Sanders Emily Noel, Chen Jim Zhongning, Nissen Timothy, Daily Joshua, Zakaria Dala, Dalby Stephen, Bolin Elijah
Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA.
Department of Internal Medicine (Hematology/Oncology), University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Pediatr Cardiol. 2024 Oct 12. doi: 10.1007/s00246-024-03651-1.
Patients born with single ventricle anatomy typically undergo surgical palliation in three stages, culminating in the Fontan procedure. Assessment of flow across a Fontan fenestration by Doppler ultrasound theoretically allows for non-invasive estimation of the transpulmonary gradient (TPG). Our objective was to determine the relationship between Doppler-derived mean fenestration gradient (mFG) and direct catheter-based measurements of TPG in patients with fenestrated Fontans.
We performed a single-center retrospective cohort study of 59 patients with fenestrated Fontans completed between 2000 and 2022. The primary outcome was catheter-based measurement of TPG and the primary predictor was mFG from echo performed within 6 months of the catheterization. Linear regression and R were used to determine the relationship between predictors and outcomes.
Catheter-based measurements of TPG and mFG were weakly correlated (R = 0.382, p < 0.001); the regression coefficient was 0.550, with a standard error of 0.09 for every increase in mFG (Cath TPG = 0.55 [mFG] + 1.92). mFG had a slightly better predictive relationship with cath-derived TPG in patients with systemic left ventricles with R of 0.47, p < 0.004.
mFG accounts for approximately 38% of the variance in catheter-derived TPG. Although mFG is non-invasive and intuitive, mFG in Fontan patients should be interpreted with caution and direct measurement by cardiac catheterization should be considered.
患有单心室解剖结构的患者通常要经历三个阶段的手术姑息治疗，最终进行Fontan手术。理论上，通过多普勒超声评估Fontan开窗处的血流可以无创估计经肺梯度（TPG）。我们的目的是确定在有开窗Fontan手术的患者中，多普勒衍生的平均开窗梯度（mFG）与基于导管的TPG直接测量值之间的关系。
我们对2000年至2022年间完成的59例有开窗Fontan手术的患者进行了单中心回顾性队列研究。主要结局是基于导管的TPG测量值，主要预测因素是在导管插入术6个月内进行的超声心动图测量的mFG。使用线性回归和R来确定预测因素与结局之间的关系。
基于导管的TPG测量值与mFG之间的相关性较弱（R = 0.382，p < 0.001）；回归系数为0.550，mFG每增加一个单位，标准误差为0.09（导管TPG = 0.55[mFG] + 1.92）。在体循环左心室患者中，mFG与导管衍生的TPG的预测关系稍好，R为0.47，p < 0.004。
mFG约占导管衍生TPG方差的38%。虽然mFG是非侵入性且直观的，但对Fontan患者的mFG应谨慎解释，应考虑通过心导管检查进行直接测量。
