Pulmonary and caval blood flow patterns in patients with intracardiac and extracardiac Fontan: a magnetic resonance study
Pulmonary and caval blood flow patterns in patients with intracardiac and extracardiac Fontan: a magnetic resonance study
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DOI：
10.1007/s00392-007-0470-z
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发表时间：
2007-03-01
影响因子：
5
通讯作者：
Gutberlet, M.
中科院分区：
文献类型：
--
作者：
Klimes, K.;Abdul-Khaliq, H.;Gutberlet, M.
目的：利用磁共振成像技术比较不同Fontan手术后的体内血流和搏动。材料与方法应用磁共振相位对比速度成像技术研究了37例连续病例（平均年龄19 ± 7.9岁，Fontan术后7.3 ± 3.2年），其中7例为心房吻合术（APC），18例为心房内侧隧道术（LTFO），12例为心外Fontan术（ECFO）。测量上级腔静脉（SVC）、下腔静脉（IVC）和两个肺动脉中的血流量（体积流量），并计算每个血管的脉动指数。结果改良后上、下腔静脉血流分布正常（1：2）。APC患者搏动正常，右心房扩张，IVC部分返流，肺动脉间血流呈生理性分布。LTFO和ECFO患者的IVC中没有逆行血流，肺动脉之间的血流分布均匀，脉动性非常低或无脉动性。结论MRI可以定量和表征Fontan改良的血流动力学特征，并可能是预测Fontan失败的有价值的工具。尽管表现出正常的脉动性，APC患者右心房扩张和IVC部分回流，证明次优Fontan循环。LTFO和ECFO均在IVC中产生单向顺行血流，但脉动性非常低或不存在，这可能促进肺动脉生长不良和肺血管阻力增加，从而导致晚期Fontan衰竭。
Aims We compared in vivo blood flow and pulsatility after different types of Fontan operation using magnetic resonance imaging. Material and methods A total of 37 consecutive patients (mean age 19 +/- 7.9 years, 7.3 +/- 3.2 years after Fontan operation), 7 with atriopulmonary anastomosis (APC), 18 with intra-atrial lateral tunnel (LTFO) and 12 with extracardiac Fontan (ECFO) were studied using magnetic resonance phase-contrast velocity mapping. Blood flow (volume flow) in the superior vena cava (SVC), inferior vena cava (IVC) and both pulmonary arteries were measured and a pulsatility index was calculated for each vessel. Results For all modifications, the blood flow distribution between the SVC and IVC was normal (1 : 2). Patients with APC had a normal pulsatility, a dilated right atrium, partial backward flow in the IVC and physiological blood flow distribution between the pulmonary arteries. LTFO and ECFO patients had no retrograde flow in the IVC, equal blood flow distribution between the pulmonary arteries and very low or absent pulsatility. Conclusions MRI allows hemodynamic quantification and characterization of various types of Fontan modifications and may be a valuable tool to predict Fontan failure. Despite showing normal pulsatility, patients with APC have right atrial dilatation and partial backward flow in the IVC, demonstrating suboptimal Fontan circulation. LTFO and ECFO both produce unidirectional antegrade flow in the IVC but pulsatility is very low or absent, which may promote poor pulmonary artery growth and increase of pulmonary vascular resistance contributing to late Fontan failure.