Whitehead Kevin K, Harris Matthew A, Glatz Andrew C, Gillespie Matthew J, DiMaria Michael V, Harrison Neil E, Dori Yoav, Keller Marc S, Rome Jonathan J, Fogel Mark A
Division of Cardiology and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Cardiology and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Am J Cardiol. 2015 Jun 15;115(12):1739-45. doi: 10.1016/j.amjcard.2015.03.022. Epub 2015 Mar 24.
The investigators recently validated a method of quantifying systemic-to-pulmonary arterial collateral flow using phase-contrast magnetic resonance imaging velocity mapping. Cross-sectional data suggest decreased collateral flow in patients with total cavopulmonary connections (TCPCs) compared with those with superior cavopulmonary connections (SCPCs). However, no studies have examined serial changes in collateral flow from SCPCs to TCPCs in the same patients. The aim of this study was to examine differences in collateral flow between patients with SCPCs and those with TCPCs. Collateral flow was quantified by 2 independent measures from 250 single-ventricle studies in 219 different patients (115 SCPC and 135 TCPC studies, 31 patients with both) and 18 controls, during routine studies using through-plane phase-contrast magnetic resonance imaging. Collateral flow was indexed to body surface area, aortic flow, and pulmonary venous flow. Regardless of indexing method, SCPC patients had significantly higher collateral flow than TCPC patients (1.64 ± 0.8 vs 1.03 ± 0.8 L/min/m(2), p <0.001). In 31 patients who underwent serial examinations, collateral flow as a fraction of aortic flow increased early after TCPC completion. In TCPC patients, indexed collateral flow demonstrated a significant negative correlation with time from TCPC. In conclusion, SCPC and TCPC patients demonstrate substantial collateral flow, with SCPC patients having higher collateral flow than TCPC patients overall. On the basis of the paired subset analysis, collateral flow does not decrease in the short term after TCPC completion and trends toward an increase. In the long term, however, collateral flow decreases over time after TCPC completion.
研究人员最近验证了一种使用相位对比磁共振成像速度图来量化体循环至肺动脉侧支血流的方法。横断面数据表明，与接受上腔静脉-肺动脉连接（SCPC）的患者相比，接受全腔静脉-肺动脉连接（TCPC）的患者侧支血流减少。然而，尚无研究考察同一患者从SCPC到TCPC过程中侧支血流的系列变化。本研究的目的是考察接受SCPC的患者与接受TCPC的患者之间侧支血流的差异。在常规研究中，通过平面相位对比磁共振成像，对219例不同患者（115例SCPC研究和135例TCPC研究，31例患者同时接受了这两种研究）的250例单心室研究以及18例对照进行了2种独立测量，对侧支血流进行了量化。侧支血流以体表面积、主动脉血流和肺静脉血流为指标进行计算。无论采用何种指标计算方法，接受SCPC的患者的侧支血流均显著高于接受TCPC的患者（1.64±0.8 vs 1.03±0.8 L/min/m²，p<0.001）。在31例接受系列检查的患者中，TCPC完成后早期，侧支血流占主动脉血流的比例增加。在接受TCPC的患者中，指标化侧支血流与TCPC术后时间呈显著负相关。总之，接受SCPC和TCPC的患者均存在大量侧支血流，总体而言，接受SCPC的患者侧支血流高于接受TCPC的患者。基于配对亚组分析，TCPC完成后短期内侧支血流并未减少，反而有增加趋势。然而，从长期来看，TCPC完成后侧支血流会随时间减少。
