Caval contribution to flow in the branch pulmonary arteries of Fontan patients with a novel application of magnetic resonance presaturation pulse
Caval contribution to flow in the branch pulmonary arteries of Fontan patients with a novel application of magnetic resonance presaturation pulse
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DOI：
10.1161/01.cir.99.9.1215
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发表时间：
1999-03-09
期刊：
影响因子：
37.8
通讯作者：
Haselgrove, J
中科院分区：
文献类型：
--
作者：
Fogel, MA;Weinberg, PM;Haselgrove, J
背景-一个完整的理解Fontan生理流体力学包括知识的腔静脉贡献右（RPA）和左（LPA）肺动脉血流，全身静脉回流，相对血流量，每个lung.Methods和Results-Ten Fontan患者进行电影MRT。对肺动脉进行了三次电影扫描：（1）无预饱和脉冲，（2）标记下腔静脉（IVC）血液的预饱和脉冲（信号空白），以及（3）标记上级腔静脉（SVC）血液的预饱和脉冲。相对信号降低与源自标记腔静脉的血液量成比例。该方法在体模中得到了验证。60+/-6%的SVC血液流入RPA，67+/-12%的IVC血液流向LPA。在LPA和RPA中的血液中，分别有48+/-14%和31+/-17%来自IVC。IVC血液占全身静脉回流总量的40+/-16%。每个肺的血液分布几乎相等（RPA/LPA血液=0.94+/-11）。结论：在全腔静脉连接的Fontan患者中，SVC血液流向RPA，IVC血液流向LPA。虽然右肺容量大于左肺，但流向两肺的血流量相等。LPA血液由等量的IVC和SVC血液组成，因为IVC对总体静脉回流的贡献小于SVC，该技术和这些发现有助于评价体静脉通路的设计变更以改善Fontan血流动力学。
Background-A complete understanding of fluid mechanics in Fontan physiology includes knowledge of the caval contributions to right (RPA) and left (LPA) pulmonary arterial blood flow, total systemic Venous return, and relative blood flow to each lung.Methods and Results-Ten Fontan patients underwent cine MRT. Three cine scans of the pulmonary arteries were performed: (1) no presaturation pulse, (2) a presaturation pulse labeling inferior vena cava (IVC) blood (signal void), and (3) a presaturation pulse labeling superior vena cava (SVC) blood. The relative signal decrease is proportional to the amount of blood originating from the labeled vena cava. This method was validated in a phantom. Whereas 60+/-6% of SVC blood flowed into the RPA, 67+/-12% of IVC blood flowed toward the LPA. Of the blood in the LPA and RPA, 48+/-14% and 31+/-17%, respectively, came from the IVC. IVC blood contributed 40+/-16% to total systemic venous return. The distributions of blood to each lung were nearly equal (RPA/LPA blood=0.94+/-11).Conclusions-In Fontan patients with total cavopulmonary connection, SVC blood is directed toward the RPA and IVC blood is directed toward the LPA. Although the right lung volume is larger than the left, an equal amount of blood flow went to both lungs. LPA blood is composed of equal amounts of IVC and SVC blood because IVC contribution to total systemic venous return is smaller than that of the SVC, This technique and these findings can help to evaluate design changes of the systemic venous pathway to improve Fontan hemodynamics.