Mark A Fogel1, Christine Li2, Felice Wilson2, Tom Pawlowski2, Susan C Nicolson3, Lisa M Montenegro3, Laura Diaz Berenstein3, Thomas L Spray4, J William Gaynor4, Stephanie Fuller4, Marc S Keller5, Matthew A Harris1, Kevin K Whitehead1, Robert Clancy6, Okan Elci7, Jim Bethel7, Arastoo Vossough5, Daniel J Licht6. 1. Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA. 2. Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA. 6. Department of Neurology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA. 7. Westat, Rockville, Maryland, USA.
Abstract
OBJECTIVE: Patients with single ventricle can develop aortic-to-pulmonary collaterals (APCs). Along with systemic-to-pulmonary artery shunts, these structures represent a direct pathway from systemic to pulmonary circulations, and may limit cerebral blood flow (CBF). This study investigated the relationship between CBF and APC flow on room air and in hypercarbia, which increases CBF in patients with single ventricle. METHODS: 106 consecutive patients with single ventricle underwent 118 cardiac magnetic resonance (CMR) scans in this cross-sectional study; 34 prior to bidirectional Glenn (BDG) (0.50±0.30 years old), 50 prior to Fontan (3.19±1.03 years old) and 34 3-9 months after Fontan (3.98±1.39 years old). Velocity mapping measured flows in the aorta, cavae and jugular veins. Analysis of variance (ANOVA) and multiple linear regression were used. Significance was p<0.05. RESULTS: A strong inverse correlation was noted between CBF and APC/shunt both on room air and with hypercarbia whether CBF was indexed to aortic flow or body surface area, independent of age, cardiopulmonary bypass time, Po2 and Pco2 (R=-0.67--0.70 for all patients on room air, p<0.01 and R=-0.49--0.90 in hypercarbia, p<0.01). Correlations were not different between surgical stages. CBF was lower, and APCs/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 single ventricle throughout surgical reconstruction on room air and in hypercarbia independent of other factors. We speculate that APC/shunt flow may have a negative impact on cerebral development and neurodevelopmental outcome. Interventions on APC may modify CBF, holding out the prospect for improving neurodevelopmental trajectory. TRIAL REGISTRATION NUMBER: NCT02135081. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE:Patients with single ventricle can develop aortic-to-pulmonary collaterals (APCs). Along with systemic-to-pulmonary artery shunts, these structures represent a direct pathway from systemic to pulmonary circulations, and may limit cerebral blood flow (CBF). This study investigated the relationship between CBF and APC flow on room air and in hypercarbia, which increases CBF in patients with single ventricle. METHODS: 106 consecutive patients with single ventricle underwent 118 cardiac magnetic resonance (CMR) scans in this cross-sectional study; 34 prior to bidirectional Glenn (BDG) (0.50±0.30 years old), 50 prior to Fontan (3.19±1.03 years old) and 34 3-9 months after Fontan (3.98±1.39 years old). Velocity mapping measured flows in the aorta, cavae and jugular veins. Analysis of variance (ANOVA) and multiple linear regression were used. Significance was p<0.05. RESULTS: A strong inverse correlation was noted between CBF and APC/shunt both on room air and with hypercarbia whether CBF was indexed to aortic flow or body surface area, independent of age, cardiopulmonary bypass time, Po2 and Pco2 (R=-0.67--0.70 for all patients on room air, p<0.01 and R=-0.49--0.90 in hypercarbia, p<0.01). Correlations were not different between surgical stages. CBF was lower, and APCs/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 single ventricle throughout surgical reconstruction on room air and in hypercarbia independent of other factors. We speculate that APC/shunt flow may have a negative impact on cerebral development and neurodevelopmental outcome. Interventions on APC may modify CBF, holding out the prospect for improving neurodevelopmental trajectory. TRIAL REGISTRATION NUMBER: NCT02135081. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Chitra Ravishankar; Victor Zak; Ismee A Williams; David C Bellinger; J William Gaynor; Nancy S Ghanayem; Catherine D Krawczeski; Daniel J Licht; Lynn Mahony; Jane W Newburger; Victoria L Pemberton; Richard V Williams; Renee Sananes; Amanda L Cook; Teresa Atz; Svetlana Khaikin; Daphne T Hsu Journal: J Pediatr Date: 2012-08-30 Impact factor: 4.406
Authors: Andrew C Glatz; Jonathan J Rome; Adam J Small; Matthew J Gillespie; Yoav Dori; Matthew A Harris; Marc S Keller; Mark A Fogel; Kevin K Whitehead Journal: Circ Cardiovasc Imaging Date: 2012-01-06 Impact factor: 7.792
Authors: Henry H Cheng; David Wypij; Peter C Laussen; David C Bellinger; Christian D Stopp; Janet S Soul; Jane W Newburger; Barry D Kussman Journal: Ann Thorac Surg Date: 2014-05-10 Impact factor: 4.330
Authors: Kevin K Whitehead; Matthew J Gillespie; Matthew A Harris; Mark A Fogel; Jonathan J Rome Journal: Circ Cardiovasc Imaging Date: 2009-07-08 Impact factor: 7.792
Authors: Daniel J Licht; David M Shera; Robert R Clancy; Gil Wernovsky; Lisa M Montenegro; Susan C Nicolson; Robert A Zimmerman; Thomas L Spray; J William Gaynor; Arastoo Vossough Journal: J Thorac Cardiovasc Surg Date: 2009-03 Impact factor: 5.209
Authors: Mark A Fogel; Christine Li; Okan U Elci; Tom Pawlowski; Peter J Schwab; Felice Wilson; Susan C Nicolson; Lisa M Montenegro; Laura Diaz; Thomas L Spray; J William Gaynor; Stephanie Fuller; Christopher Mascio; Marc S Keller; Matthew A Harris; Kevin K Whitehead; Jim Bethel; Arastoo Vossough; Daniel J Licht Journal: Circulation Date: 2016-12-28 Impact factor: 29.690
Authors: Vincent J Schmithorst; Daryaneh Badaly; Sue R Beers; Vincent K Lee; Jacqueline Weinberg; Cecilia W Lo; Ashok Panigrahy Journal: Semin Thorac Cardiovasc Surg Date: 2021-11-10
Authors: Pablo Caro-Dominguez; Rajiv Chaturvedi; Govind Chavhan; Simon C Ling; Deane Yim; Prashob Porayette; Christopher Z Lam; Tae Kyoung Kim; Mike Seed; Lars Grosse-Wortmann; Shi Joon Yoo Journal: Korean J Radiol Date: 2019-07 Impact factor: 3.500