Spurgin Stephen B, Arar Yousef M, Zellers Thomas M, Wang Jijia, Madsen Nicolas L, Veeram Reddy Surendranath R, Cleaver Ondine, Divekar Abhay A
Department of Pediatrics, Southwestern Medical Center, Dallas, TX 75390, USA.
Pediatric Cardiology, Children's Medical Center, Dallas, TX 75235, USA.
medRxiv. 2024 Jan 9:2024.01.08.24300994. doi: 10.1101/2024.01.08.24300994.
Individuals with single ventricle physiology who are palliated with superior cavopulmonary anastomosis (Glenn surgery) may develop pulmonary arteriovenous malformations (PAVMs). The traditional tools for PAVM diagnosis are often of limited diagnostic utility in this patient population. We sought to measure the pulmonary capillary transit time (PCTT) to determine its value as a tool to identify PAVMs in patients with single ventricle physiology.
We defined the angiographic PCTT as the number of cardiac cycles required for transit of contrast from the distal pulmonary arteries to the pulmonary veins. Patients were retrospectively recruited from a single quaternary North American pediatric center, and angiographic and clinical data was reviewed. PCTT was calculated in 20 control patients and compared to 20 single ventricle patients at the pre-Glenn, Glenn, and Fontan surgical stages (which were compared with a linear-mixed model). Correlation (Pearson) between PCTT and hemodynamic and injection parameters was assessed using 84 Glenn angiograms. Five independent observers calculated PCTT to measure reproducibility (intra-class correlation coefficient).
Mean PCTT was 3.3 cardiac cycles in the control population, and 3.5, 2.4, and 3.5 in the pre-Glenn, Glenn, and Fontan stages, respectively. PCTT in the Glenn population did not correlate with injection conditions. Intraclass correlation coefficient was 0.87.
Pulmonary angiography can be used to calculate the pulmonary capillary transit time, which is reproducible between observers. PCTT accelerates in the Glenn stage, correlating with absence of direct hepatopulmonary venous flow.
接受上腔静脉-肺动脉吻合术（格林手术）姑息治疗的单心室生理患者可能会发生肺动静脉畸形（PAVM）。传统的PAVM诊断工具在这一患者群体中的诊断效用往往有限。我们试图测量肺毛细血管通过时间（PCTT），以确定其作为识别单心室生理患者PAVM的工具的价值。
我们将血管造影的PCTT定义为造影剂从远端肺动脉到肺静脉通过所需的心动周期数。患者从北美一家单一的四级儿科中心回顾性招募，并对血管造影和临床数据进行了审查。计算了20名对照患者的PCTT，并将其与20名单心室患者在格林手术前、格林手术和Fontan手术阶段的PCTT进行比较（采用线性混合模型进行比较）。使用84例格林手术血管造影评估PCTT与血流动力学和注射参数之间的相关性（Pearson相关性）。五名独立观察者计算PCTT以测量可重复性（组内相关系数）。
对照组的平均PCTT为3.3个心动周期，在格林手术前、格林手术和Fontan手术阶段分别为3.5、2.4和3.5个心动周期。格林手术组的PCTT与注射条件无关。组内相关系数为0.87。
肺血管造影可用于计算肺毛细血管通过时间，观察者之间的结果具有可重复性。PCTT在格林手术阶段加快，与不存在直接的肝肺静脉血流相关。
