Journal article

Publication year: 2020

Pages: 28-34

Journal: International Journal of Cardiology

Volume number: 311

ISSN: 0167-5273

eISSN: 1874-1754

DOI Link: https://doi.org/10.1016/j.ijcard.2020.01.065

Publisher: Elsevier

Abstract: 

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 SVmorphology.

Methods: Forty-one Fontan patients (age at first CMR13.4 +/- 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. (c) 2020 Elsevier B.V. All rights reserved.

Harvard Citation style: Latus, H., Kruppa, P., Hofmann, L., Reich, B., Jux, C., Apitz, C., et al. (2020) Impact of aortopulmonary collateral flow and single ventricle morphology on longitudinal hemodynamics in Fontan patients: A serial CMR study, International Journal of Cardiology, 311, pp. 28-34. https://doi.org/10.1016/j.ijcard.2020.01.065

APA Citation style: Latus, H., Kruppa, P., Hofmann, L., Reich, B., Jux, C., Apitz, C., Schranz, D., Voges, I., Khalil, M., & Gummel, K. (2020). Impact of aortopulmonary collateral flow and single ventricle morphology on longitudinal hemodynamics in Fontan patients: A serial CMR study. International Journal of Cardiology. 311, 28-34. https://doi.org/10.1016/j.ijcard.2020.01.065