Quantification of collateral aortopulmonary flow in patients subsequent to construction of bidirectional cavopulmonary shunts

Abstract

The use of scintigraphy combined with catheterization allows accurate determination of aortopulmonary collateral flow, and avoids overestimation of pulmonary vascular resistance in these candidates for the Fontan circulation.

Aortopulmonary Collaterals After Bidirectional Cavopulmonary Connection or Fontan Completion

“…Owing to extensive data processing, the results cannot be viewed until after the examination. The calculated APC flow in our BCPC cohort (1.42, 0.58 to 3.83 L/min/m 2 ) was comparable to that by Inuzuka et al, 7 who used a combined approach with nuclear imaging and catheterization (1.75Ϯ0.43 L/min/m 2 ). 7 Their method, however, relies on a number of assumptions, is invasive, requires ionizing radiation, and cannot be used in Fontan patients.…”

“…Furthermore, it requires intracardiac access, which is not otherwise necessary when extracardiac modifications or catheter laboratory completions of the Fontan procedure are performed. Inuzuka et al 7 recently used nuclear imaging in combination with catheterization to quantify APC flow in BCPC patients. To date, no noninvasive and readily applicable method has been proposed to quantify APC blood flow in patients with functionally single ventricles, except for in a case report, using MRI.…”

Acute effects of the ACE inhibitor enalaprilat on the pulmonary, cerebral and systemic blood flow and resistance after the bidirectional cavopulmonary connection

“…The multifocal nature of pulmonary blood flow in the BCPC (SVC and APC flows) means that, for an accurate assessment of pulmonary blood flow and resistance, a simple application of the Fick principle is invalid. While more complex methods of combining oxygen consumption measurements and radionuclide scans have been described,14 we wanted to evaluate multiple vascular beds and this was most conveniently done by MRI flow calculations.…”

Quantification of Systemic-to-Pulmonary Artery Collateral Flow

“…In the absence of an optimal quantitative, noninvasive technique to measure SPC flow, investigators were unable to reliably determine the hemodynamic burden caused by these collaterals and to objectively evaluate the efficacy of coil occlusion during cardiac catheterization. [1][2][3]11 The recent development of a cardiac MR technique to measure SPC flow noninvasively has overcome the drawbacks of previous methods to quantify collateral flow in patients with FSV. 12 First described in a case report by Grosse-Wartmann et al in 2007, 13 this method was subsequently refined and systematically evaluated in small cohorts by the same group and by Whitehead et al 14,15 Using phase contrast cine cardiac MR flow measurements in the aorta, superior and inferior venae cavae, branch pulmonary arteries, and pulmonary veins, SPC flow can be calculated in 2 different ways: (1) SPC flowϭsum of pulmonary vein flowϪsum of branch pulmonary artery flow; and (2) SPC flowϭascending aorta flowϪsum of caval flow (Figure).…”