Pulmonary Venous Flow Index as a Predictor of Pulmonary Vascular Resistance Variability in Congenital Heart Disease with Increased Pulmonary Flow: A Comparative Study before and after Oxygen Inhalation

Rivera, Ivan Romero; Mendonça, Maria Alayde; Andrade, José L.; Moisés, Valdir Ambrósio; Campos, Orlando; Silva, Celia Camelo; Carvalho, Antônio Carlos

doi:10.1111/echo.12163

Cited by 13 publications

(11 citation statements)

References 39 publications

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“…* Obtained according to previously described methodology. 16,17 Reference values from our patients with unrestrictive cardiac communications with no signs of PH were: Qp/Qs, 2.8 (2.4–3.4); VTI PV , 22.5 (19.5–25.3) cm.…”

Section: Resultsmentioning

confidence: 86%

“…In addition to providing anatomic data, transthoracic echocardiography was used to estimate pulmonary-to-systemic blood flow ratio (Qp/Qs) and the velocity-time integral of blood flow in pulmonary veins (VTI PV ). 16,17 Cardiac catheterization was performed under general anesthesia and mechanical ventilation. Pulmonary and systemic blood flow were calculated by the Fick method and used in the assessment of pulmonary and systemic vascular resistance (PVR and SVR, Wood units × m 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…Numeric variables are expressed as medians (interquartile ranges; columns All patients, n ¼ 33 and Patients selected for surgery, n ¼ 30) or medians (range; column Patients not selected for surgery, n ¼ 3). *Obtained according to previously described methodology 16,17. Reference values from our patients with unrestrictive cardiac communications with no signs of PH were: Qp/Qs, 2.8 (2.4-3.4); VTI PV , 22.5(19.5-25.3) cm.…”

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confidence: 99%

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Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments

Thomaz¹,

Kajita

Aiello³

et al. 2019

Pulm. circ.

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Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6–37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9–7.2) Wood units × m2 (median with IQR). Twenty-two patients had a ≥ 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles ( P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a ≥ 30% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0–4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower ( P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions ( P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U × m2, respectively). A preoperative PVR/SVR of ≥24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of ≥4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI] = 1.09 [1.01–1.18], P = 0.036; and 0.69 [0.49–0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent.

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Section: Resultsmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments

Thomaz¹,

Kajita

Aiello³

et al. 2019

Pulm. circ.

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“…In our model, pulmonary vascular resistance (PVR) was held constant. There is some evidence that PVR may decrease with increased pulmonary blood flow and some degree of pulsatility [69,70]. If so, then the IJS may have this additional collateral benefit.…”

Section: Discussionmentioning

confidence: 99%

Parametric Investigation of an Injection-Jet Self-Powered Fontan Circulation

Prather

Das²,

Farias

et al. 2021

Preprint

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Rationale: Approximately 1/2500 babies are born with only one functioning ventricle and the Fontan is the third and, ideally final staged palliative operation for these patients. This altered circulation is prone to failure with survival rates below 50% into adulthood in some series. Chronically elevated inferior vena cava (IVC) pressure is implicated as one cause of the mortality and morbidity in this population.Objective: An injection jet shunt (IJS) drawing blood-flow directly from the aortic arch to significantly lower IVC pressure is proposed.Methods and Results: A computer-generated 3D model of a 2–4 year old patient with a fenestrated Fontan and a cardiac output of 2.3L/min was generated. The detailed 3D pulsatile hemodynamics are resolved in a zero-dimensional lumped parameter network tightly-coupled to a 3D computational fluid dynamics model accounting for non-Newtonian blood rheology and resolving turbulence using large eddy simulation. IVC pressure and systemic oxygen saturation were tracked for various IJS-assisted Fontan configurations, altering design parameters such as shunt and fenestration diameters and locations.A baseline “failing” Fontan with 4mm fenestration was tuned to elevated IVC pressure (\(+17.8mmHg\)). Enlargement of the fenestration to 8mm resulted in a 3mmHg IVC pressure drop but an unacceptable reduction in systemic oxygen saturation below 80%. Addition of an IJS with a 2mm nozzle and minor volume load to the ventricle improved the IVC pressure drop to 3.2mmHg while increasing systemic oxygen saturation above 80%.Conclusions: The salutary effects of the IJS to effectively lower IVC pressure while retaining acceptable levels of oxygen saturation are successfully demonstrated.

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“…The velocity-time integral of pulmonary venous blood flow was obtained (VTI PV , cm), and a mean value per patient was calculated. VTI PV has been shown to be inversely related to pulmonary vascular resistance [ 15 ]. The pulmonary-to-systemic blood flow ratio (Qp/Qs) was also estimated [ 16 ], but it was considered less accurate in some cases due to the presence of a communication distal to the aortic and pulmonary valves (patent ductus arteriosus).…”

Section: Methodsmentioning

confidence: 99%

Serum Cytokines in Young Pediatric Patients with Congenital Cardiac Shunts and Altered Pulmonary Hemodynamics

Zorzanelli

Maeda

Clavé

et al. 2016

Mediators of Inflammation

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Background and Objective. Inflammation is central in the pathogenesis of pulmonary hypertension. We investigated how serum cytokines correlate with clinical features, hemodynamics, and lung histology in young patients with pulmonary hypertension associated with congenital cardiac shunts. Design. Prospective, observational study. Methods and Results. Patients (n = 44) were aged 2.6 to 37.6 months. Group I patients (n = 31) were characterized by pulmonary congestion and higher pulmonary blood flow compared to group II (p = 0.022), with no need for preoperative cardiac catheterization. Group II patients (n = 13) had no congestive features. At catheterization, they had elevated pulmonary vascular resistance (5.7 [4.4–7.4] Wood units·m2, geometric mean with 95% CI). Cytokines were measured by chemiluminescence. Macrophage migration inhibitory factor (MIF) was found to be inversely related to pulmonary blood flow (r = −0.33, p = 0.026) and was higher in group II (high pulmonary vascular resistance) compared to group I (high pulmonary blood flow) (p = 0.017). In contrast, RANTES chemokine (regulated on activation, normal T cell expressed and secreted) was characteristically elevated in Group I (p = 0.022). Interleukin 16 was also negatively related to pulmonary blood flow (r S = −0.33, p = 0.029) and was higher in patients with obstructive vasculopathy at intraoperative lung biopsy (p = 0.021). Conclusion. Cytokines seem to be important and differentially regulated in subpopulations of young patients with cardiac shunts.

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Pulmonary Venous Flow Index as a Predictor of Pulmonary Vascular Resistance Variability in Congenital Heart Disease with Increased Pulmonary Flow: A Comparative Study before and after Oxygen Inhalation

Abstract: The VTIpv correlated well with the PVR. The measurement of this index before and after oxygen inhalation may become a useful noninvasive test for differentiating persistent vascular disease from dynamic and flow-related pulmonary hypertension.

Cited by 13 publications

References 39 publications

Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments

Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments

Parametric Investigation of an Injection-Jet Self-Powered Fontan Circulation

Serum Cytokines in Young Pediatric Patients with Congenital Cardiac Shunts and Altered Pulmonary Hemodynamics

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