Aortopulmonary Collaterals After Bidirectional Cavopulmonary Connection or Fontan Completion

Grosse-Wortmann, Lars; Alotay, Abdulmajeed; Yoo, Shi Joon

doi:10.1161/circimaging.108.834192

Cited by 171 publications

(159 citation statements)

References 22 publications

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“…The flows in each individual pulmonary vein can also be measured and the difference between cumulative pulmonary vein flow and pulmonary arterial flow provide a quantification of aorto-pulmonary collateral burden [29]. An alternative technique to estimate the aorto-pulmonary collateral burden is the difference between the ascending aorta flow and total systemic venous flow [30].…”

Section: Flowsmentioning

confidence: 99%

Role of cardiac MRI and CT in Fontan circulation

Yeong

Loughborough

Hamilton

et al. 2017

J Congenit Heart Dis

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A Fontan circulation is a series of palliative surgical procedures, which result in the diversion of the systemic venous return into pulmonary arterial circulation without passing through a ventricle. It is one of the available surgical strategies for patients with cardiac defects that preclude a successful bi-ventricular repair, which encompass a range of complex anatomy. This surgical repair has gone through a series of modifications since the concept was introduced in 1971. Echocardiography remains a vital tool in assessing patients with Fontan circulations but its limitations are well recognised. Cross-sectional imaging modalities such as cardiac MRI and CT are essential components in the systematic clinical evaluation of these patients. The purpose of this review is to understand the information that can be obtained with each cross-sectional modality as well as highlight the challenges that each modality faces.

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Section: Flowsmentioning

confidence: 99%

Role of cardiac MRI and CT in Fontan circulation

Yeong

Loughborough

Hamilton

et al. 2017

J Congenit Heart Dis

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“…In the present setting, MRI catheterization is a unique tool that combines invasive pressures and VEC MRI-derived flow data that also account for collateral aortopulmonary blood flow. 3,16,28 For reliable assessment of the PVR in the Fontan circulation, which is very susceptible to changes in volume load, pulmonary pressures and blood flow were measured in our study simultaneously but not sequentially. The MRI method used in this study for measuring collateral blood flow was adopted from the work published by GrosseWortmann et al 3 and Whitehead et al 14 In these studies, collateral flow was estimated by 2 approaches.…”

Section: Blood Flow and Pvrmentioning

confidence: 99%

“…1,2 Other authors have reported significant left-to-right shunting through aortopulmonary collaterals. 3,4 Both factors may have a direct impact on the PVR that cannot be measured in the Fontan circulation by conventional techniques, such as thermodilution or oxymetry.…”

mentioning

confidence: 99%

Pulmonary Vascular Resistance, Collateral Flow, and Ventricular Function in Patients With a Fontan Circulation at Rest and During Dobutamine Stress

Schmitt

Steendijk

Ovroutski

et al. 2010

Circ: Cardiovascular Imaging

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Background-The role, interplay, and relative importance of the multifactorial hemodynamic and myocardial mechanisms causing dysfunction of the Fontan circulation remain incompletely understood. Methods and Results-Using an MRI catheterization technique, we performed a differential analysis of pulmonary vascular resistance and aortopulmonary collateral blood flow in conjunction with global ventricular pump function, myocontractility (end-systolic pressure-volume relation), and diastolic compliance (end-diastolic pressure-volume relation) in 10 patients with a Fontan circulation at rest and during dobutamine stress. Pulmonary and ventricular pressures were measured invasively and synchronized with velocity-encoded MRI-derived pulmonary and aortic blood flows and cine MRI-derived ventricular volumes. Pulmonary vascular resistance and end-systolic and end-diastolic pressure-volume relations were then determined. Aortopulmonary collateral flow was calculated as the difference between aortic and pulmonary flow. Compared to rest, dobutamine caused a small increase in mean pulmonary pressures (PϽ0.05). Collateral flow was significantly augmented (PϽ0.001) and contributed importantly to an increase in pulmonary flow (PϽ0.01). Pulmonary vascular resistance decreased significantly (PϽ0.01). Dobutamine did not increase stroke volumes significantly despite slightly enhanced contractility (end-systolic pressure-volume relation). Active early relaxation () was inconspicuous, but the end-diastolic pressure-volume relation shifted upward, indicating reduced compliance. Conclusions-In patients with a Fontan circulation, aortopulmonary collateral flow contributes substantially to enhanced pulmonary flow during stress. Our data indicate that pulmonary vascular response to augmented cardiac output was adequate, but decreased diastolic compliance was identified as an important component of ventricular dysfunction. (Circ Cardiovasc Imaging. 2010;3:623-631.)

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“…In BDG circulation with decreased arterial oxygen saturation and ordinary inspiratory oxygen concentration, the effects of low oxygen fall into categories (2) and (3); in other words, the responses are mediated by the chemoreceptor and peripheral vessels and the effects of this pathway are considered as the same as in the previous publications. Hypoxia stimulates excitatory impulses from the chemoreceptor to the brainstem vasomotor center, and enhances systemic SNA.…”

Section: Sna Under Low-oxygen Conditionsmentioning

confidence: 99%