Journal article

Publication year: 2016

Pages: 504-511

Journal: Pediatric Cardiology

Volume number: 37

Issue number: 3

ISSN: 0172-0643

eISSN: 1432-1971

DOI Link: https://doi.org/10.1007/s00246-015-1307-1

Publisher: Springer

Abstract: 
Invasive hemodynamic studies have shown that nitric oxide (NO), a selective pulmonary vasodilator, can lower pulmonary vascular resistance in Fontan patients. Because oximetry-derived flow quantification may be unreliable, we sought to detect changes in blood flow within the Fontan circulation after inhalation of NO using cardiovascular magnetic resonance (CMR). Thirty-three patients (mean age 12.8 +/- A 7.0 years) after the Fontan procedure underwent CMR as part of their routine clinical assessment. Standard two-dimensional blood flow measurements were performed in the Fontan tunnel, superior vena cava (SVC) and ascending aorta (AAO) before and after inhalation of 40 ppm NO for 8-10 min. Systemic-to-pulmonary collateral (SPC) flow was calculated as AAO - (SVC + tunnel). Heart rate (82 +/- A 18 to 81 +/- A 18 bpm; p = 0.31) and transcutaneous oxygen saturations (93 +/- A 4 to 94 +/- A 3 %; p = 0.13) did not change under NO inhalation. AAO flow (3.23 +/- A 0.72 to 3.12 +/- A 0.79 l/min/m(2); p = 0.08) decreased, tunnel flow (1.58 +/- A 0.40 to 1.65 +/- A 0.46 l/min/m(2); p = 0.032) increased, and SVC flow (1.01 +/- A 0.39 to 1.02 +/- A 0.40 l/min/m(2); p = 0.50) remained unchanged resulting in higher total caval flow (Qs) (2.59 +/- A 0.58 to 2.67 +/- A 0.68 l/min/m(2); p = 0.038). SPC flow decreased significantly from 0.64 +/- A 0.52 to 0.45 +/- A 0.51 l/min/m(2) (p = 0.002) and resulted in a significant decrement of the Qp/Qs ratio (1.23 +/- A 0.23 to 1.15 +/- A 0.23; p = 0.001). Inhalation of NO in Fontan patients results in significant changes in pulmonary and systemic blood flow. The reduction in SPC flow is accompanied by a net increase in effective systemic blood flow suggesting beneficial effects of pulmonary vasodilators on cardiac output, tissue perfusion and exercise capacity.

Harvard Citation style: Latus, H., Gerstner, B., Kerst, G., Moysich, A., Gummel, K., Apitz, C., et al. (2016) Effect of Inhaled Nitric Oxide on Blood Flow Dynamics in Patients After the Fontan Procedure Using Cardiovascular Magnetic Resonance Flow Measurements, Pediatric Cardiology, 37(3), pp. 504-511. https://doi.org/10.1007/s00246-015-1307-1

APA Citation style: Latus, H., Gerstner, B., Kerst, G., Moysich, A., Gummel, K., Apitz, C., Bauer, J., & Schranz, D. (2016). Effect of Inhaled Nitric Oxide on Blood Flow Dynamics in Patients After the Fontan Procedure Using Cardiovascular Magnetic Resonance Flow Measurements. Pediatric Cardiology. 37(3), 504-511. https://doi.org/10.1007/s00246-015-1307-1