Author + information
- Andrew C. Glatz,
- Neil Harrison,
- Adam Small,
- Yoav Dori,
- Matthew Gillespie,
- Matthew Harris,
- Mark Fogel,
- Jonathan Rome and
- Kevin Whitehead
Systemic-pulmonary arterial collateral flow (CollF) is common in single ventricle pts with cavo-pulmonary connections (CPC), although associations with CollF are not well understood. We previously described a method to quantify CollF by cardiac magnetic resonance imaging (CMR). We sought to identify factors associated with CollF in a large cross-section of patients with CPC.
A retrospective chart review of events from birth to study CMR was performed for all CPC pts who had CollF quantified. CollF as a % of aortic flow (CollF/Ao) was defined as the primary outcome variable.
CollF measured in 96 superior CPC (SCPC) and 52 total CPC (TCPC) pts at 2.6 ± 1.1 and 4.5 ± 1.8 yrs of age (2.1 ± 1.1 and 1.7 ± 1.6 yrs after last CPC) was 33.5 ± 11.1% and 35.6 ± 14.7% of aortic flow. Significant associations existed between various peri-operative/clinical factors and CollF/Ao (see Table). In SCPC pts, CollF/Ao was higher in pts with a prior BT shunt (35 ± 12 v. 29 ± 8%, p=0.009). CollF/Ao was higher in pts with fenestrated TCPC (37 ± 15 v. 26 ± 12%, p=0.04). A multivariate model with chest tube days, ventilator days after TCPC, 02 sat at SCPC discharge, bypass time at TCPC, heterotaxy, and TCPC fenestration (all p<0.04) accounted for 59% of the variance in CollF/Ao.
These data support hypotheses that perioperative morbidity and pleural inflammation play a role in CollF development; that CollF affects pulmonary blood flow and ventricular volume loading; and that CollF may affect outcomes after TCPC.
Factors Associated with CollF/Ao in Cavo-Pulmonary Connection Patients
|SCPC cohort (n=96)||TCPC cohort (n=52)|
|Total ICU duration (days)||17.5||2–261||0.29||0.008||22||6–154||0.44||0.003|
|Total hospital duration (days)||33.5||5–342||0.33||0.002||39||16–180||0.55||0.0001|
|Total chest tube duration (days)||3||0–54||0.24||0.02||8||2–84||0.34||0.02|
|TCPC ventilator days||0||0–109||0.4||0.004|
|Total ventilator days||2||0–144||0.29||0.008||3.5||0–117||0.29||0.05|
|02 saturation at SCPC discharge (%)||80.8||3.75||0.19||0.06||80.7||4||0.31||0.03|
|End-diastolic volume (cc/m2)||92.2||31.5||0.2||0.046||80.5||20.1||0.41||0.04|
|Cardiopulmonary bypass time at TCPC (min)||74.6||25.5||0.35||0.01|
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Single Ventricles
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1203-125
- 2013 American College of Cardiology Foundation