Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 22:11:1304087.
doi: 10.3389/fcvm.2024.1304087. eCollection 2024.

Systemic-to-pulmonary collateral flow associations with antegrade pulmonary flow in single ventricle patients: insights from cardiac magnetic resonance imaging

Anna Yanovskiy #  1 , Laura Martelius #  1 , Nicolina Nyman  2 , Teemu Vepsäläinen  2 , Ilkka Mattila  3 , Otto Rahkonen  2 , Tiina Ojala  4
Affiliations

Systemic-to-pulmonary collateral flow associations with antegrade pulmonary flow in single ventricle patients: insights from cardiac magnetic resonance imaging

Anna Yanovskiy et al. Front Cardiovasc Med. .

Abstract

Purpose: In the palliated single ventricle anomalies, a considerable amount of the aortic flow may be absorbed by the systemic-pulmonary collateral flow (SPCF), which can be noninvasively assessed by cardiac magnetic resonance (CMR). The aims of this study were to (1) identify factors associated with SCPF in pediatric single ventricle patients, and (2) establish a cutoff values indicating an association between SCPF and a reduction in antegrade pulmonary flow.

Methods: A retrospective single-tertiary-center cohort study included 158 consecutive CMR studies of patients with a single ventricle. In the uni- and multivariable analysis, SPCF was presented as a percentage of the total pulmonary venous flow (SPCF%PV). The minimal clinically important difference in QP/QS ratios was estimated as ≥0.50, and an optimal cutoff value was defined using the receiver operating characteristic (ROC) curve.

Results: SPCF%PV was significantly smaller in the post-total cavopulmonary connection (TCPC) group than in the pre-TCPC patients (p < 0.001). The patient's higher age and a higher antegrade pulmonary flow were associated with a lower SPCF%PV. A negative weak association was observed between the SPCF%PV and systemic saturation (r = -0.39, p < 0.001). SPCF%PV did not associate with ventricular volumes nor ejection fraction. The SPCF%PV was significantly smaller in patients that were palliated primarily with a pulmonary artery banding compared to those palliated with a BT-shunt (p = 0.002) or RV-PA- shunt (p = 0.044). In the ROC analysis, for pre-TCPC patient's, a cutoff of SPCF%PV 42% yielded a sensitivity of 100% and specificity of 80% for significantly reduced antegrade pulmonary flow (AUC 0.97). In the post-TCPC group, the optimal SPCF%PV cutoff was 34% (sensitivity 100%, specificity 98%, AUC 0.99).

Conclusion: SPCF results in a considerable left-to-right shunt, which subsequently diminishes spontaneously after TCPC. Our findings indicated that for pre-TCPC patients, an SPCF%PV threshold of 42% (sensitivity 100%, specificity 80%), and for the post-TCPC group, a threshold of 34% (sensitivity 100%, specificity 98%) were effective in identifying reduced antegrade pulmonary flow.

Keywords: PVRI; cardiac magnetic resonance; pulmonary flow; single ventricle; systemic to pulmonary collateral flow.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Ali LA, Cadoni A, Rossi G, Keilberg P, Passino C, Festa P. Effective cardiac Index and systemic-pulmonary collaterals evaluated by cardiac magnetic resonance late after fontan palliation. Am J Cardiol. (2017) 119(12):2069–72. 10.1016/j.amjcard.2017.03.040 - DOI - PubMed
    1. Spearman AD, Ginde S. Pulmonary vascular sequelae of palliated single ventricle circulation: arteriovenous malformations and aortopulmonary collaterals. J. Cardiovasc. Dev. Dis. (2022) 9:309. 10.3390/jcdd9090309 - DOI - PMC - PubMed
    1. Kodama Y, Ishikawa Y, Kuraoka A, Nakamura M, Oda S, Nakano T, et al. Systemic-to-Pulmonary collateral flow correlates with clinical condition late after the fontan procedure. Pediatr Cardiol. (2020) 41(8):1800–6. 10.1007/s00246-020-02450-8 - DOI - PubMed
    1. Latus H, Gummel K, Diederichs T, Bauer A, Rupp S, Kerst G, et al. Aortopulmonary collateral flow is related to pulmonary artery size and affects ventricular dimensions in patients after the fontan procedure. PLoS One. (2013) 8(11):e81684. 10.1371/journal.pone.0081684 - DOI - PMC - PubMed
    1. Ovroutski S, Ewert P, Alexi-Meskishvili V, Hölscher K, Miera O, Peters B, et al. Absence of pulmonary artery growth after fontan operation and its possible impact on late outcome. Ann Thorac Surg. (2009) 87(3):826–31. 10.1016/j.athoracsur.2008.10.075 - DOI - PubMed

LinkOut - more resources