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Aortopulmonary collateral flow quantification by MR at rest and during continuous submaximal exercise in patients with total cavopulmonary connection
Author(s) -
Mkrtchyan Naira,
Frank Yvonne,
Steinlechner Eva,
Calavrezos Lenika,
Meierhofer Christian,
Hager Alfred,
Martinoff Stefan,
Ewert Peter,
Stern Heiko
Publication year - 2018
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25889
Subject(s) - medicine , cardiology , ascending aorta , ventricle , collateral circulation , blood flow , aorta , fontan procedure , population , descending aorta , environmental health
Background Aortopulmonary collateral flow is considered to have significant impact on the outcome of patients with single ventricle circulation and total cavopulmonary connection (TCPC). There is little information on collateral flow during exercise. Purpose To quantify aortopulmonary collateral flow at rest and during continuous submaximal exercise in clinical patients doing well with TCPC. Study Type Prospective, case controlled. Population Thirteen patients with TCPC (17 (11–37) years) and 13 age and sex‐matched healthy controls (18 (11–38) years). Field Strength 1.5T; free breathing; phase sensitive gradient echo sequence. Assessment Blood flow in the ascending and descending aorta and superior vena cava were measured at rest and during continuous submaximal physical exercise in patients and controls. Systemic blood flow (Q s ) was assumed to be represented by the sum of flow in the superior caval vein (Q svc ) and the descending aorta (Q AoD ) at the diaphragm level. Aortopulmonary collateral flow (Q coll ) was calculated by subtracting Q s from flow in the ascending aorta (Q AoA ). Statistics Mann–Whitney U ‐test and Wilcoxon test for comparison between groups and between rest and exercise. Results Absolute collateral flow in TCPC patients at rest was 0.4 l/min/m 2 (–0.1–1.2), corresponding to 14% (–2–42) of Q s . Collateral flow did not change during exercise (difference –0.01 (–0.7–1.0) l/min/m 2 , P = 0.97). TCPC patients had significantly lower Q s at rest (2.5 (1.6–4.1) vs. 3.5 (2.6–4.8) l/min/m 2 , P = 0.001) and during submaximal exercise (3.2 (2.0–6.0) vs. 4.8 (3.3–6.9) l/min/m 2 , P = 0.001), compared to healthy controls. The increase in Q s with exercise was also significantly lower in patients than in healthy controls (median 0.6 vs. 1.2 l/min/m 2 , P < 0.02). Data Conclusion Clinical patients doing well with TCPC have significant aortopulmonary collateral flow at rest (14% of Q s ) compared to healthy controls, which does not change during submaximal exercise. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1509–1516.