Pulmonary Artery Wall Thickness in Children With Fontan Physiology – An Optical Coherence Tomography Case Control Study

McGovern, Eiméar; Voss, Christine; Duncombe, Stephanie L.; Hosking, MC; Harris, KC

doi:10.1016/j.cjca.2017.07.030

Cited by 1 publication

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“…Other studies have also verified the strong correlation between histological and OCT measurements of PA wall thickness in patients with pulmonary arterial hypertension 27 . However, in complex CHD that has undergone a Glenn or Fontan circulation, the PA wall thickness had no correlation with mPAP and PVRi 23 . It might be due to a small sample size or different pulmonary circulation conditions.…”

Section: Discussionmentioning

confidence: 94%

“…Three studies have reported PA wall dimensions. McGovern et al 23 . employed OCT to evaluate structural changes within the pulmonary arteries of 12 Fontan patients and 11 individuals with normal pulmonary circulation.…”

Section: Resultsmentioning

confidence: 99%

“…The results indicated that PA wall thickness correlated significantly with mPAP, PVRi, and Qp/Qs and OCT might represent a promising tool for evaluating the PA wall in children with CHD. McGovern et al 23 . measured PA wall thickness, PA pressure, and PVRi in Fontan and control patients.…”

Section: Resultsmentioning

confidence: 99%

“…The position of the OCT guidewire, the distance between the wire and the PA wall, and the degree of blood flushing are all factors that influence the delineation of the three‐layer structure of the pulmonary vessel wall 7 . However, besides these factors, it was thought that loss of the media may reflect an early sign of vascular change or the hallmark of pulmonary vascular disease in CHD pediatric patients which presents with a single‐layered vascular wall and homogeneous signal‐rich bands 23,28 . But others thought that the three‐layered appearance may reflect pathological changes.…”

Section: Discussionmentioning

confidence: 99%

“…It also indirectly indicated that Glenn or Fontan patients had no pulmonary arterial hypertension when less medial layer thickened. It is well known that PAH is associated with medial or intimal hypertrophy, and several studies have supported endothelial dysfunction in the pulmonary arteries of univentricular or biventricular patients 9,23,30 . If PA wall thickness measured using OCT served as an alternative indicator of the very early stages of PAH and can be used to identify the development of PA remodeling among Eisenmenger's syndrome, cyanotic heart disease or Fontan patients, it may be a useful tool for prognostication and assessing response to PAH therapy or medical decision‐making during follow‐up.…”

Section: Discussionmentioning

confidence: 99%

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Optical coherence tomography of the pulmonary arteries in children with congenital heart diseases: A systematic review

Sun

Jiang

Xie

et al. 2022

Pediatric Investigation

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Importance: Optical coherence tomography (OCT) is a high-resolution intravascular imaging tool and has shown promise for providing real-time quantitative and qualitative descriptions of pulmonary vascular structures in vivo in adult pulmonary hypertension (PH), while not popular in pediatric patients with congenital heart diseases (CHD). Objective: The aim of this review is to summarize all the available evidence on the use of OCT for imaging pulmonary vascular remodeling in pediatric patients. Methods: We conducted the systematic literature resources (Cochran Library database, Medline via PubMed, EMBASE, and Web of Knowledge) from January 2010 to December 2021 and the search terms were "PH", "child", "children", "pediatric", "OCT", "CHD", "pulmonary vessels", "pulmonary artery wall". Studies in which OCT was used to image the pulmonary vessels in pediatric patients with CHD were considered for inclusion. Results: Five studies met the inclusion criteria. These five papers discussed the study of OCT in the pulmonary vasculature of different types of CHD, including common simple CHD, complex cyanotic CHD, and Williams-Beuren syndrome. In biventricular anatomy, pulmonary vascular remodeling was primarily reflected by pulmonary intima thickening from two-dimensional OCT. In single-ventricle anatomy, due to the state of hypoxia, the morphology of pulmonary vessels was indirectly reflected by the number and shape of nourishing vessels from three-dimensional OCT. Interpretation: OCT may be an adequate imaging procedure for the demonstration of pulmonary vascular structures and provide additional information in pediatric patients.

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Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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