Department of Congenital Heart Diseases, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Augustenburger Platz 1, 13533, Berlin, Germany.
Clin Res Cardiol. 2012 Feb;101(2):133-8. doi: 10.1007/s00392-011-0374-4. Epub 2011 Nov 18.
Failing Fontan circulation is a multifactorial problem without clear predictors and with uncertain onset. We sought to investigate the correlations between systemic venous flow return and the clinical condition of Fontan patients.
Flow measurements using phase contrast magnetic resonance imaging (MRI) were performed in the superior and inferior vena cava (SVC, IVC) in 61 Fontan patients. Median postoperative follow-up time was 6.7 (0.6-14.1) years; median age at MRI was 11.6 (4.0-44.6) years. Eight patients were identified clinically as a subgroup with suboptimal hemodynamics. The effective forward flow of combined SVC and IVC flow volume was defined as the venous cardiac index (vCI, l/min/m(2)). SVC flow ratio was defined as SVC flow in relation to vCI. The vCI and flow distribution between the SVC and IVC were investigated in relation to the hemodynamics and patients' age at MRI.
Venous flow return through the SVC was 1.1 (0.6-3.4) l/min/m(2) and through the IVC 1.8 (0.6-3.2) l/min/m(2); total vCI was 3 l/min/m(2) (1.2-5.1). Patients with suboptimal Fontan hemodynamics showed significantly lower IVC flow return (median of 1.5 vs. 1.9 l/min/m(2), p = 0.027) and increased SVC flow ratio (0.56 vs. 0.35, p = 0.005) in comparison to those with good clinical condition. The total vCI decrease was correlated with older patient age (r = 0.575, p < 0.001).
Altered systemic venous flow return is associated with suboptimal Fontan hemodynamics and seems to progress with patients' age and long-term follow-up after Fontan operation. Thus, MRI flow volume measurements might help in monitoring Fontan patients before the onset of clinical signs of suboptimal hemodynamics.
Fontan 循环衰竭是一种多因素问题，没有明确的预测因素，发病情况也不确定。我们试图研究体循环静脉回流与 Fontan 患者临床状况之间的相关性。
对 61 例 Fontan 患者的上腔静脉（SVC）和下腔静脉（IVC）进行相位对比磁共振成像（MRI）的流量测量。术后中位随访时间为 6.7 年（0.6-14.1 年）；MRI 时的中位年龄为 11.6 岁（4.0-44.6 岁）。8 例患者临床诊断为血流动力学不佳的亚组。将 SVC 和 IVC 联合的有效前向血流定义为静脉心输出量指数（vCI，l/min/m²）。将 SVC 血流量与 vCI 的比值定义为 SVC 血流量比。研究了 SVC 和 IVC 之间的静脉血流分布与患者的 MRI 年龄及血流动力学之间的关系。
SVC 静脉血流回流为 1.1（0.6-3.4）l/min/m²，IVC 为 1.8（0.6-3.2）l/min/m²；总 vCI 为 3l/min/m²（1.2-5.1）。Fontan 血流动力学不佳的患者 IVC 血流回流明显降低（中位数分别为 1.5 和 1.9l/min/m²，p=0.027），SVC 血流量比增加（0.56 和 0.35，p=0.005）。总 vCI 降低与患者年龄较大有关（r=0.575，p<0.001）。
系统静脉血流回流改变与 Fontan 血流动力学不佳有关，且似乎随着患者年龄的增长和 Fontan 手术后的长期随访而进展。因此，MRI 流量测量可能有助于在出现 Fontan 血流动力学不佳的临床症状之前监测 Fontan 患者。
