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. 2024 Jan 2;38(1):ivae011.
doi: 10.1093/icvts/ivae011.

Pulmonary blood flow in children with univentricular heart and unilateral diaphragmatic paralysis

Tobias Kratz  1 , Lisa Gaukstern  1 , Walter Wiebe  2 , Nicole Müller  1 , Noa Freudenthal  1 , Johannes Breuer  1 , Julian Luetkens  3 , Christopher Hart  1   3
Affiliations

Pulmonary blood flow in children with univentricular heart and unilateral diaphragmatic paralysis

Tobias Kratz et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Spontaneous breathing has an important effect on pulmonary arterial blood flow in patients with Glenn/Fontan circulation. Unilateral diaphragmatic paralysis (DP) is a frequent complication after heart surgery in congenital heart disease. The aim of this study was to investigate the influence of unilateral DP on blood flow distribution in the pulmonary arteries with Glenn/Fontan circulation.

Methods: Magnetic resonance phase-contrast imaging was used to evaluate stroke volume index (SVI) in the left and right pulmonary arteries in patients with Glenn/Fontan circulation with unilateral DP. Data for 18 patients with univentricular heart and unilateral DP were analysed, 8 in the Glenn stage and 10 in the Fontan stage. Ten patients had right-sided DP, and 8 had left-sided DP. A diaphragmatic plication was performed in 7 patients. The control group consisted of 36 patients with Glenn (n = 16)/Fontan (n = 20) circulation without DP.

Results: In both left- and right-sided DP, the SVI to the ipsilateral side was significantly lower than in controls [2.81 (1.45-4.50) ml/m2 left vs 11.97 (7.36-16.37) ml/m2 in controls, P < 0.0002; 8.2 (4.49-12.64) ml/m2 with right vs 12.64 (9.66-16.61) ml/m2 in controls; P = 0.0284]. The SVI to the contralateral side showed a slight but non-significant increase in the presence of unilateral DP.

Conclusions: Unilateral DP in patients with Glenn/Fontan circulation has a negative impact on pulmonary arterial SVI on the side of the paralysis.

Keywords: Congenital heart disease; Diaphragmatic paralysis; Fontan; Glenn; Pulmonary blood flow.

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Figures

Figure 1:
Figure 1:
MRI with diagnosis of a right-sided diaphragmatic paralysis.
Figure 2:
Figure 2:
Flow in the LPA (ml/m2) in relation to the location of DP and control group. DP: diaphragmatic paralysis; LPA: left pulmonary artery.
Figure 3:
Figure 3:
Flow in the RPA (ml/m2) in relation to the location of DP and control group. DP: diaphragmatic paralysis; RPA: right pulmonary artery.
Figure 4:
Figure 4:
Flow in the LPA (ml/m2) in relation to the location of DP and control group in Glenn stage. DP: diaphragmatic paralysis; LPA: left pulmonary artery.
Figure 5:
Figure 5:
Flow in the RPA (ml/m2) in relation to the location of DP and control group in Glenn stage. DP: diaphragmatic paralysis; RPA: right pulmonary artery.
Figure 6:
Figure 6:
Flow in the LPA (ml/m2) in relation to the location of DP and control group in Fontan stage. DP: diaphragmatic paralysis; LPA: left pulmonary artery.
Figure 7:
Figure 7:
Flow in the RPA (ml/m2) in relation to the location of DP and control group in Fontan stage. DP: diaphragmatic paralysis; RPA: right pulmonary artery.
None
See this image and copyright information in PMC

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