Cerebral Blood Flow in Single Ventricle Patients With Aortopulmonary Collaterals

Study Questions:

What is the relationship between cerebral blood flow (CBF) and aortic-to-pulmonary artery collaterals (APCs) in patients with single ventricle lesions?

Methods:

A cross-sectional study was performed at a single center. A total of 106 consecutive patients underwent 118 cardiac magnetic resonance (CMR) scans. Thirty-four patients were prior to bidirectional Glenn (BDG) (0.5 ± 0.3 years old), 50 were prior to Fontan (3.19 ± 1.03 years old), and 34 were 3-9 months after Fontan (3.98 ± 1.39 years old). Velocity mapping measured flows in the aorta, vena cavae, and jugular veins. Room air measures were studied in all patients. Flows of the pre-BDG and BDG patients were also measured after administration of 7% CO2 to create hypercarbic conditions.

Results:

An inverse correlation was seen between CBF and APC/shunt both on room air and with hybercarbia (R = -0.67 to -0.70 for all patients on room air, p < 0.01 and R = -0.49 to -0.90 in hypercarbia, p < 0.01). Correlations were similar between surgical stages. CBF was lower and APC/shunt flow was higher prior to BDG than in other stages.

Conclusions:

There is a strong inverse relationship between CBF and APC/shunt flow in patients with a single ventricle throughout surgical reconstruction on room air and in hypercarbia independent of other factors. The authors speculate that APC/shunt flow may have a negative impact on cerebral development and neurodevelopmental outcome.

Perspective:

This study demonstrated a significant inverse relationship between CBF and APCs. The next step will be to understand if there is an association between neurodevelopmental outcomes and collaterals. It may, however, be difficult to correct for the possibility that sicker patients (who may be more likely to have poorer neurodevelopmental outcomes) may be the ones that develop collaterals. Ultimately, it will be important to determine if intervention on APCs favorably impacts neurodevelopmental outcomes.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Interventions, Interventions and Structural Heart Disease

Keywords: Aorta, Cardiac Surgical Procedures, Heart Defects, Congenital, Heart Ventricles, Jugular Veins, Magnetic Resonance Spectroscopy, Pulmonary Artery, Venae Cavae


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