Characterization of Flow Efficiency, Pulsatility, and Respiratory Variability in Different Types of Fontan Circuits Using Quantitative Parameters
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Purpose: Details on the hemodynamic differences among Fontan operations remain unclear according to respiratory and cardiaccycles. This study was undertaken to investigate hemodynamic characteristics in different types of Fontan circulation by quantificationof blood flow with the combined influence of cardiac and respiratory cycles. Materials and Methods: Thirty-five patients [10 atriopulmonary connections (APC), 13 lateral tunnels (LT), and 12 extracardiacconduits (ECC)] were evaluated, and parameters were measured in the superior vena cava, inferior vena cava (IVC), hepatic vein(HV), baffles, conduits, and left and right pulmonary artery. Pulsatility index (PIx), respiratory variability index (RVI), net antegradeflow integral (NAFI), and inspiratory/expiratory blood flow (IQ/EQ) were measured by intravascular Doppler echocardiography. Results: The PIx between APC and total cavopulmonary connection (TCPC; LT and ECC) showed significant differences at all interrogationpoints regardless of respiratory cycles. The PIxs of HVs and IVCs in APC significantly increased, compared with that in LTand ECC, and the RVI between APC and TCPC showed significant differences at all interrogation points (p<0.05). The NAFI andIQ/EQ between APC and TCPC showed significant differences at some interrogation points (p<0.05). Conclusion: Patients with different types of Fontan circulation show different hemodynamic characteristics in various areas ofthe Fontan tract, which may lead to different risks causing long-term complications. We believe the novel parameters developedin this study may be used to determine flow characteristics and may serve as a clinical basis of management in patients after Fontanoperations.
Abstract
Purpose: Details on the hemodynamic differences among Fontan operations remain unclear according to respiratory and cardiaccycles. This study was undertaken to investigate hemodynamic characteristics in different types of Fontan circulation by quantificationof blood flow with the combined influence of cardiac and respiratory cycles. Materials and Methods: Thirty-five patients [10 atriopulmonary connections (APC), 13 lateral tunnels (LT), and 12 extracardiacconduits (ECC)] were evaluated, and parameters were measured in the superior vena cava, inferior vena cava (IVC), hepatic vein(HV), baffles, conduits, and left and right pulmonary artery. Pulsatility index (PIx), respiratory variability index (RVI), net antegradeflow integral (NAFI), and inspiratory/expiratory blood flow (IQ/EQ) were measured by intravascular Doppler echocardiography. Results: The PIx between APC and total cavopulmonary connection (TCPC; LT and ECC) showed significant differences at all interrogationpoints regardless of respiratory cycles. The PIxs of HVs and IVCs in APC significantly increased, compared with that in LTand ECC, and the RVI between APC and TCPC showed significant differences at all interrogation points (p<0.05). The NAFI andIQ/EQ between APC and TCPC showed significant differences at some interrogation points (p<0.05). Conclusion: Patients with different types of Fontan circulation show different hemodynamic characteristics in various areas ofthe Fontan tract, which may lead to different risks causing long-term complications. We believe the novel parameters developedin this study may be used to determine flow characteristics and may serve as a clinical basis of management in patients after Fontanoperations.
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