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Lam CZ, David D, Acosta Izquierdo L, Pezeshkpour P, Dipchand AI, Jean-St-Michel E, Chaturvedi RR, Ling SC, Wald RM, Chavhan GB, Seed M, Yoo SJ. MRI Phase-Contrast Blood Flow in Fasting Pediatric Patients with Fontan Circulation Correlates with Exercise Capacity. Radiol Cardiothorac Imaging 2022; 4:e210303. [PMID: 35506132 PMCID: PMC9059244 DOI: 10.1148/ryct.210303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Abstract
Purpose To assess regional blood flow in fasting pediatric patients with Fontan circulation by using MRI and to explore associations with clinical parameters. Materials and Methods In this retrospective study, pediatric patients who had undergone the Fontan procedure (<18 years of age) and had undergone clinical cardiac MRI, performed after at least 4 hours of fasting, between 2018 and 2021 were included. Regional blood flow was compared with published healthy volunteer data (n = 19) and assessed in relation to hemodynamic parameters and clinical status. Data are presented as medians, with first to third quartiles in parentheses. Mann-Whitney U, Kruskal-Wallis, χ2, and Spearman rank correlation tests were used. Results Fifty-five patients (38 boys) with median age at MRI of 14 years (IQR, 11-16 years) and median time from Fontan procedure to MRI of 10 years (IQR, 8-12 years) were included. Patients after Fontan procedure had lower ascending aortic, inferior vena cava, and total systemic blood flow compared with healthy volunteers (3.00 L/min/m2 [IQR, 2.75-3.30 L/min/m2] vs 3.61 L/min/m2 [IQR, 3.29-4.07 L/min/m2]; 1.73 L/min/m2 [IQR, 1.40-1.94 L/min/m2] vs 2.24 L/min/m2 [IQR, 2.06-2.75 L/min/m2]; 2.78 L/min/m2 [IQR, 2.45-3.10 L/min/m2] vs 3.95 L/min/m2 [IQR, 3.20-4.30 L/min/m2], respectively; P < .001). Portal vein flow was greater than hepatic vein flow in 25% of patients. Fontan blood flow was inversely correlated with pre-Fontan mean pulmonary artery pressure (Spearman rank correlation coefficient [rs ]= -0.42, P = .005) and ventricular end diastolic pressure (rs = -0.33, P = .04) and positively correlated with post-Fontan percent predicted oxygen consumption at peak workload (rs = 0.34, P = .02). Conclusion Reference ranges are provided for regional systemic blood flow derived by using MRI in fasting pediatric patients with Fontan circulation, who had lower systemic blood flow compared with healthy volunteers. Lower fasting Fontan blood flow correlated with lower exercise capacity.Keywords: Pediatrics, Heart, Congenital, MR Imaging, Hemodynamics/Flow Dynamics, Cardiac Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Christopher Z. Lam
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Dawn David
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Laura Acosta Izquierdo
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Parneyan Pezeshkpour
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Anne I. Dipchand
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Emilie Jean-St-Michel
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Rajiv R. Chaturvedi
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Simon C. Ling
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Rachel M. Wald
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Govind B. Chavhan
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Michael Seed
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
| | - Shi-Joon Yoo
- From the Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I.,
P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics
(A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of
Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick
Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G
1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada
(C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging,
University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac
Centre, University Health Network, Toronto General Hospital, Toronto, Canada
(R.M.W.)
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