The 52st Annual Meeting of Japanese Society of Pediatric Cardiology and Cardiac Surgery

Presentation information

一般口演

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一般口演1-07(I-OR107)
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Wed. Jul 6, 2016 11:05 AM - 11:55 AM 第E会場 (シンシア ノース)

座長:
富松 宏文(東京女子医科大学心臓病センター 循環器小児科)

I-OR107-01~I-OR107-05

11:05 AM - 11:55 AM

[I-OR107-04] フォンタン生理機能下における大動脈肺動脈側副血行発達危険因子の同定

稲毛 章郎1, 水野 直和2, 齋藤 美香1, 浜道 裕二1, 石井 卓1, 中本 祐樹1, 上田 知実1, 松田 純2, 矢崎 諭1, 嘉川 忠博1 (1.榊原記念病院 小児循環器科, 2.榊原記念病院 放射線科)

Keywords:Fontan completions、aortopulmonary collaterals、phase-contrast MRI

Objective: To quantify aortopulmonary collateral (APC) flow volume using phase-contrast MR and to assess its impact on ventricular volume and function after Fontan completions, and to identify risk factors for the development of APCs.
Methods and results: 25 patients (mean age 17.3+/-8.2 years) underwent cardiac MRI as part of their routine clinical assessment that included ventricular functional analysis and flow measurements. APC flow volume was calculated by subtracting the blood flow volume through the pulmonary arteries from that through the pulmonary veins. The ratio of pulmonary to systemic blood flow (Qp/Qs) was 1.27+/-0.32. APC flow volume was 0.76 (range; 0.50 to 1.53) L/min/m2. The mean inaccuracies corresponded to 6.3+/-11.9 % of ascending aortic flow. The patient cohort was divided into two groups according to the median APC flow: group 1<0.45 l/min/m2 and group 2>0.45 l/min/m2. Group 1 patients had significant smaller ventricular end-diastolic volume (66+/-18 vs. 88+/-24 ml/m2; p=0.003) and -systolic volumes (27+/-13 vs. 42+/-23 ml/m2; p=0.01) whereas ejection fraction (57+/-11 vs. 53+/-16 %; p=0.32) differed not significantly. Qp/Qs was negatively correlated with a younger age at the time of the bidirectional cavopulmonary connections (r=0.55) and positively correlated with the age at the time of the Fontan completions (r=0.69).
Conclusion: APC blood flow can be noninvasively measured in Fontan patients, using MRI. Volume load due to APC flow in Fontan patients affected ventricular dimensions, but did not result in an impairment of ventricular function.