Abstract 8683: Systemic to Pulmonary Collateral Flow as Measured by Cardiac Magnetic Resonance Imaging is Associated with Acute Post-Fontan Clinical Outcomes
Introduction: Systemic-pulmonary collateral (SPC) flow occurs commonly in single ventricle patients after superior cavo-pulmonary connection, with unclear clinical significance. We sought to evaluate the association between SPC flow and acute post-Fontan clinical outcomes using a novel method of quantifying SPC flow by cardiac magnetic resonance (CMR).
Hypothesis: In single ventricle patients with Stage 2 physiology, a greater amount of SPC flow, as quantified by CMR, will be associated with prolonged hospital and chest tube duration following Fontan completion.
Methods: We performed a retrospective medical record review of the Fontan hospitalization of all patients who had SPC flow quantified by CMR prior to Fontan completion in order to evaluate associations between measures of SPC flow and post-Fontan clinical outcomes.
Results: Forty-four subjects were included who had Fontan completion between May, 2008 and September, 2010. SPC flow prior to Fontan measured 1.5 ± 0.9 L/min/m2, accounting for 31 ± 11% of total aortic flow and 44 ± 15% of total pulmonary venous flow. There was a significant linear association between natural log-transformed duration of hospitalization and SPC flow as a proportion of total aortic (rho=0.31, p=0.04) and total pulmonary venous flow (rho=0.29, p=0.05). After adjustment for Fontan type and presence of a fenestration, absolute SPC flow was significantly associated with hospital duration ≥ 7 days (OR=9.2, p=0.02) and chest tube duration ≥ 10 days (OR=22.7, p=0.009). Similar associations exist for SPC flow as a percentage of total aortic (OR=1.09, p=0.048 for hospitalization ≥ 7 days; OR=1.24, p=0.007 for chest tube duration ≥ 10 days) and total pulmonary venous flow (OR=1.07, p=0.048 for hospitalization ≥ 7 days; OR=1.18, p=0.006 for chest tube duration ≥ 10 days).
Conclusion: A greater amount of SPC flow before Fontan, as measured by CMR, is associated with increased duration of hospitalization and chest tube following Fontan completion.
- © 2011 by American Heart Association, Inc.