磁共振成像评估开窗及完成 Fontan 循环中的血流分布，特别强调腹部血流。
Magnetic Resonance Imaging Assessment of Blood Flow Distribution in Fenestrated and Completed Fontan Circulation with Special Emphasis on Abdominal Blood Flow.
机构信息
Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
出版信息
Korean J Radiol. 2019 Jul;20(7):1186-1194. doi: 10.3348/kjr.2018.0921.
OBJECTIVE
To investigate the regional flow distribution in patients with Fontan circulation by using magnetic resonance imaging (MRI).
MATERIALS AND METHODS
We identified 39 children (18 females and 21 males; mean age, 9.3 years; age range, 3.3-17.0 years) with Fontan circulation in whom flow volumes across the thoracic and abdominal arteries and veins were measured by using MRI. The patients were divided into three groups: fenestrated Fontan circulation group with MRI performed under general anesthesia (GA) (Group 1, 15 patients; average age, 5.9 years), completed Fontan circulation group with MRI performed under GA (Group 2, 6 patients; average age, 8.7 years), and completed Fontan circulation group with MRI performed without GA (Group 3, 18 patients; average age, 12.5 years). The patient data were compared with the reference ranges in healthy controls.
RESULTS
In comparison with the controls, Group 1 showed normal cardiac output (3.92 ± 0.40 vs. 3.72 ± 0.69 L/min/m², = 0.30), while Group 3 showed decreased cardiac output (3.24 ± 0.71 vs. 3.96 ± 0.64 L/min/m², = 0.003). Groups 1 and 3 showed reduced abdominal flow (1.21 ± 0.28 vs. 2.37 ± 0.45 L/min/m², < 0.001 and 1.89 ± 0.39 vs. 2.64 ± 0.38 L/min/m², < 0.001, respectively), which was mainly due to the diversion of the cardiac output to the aortopulmonary collaterals in Group 1 and the reduced cardiac output in Group 3. Superior mesenteric and portal venous flows were more severely reduced in Group 3 than in Group 1 (ratios between the flow volumes of the patients and healthy controls was 0.26 and 0.37 in Group 3 and 0.63 and 0.53 in Group 1, respectively). Hepatic arterial flow was decreased in Group 1 (0.11 ± 0.22 vs. 0.34 ± 0.38 L/min/m², = 0.04) and markedly increased in Group 3 (0.38 ± 0.22 vs. -0.08 ± 0.29 L/min/m², < 0.0001). Group 2 showed a mixture of the patterns seen in Groups 1 and 3.
CONCLUSION
Fontan circulation is associated with reduced abdominal flow, which can be attributed to reduced cardiac output and portal venous return in completed Fontan circulation, and diversion of the cardiac output to the aortopulmonary collaterals in fenestrated Fontan circulation.
目的
利用磁共振成像（MRI）研究 Fontan 循环患者的区域血流分布。
材料和方法
我们确定了 39 名 Fontan 循环患儿（18 名女性和 21 名男性；平均年龄 9.3 岁；年龄范围 3.3-17.0 岁），通过 MRI 测量了胸、腹动脉和静脉的流量。将患者分为三组：在全身麻醉（GA）下进行 MRI 的有孔 Fontan 循环组（Group 1，15 名患者；平均年龄 5.9 岁）、在 GA 下进行 MRI 的完全 Fontan 循环组（Group 2，6 名患者；平均年龄 8.7 岁）和不在 GA 下进行 MRI 的完全 Fontan 循环组（Group 3，18 名患者；平均年龄 12.5 岁）。将患者数据与健康对照组的参考范围进行比较。
结果
与对照组相比，Group 1 显示心输出量正常（3.92±0.40 vs. 3.72±0.69 L/min/m²， = 0.30），而 Group 3 显示心输出量降低（3.24±0.71 vs. 3.96±0.64 L/min/m²， = 0.003）。Group 1 和 Group 3 显示腹部血流量减少（1.21±0.28 vs. 2.37±0.45 L/min/m²， <0.001 和 1.89±0.39 vs. 2.64±0.38 L/min/m²， <0.001，分别），这主要是由于 Group 1 中心输出量分流至体肺侧支循环，而 Group 3 中心输出量降低。肠系膜上和门静脉血流量在 Group 3 中比在 Group 1 中减少更严重（患者与健康对照组之间的流量比值分别为 0.26 和 0.37 在 Group 3 和 0.63 和 0.53 在 Group 1）。Group 1 肝动脉流量减少（0.11±0.22 vs. 0.34±0.38 L/min/m²， = 0.04），而 Group 3 肝动脉流量显著增加（0.38±0.22 vs. -0.08±0.29 L/min/m²， <0.0001）。Group 2 显示了 Group 1 和 Group 3 所见模式的混合。
结论
Fontan 循环与腹部血流量减少有关，这可归因于完全 Fontan 循环中的心输出量和门静脉回流减少，以及有孔 Fontan 循环中心输出量分流至体肺侧支循环。
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