) ;
  • Zahra Esmaeeli (Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences) ;
  • Aliyeh Nikdoost (Department of Pediatric Cardiology, Payambar Azam Hospital, Kerman University of Medical Sciences) ;
  • Manizheh Ahani (Department of Pediatric Cardiac Surgery, Children's Medical Center, Tehran University of Medical Sciences) ;
  • Mitra Rahimzadeh (Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Alborz University of Medical Sciences) ;
  • Alireza Dehestan (Department of Pediatric Cardiac Surgery, Children's Medical Center, Tehran University of Medical Sciences) ;
  • Mohammad Ali Navabi (Department of Pediatric Cardiac Surgery, Children's Medical Center, Tehran University of Medical Sciences)
  • 투고 : 2021.08.13
  • 심사 : 2021.10.12
  • 발행 : 2022.04.27
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

BACKGROUND: Adding pulsation to the Fontan circulation might change the fate of patients palliated by this procedure. Our aim was to compare the pulsatility index (PI) of the pulmonary artery (PA) between the various modifications of Fontan palliation. METHODS: Doppler-derived PI was measured in PA branches of a cohort of 28 patients palliated by 6 modifications of Fontan procedure. A group of normal individuals was included for comparison. RESULTS: Atriopulmonary connection (APC) group had the highest PA branches PI and statistically was close to the PI of the normal individuals (right pulmonary artery [RPA] PI of 1.58 vs. 1.63; p = 0.99 and left pulmonary artery [LPA] PI of 1.54 vs. 1.68; p = 0.46, respectively). The lowest PA branches PI was seen in the group of extracardiac total cavopulmonary connection (RPA PI of 0.62 and LPA PI of 0.65). Other 4 modifications including the extracardiac conduit with oversewn pulmonary valve, extracardiac conduit with preserved adjusted antegrade flow, extracardiac conduit from inferior vena cava onto the rudimentary right ventricle and lateral tunnel had a mean "RPA and LPA" PI of "1.19 and 1.17", "1.16 and 1.11", "1.13 and 1.11", "0.82 and 0.84", respectively. The modified Dunnett's post hoc test has shown a significant statistical decline in PI of all modifications compared to the normal individuals except for the APC group. CONCLUSIONS: Fontan palliated patients in different groups of surgical modification showed a spectrum of Doppler-derived PI with the highest amounts belong to the groups of pulsatile Fontan.

키워드

참고문헌

  1. Khairy P, Poirier N. Is the extracardiac conduit the preferred Fontan approach for patients with univentricular hearts? The extracardiac conduit is not the preferred Fontan approach for patients with univentricular hearts. Circulation 2012;126:2516-25.
  2. Klimes K, Abdul-Khaliq H, Ovroutski S, et al. Pulmonary and caval blood flow patterns in patients with intracardiac and extracardiac Fontan: a magnetic resonance study. Clin Res Cardiol 2007;96:160-7.
  3. Henaine R, Vergnat M, Bacha EA, et al. Effects of lack of pulsatility on pulmonary endothelial function in the Fontan circulation. J Thorac Cardiovasc Surg 2013;146:522-9.
  4. Ferns SJ, Zein CE, Subramanian S, Husayni T, Ilbawi MN. Post-Fontan pulmonary artery growth in patients with a bidirectional cavopulmonary shunt with additional antegrade pulsatile blood flow. Asian Cardiovasc Thorac Ann 2021;29:743-50.
  5. de Leval MR, Deanfield JE. Four decades of Fontan palliation. Nat Rev Cardiol 2010;7:520-7.
  6. Egbe AC, Connolly HM, Miranda WR, et al. Hemodynamics of Fontan failure: the role of pulmonary vascular disease. Circ Heart Fail 2017;10:e004515.
  7. Shabanian R, Mirzaaghayan MR, Dadkhah M, et al. Echocardiographic assessment of pulmonary arteries pulsatility index in Fontan circulation. J Cardiovasc Ultrasound 2015;23:228-32.
  8. Houlind K, Stenbog EV, Sorensen KE, et al. Pulmonary and caval flow dynamics after total cavopulmonary connection. Heart 1999;81:67-72.
  9. Ha KS, Choi JY, Jung SY, Park HK. Characterization of flow efficiency, pulsatility, and respiratory variability in different types of Fontan circuits using quantitative parameters. Yonsei Med J 2019;60:56-64.
  10. Ovroutski S, Ewert P, Alexi-Meskishvili V, et al. Absence of pulmonary artery growth after Fontan operation and its possible impact on late outcome. Ann Thorac Surg 2009;87:826-31.
  11. Raj JU, Kaapa P, Anderson J. Effect of pulsatile flow on microvascular resistance in adult rabbit lungs. J Appl Physiol (1985) 1992;72:73-81.
  12. Presson RG Jr, Baumgartner WA Jr, Peterson AJ, Glenny RW, Wagner WW Jr. Pulmonary capillaries are recruited during pulsatile flow. J Appl Physiol (1985) 2002;92:1183-90.
  13. Yeong M, Loughborough W, Hamilton M, Manghat N. Role of cardiac MRI and CT in Fontan circulation. Journal of Congenital Cardiology 2017;1:8.
  14. Rebergen SA, Ottenkamp J, Doornbos J, van der Wall EE, Chin JG, de Roos A. Postoperative pulmonary flow dynamics after Fontan surgery: assessment with nuclear magnetic resonance velocity mapping. J Am Coll Cardiol 1993;21:123-31.
  15. van Son JA, Mohr FW, Hambsch J, Schneider P, Hess H, Haas GS. Conversion of atriopulmonary or lateral atrial tunnel cavopulmonary anastomosis to extracardiac conduit Fontan modification. Eur J Cardiothorac Surg 1999;15:150-7.
  16. Kao JM, Alejos JC, Grant PW, Williams RG, Shannon KM, Laks H. Conversion of atriopulmonary to cavopulmonary anastomosis in management of late arrhythmias and atrial thrombosis. Ann Thorac Surg 1994;58:1510-4.