Postoperative pulmonary flow dynamics after fontan surgery: Assessment with nuclear magnetic resonance velocity mapping

Rebergen, Sidney A.; Ottenkamp, Jaap; Doornbos, Joost; Wall, Ernst E. van der; Chin, J. G. J.; Roos, Albert de

doi:10.1016/0735-1097(93)90726-h

Cited by 124 publications

(41 citation statements)

References 39 publications

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“…Their analysis was performed in the cross-sectional plane of the branch PAs and perhaps it is a more sensitive method for analyzing branch PA flow. Branch PA flow observed in our study was biphasic and agrees with other studies in this regard [18,19].…”

Section: Branch Pulmonary Artery Flowsupporting

confidence: 93%

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

Sharma¹,

Ensley

Hopkins

et al. 2001

The Annals of Thoracic Surgery

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Background. The total cavopulmonary connection (TCPC) design continues to be refined on the basis of flow analysis at the connection site. These refinements are of importance for myocardial energy conservation in the univentricular supported circulation. In vivo mag netic resonance phase contrast imaging provides semiquantitative flow visualization information. The purpose of this study was to understand the in vivo TCPC flow characteristics obtained by magnetic resonance phase contrast imaging and compare the results with our pre vious in vitro TCPC flow experiments in an effort to further refine TCPC surgical design.Methods. Twelve patients with TCPC underwent se dated three-dimensional, multislice magnetic resonance phase contrast imaging. Seven patients had intraatrial lateral tunnel TCPC and 5 had extracardiac TCPC.Results. In all patients in both groups a disordered flow pattern was observed in the inferior caval portion of the TCPC. Flow at the TCPC site appeared to be determined by connection geometry, being streamlined at the superior

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Section: Branch Pulmonary Artery Flowsupporting

confidence: 93%

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

Sharma¹,

Ensley

Hopkins

et al. 2001

The Annals of Thoracic Surgery

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“…Planar models and steady flow were used for simplicity while in vivo, the connection often incorporates superiorinferior curvature and the flow may be biphasic within the TCPC [12]. Both of these factors may contribute to TCPC hemodynamics and would be an additional con sideration for further study.…”

Section: Limitationsmentioning

confidence: 99%

Toward designing the optimal total cavopulmonary connection: an in vitro study

Ensley

Lynch

Chatzimavroudis

et al. 1999

The Annals of Thoracic Surgery

109

100

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Background. Understanding the total cavopulmonary connection (TCPC) hemodynamics may lead to improved surgical procedures which result in a more efficient modified circulation. Reduced energy loss will translate to less work for the single ventricle and although uni ventricular physiology is complex, this improvement could contribute to improved postoperative outcomes. Therefore to conserve energy, one surgical goal is opti mization of the TCPC geometry. In line with this goal, this study investigated whether addition of caval curva ture or flaring at the connection conserves energy.Methods. TCPC models were made varying the curva ture of the caval inlet or by flaring the anastomosis. Steady flow pressure measurements were made to calcu late the power loss attributed to each connection design over a range of pulmonary flow splits (70:30 to 30:70). Particle flow visualization was performed for each design and was qualitatively compared to the power losses.Results. Results indicate that curving the cavae toward

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“…AFTER FONTAN COMPLETION for a functionally univentricular heart, the systemic venous return is directly connected to the pulmonary arteries (PAs), resulting in substantial or total loss of pulsatile flow into the lung (1)(2)(3)(4). The long-term effects of this abnormal flow pattern on PA growth and function are a matter of concern.…”

mentioning

confidence: 99%

Pulmonary artery size and function after Fontan operation at a young age

Robbers‐Visser

Helderman

Strengers

et al. 2008

Magnetic Resonance Imaging

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Purpose: To assess pulmonary artery (PA) size, flow variables, and wall shear stress (WSS) in patients after Fontan operation at a young age. Materials and Methods:Flow in the branch PA was obtained with phase contrast velocity-encoded cardiovascular magnetic resonance imaging in 14 patients before and after low-dose dobutamine stress (7.5 g/kg/min) and in 17 healthy controls at rest.Results: At rest, stroke index, total flow, average, and peak flow rate were all statistically significantly lower in patients than in controls (P Ͻ 0.001). With stress-testing, all variables increased in patients (P Ͻ 0.001), apart from stroke index, which did not change. At rest, branch PA area did not differ between patients and controls. Distensibility was lower in patients than in controls (P Ͻ 0.001). With stresstesting, area and distensibility did not change. At rest, WSS was lower in patients than in controls (P Ͻ 0.001). WSS increased with stress-testing (P Ͻ 0.001), but not to the same levels as during resting conditions of the control group.Conclusion: PA size is normal long-term after Fontan operation at a young age. Flow variables, distensibility, and WSS are significantly lower compared to healthy controls, and do not show adequate reactions with stress-testing, which is suggestive of pulmonary artery endothelial and/or vascular dysfunction.

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Postoperative pulmonary flow dynamics after fontan surgery: Assessment with nuclear magnetic resonance velocity mapping

Cited by 124 publications

References 39 publications

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

Toward designing the optimal total cavopulmonary connection: an in vitro study

Pulmonary artery size and function after Fontan operation at a young age

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