Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: email:
Department of Radiology, Institute of Cardiology, Warsaw, Poland
Kardiol Pol. 2019 Nov 22;77(11):1062-1069. doi: 10.33963/KP.15010. Epub 2019 Oct 4.
The Fontan procedure is performed in patients with congenital heart diseases and abnormal anatomy of the heart, which preclude intracardiac repair involving a separation of the systemic and pulmonary circulations. The role of computed tomography (CT) in assessing patients' clinical status after the total cavopulmonary connection (TCPC) procedure is not well defined.
To determine a potential role and diagnostic capability of CT in the functional assessment of adults with the TCPC.
Data obtained from 18 patients (10 women; mean [SD] age, 27.9 [6.3] years) with the TCPC were analyzed retrospectively. All patients underwent biochemical evaluation, cardiopulmonary exercise test, transthoracic echocardiography, and CT. Upon CT examination, the dimensions of the left and right pulmonary arteries, superior and inferior venae cavae, all pulmonary veins, and extracardiac conduits were measured. The measurements acquired by CT were correlated with the results of transthoracic echocardiography, cardiopulmonary exercise test, and biochemical analysis.
The mean (SD) time after the TCPC was 18.5 (6.5) years. The area and circumference of the inferior vena cava significantly correlated with age (r = 0.503, P <0.05). A significant positive correlation was found between the area and circumference of a conduit and the predicted maximal oxygen uptake (r = 0.664, P <0.01). The area (β = 0.746, R2 = 0.556, P <0.01) and the circumference (β = 0.757, R2 = 0.572, P <0.01) of a conduit were considered significant predictors in estimating the value of maximal oxygen uptake.
Our study showed an association between the dimensions of an extracardiac conduit and patient functional status, time elapsed since the procedure, and age of adults who underwent the TCPC in childhood. These findings support a more extensive use of CT in patients with TCPC, complemented by the measurements of the superior and inferior venae cavae and the conduit.
Fontan 手术应用于患有先天性心脏病且心脏解剖结构异常的患者，这些患者无法进行涉及体循环和肺循环分离的心内修复。计算机断层扫描（CT）在评估全腔静脉肺动脉连接（TCPC）术后患者临床状况中的作用尚未明确。
确定 CT 在评估接受 TCPC 的成人功能方面的潜在作用和诊断能力。
回顾性分析 18 例接受 TCPC 的患者（10 例女性；平均[标准差]年龄，27.9[6.3]岁）的数据。所有患者均接受生化评估、心肺运动试验、经胸超声心动图和 CT 检查。在 CT 检查时，测量左、右肺动脉、上、下腔静脉、所有肺静脉和心外导管的尺寸。CT 测量值与经胸超声心动图、心肺运动试验和生化分析结果相关。
TCPC 后平均（标准差）时间为 18.5（6.5）年。下腔静脉的面积和周长与年龄显著相关（r = 0.503，P <0.05）。导管的面积和周长与预测最大摄氧量呈显著正相关（r = 0.664，P <0.01）。导管的面积（β = 0.746，R2 = 0.556，P <0.01）和周长（β = 0.757，R2 = 0.572，P <0.01）是估计最大摄氧量的显著预测因子。
我们的研究表明，心外导管的尺寸与患者功能状态、手术后时间以及儿童时期接受 TCPC 的成年患者的年龄之间存在关联。这些发现支持在接受 TCPC 的患者中更广泛地使用 CT，并结合上、下腔静脉和导管的测量。
