Barak-Corren Yuval, Gupta Mudit, Dori Yoav, Tang Jessica, Smith Christopher L, Rome Jonathan J, Gillespie Matthew J, Jolley Matthew A, O'Byrne Michael L, Callahan Ryan
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Soc Cardiovasc Angiogr Interv. 2025 Mar 25;4(4):102639. doi: 10.1016/j.jscai.2025.102639. eCollection 2025 Apr.
Restenosis in pediatric pulmonary vein stenosis (PVS) is common and requires careful monitoring. Lung perfusion scintigraphy (LPS) is often used but involves excess radiation, is resource-intensive, and can cause patient discomfort, with no real-time data available. This study evaluated the fluoroscopic flow calculator (FFC) as a real-time tool for estimating pulmonary blood flow (Qp) using angiograms during catheterization, with the potential to replace or complement LPS.
A retrospective cross-sectional study was conducted on patients with PVS who underwent cardiac catheterization between April 1, 2023, and March 31, 2024 at the Children's Hospital of Philadelphia. The study included patients who had a right ventricular angiogram and available LPS data. The FFC tool was used to analyze angiograms and estimate Qp distribution. Accuracy was assessed by comparing FFC predictions to LPS measurements using median absolute error and Bland-Altman analysis.
The study included 21 procedures involving 18 patients, with a median age of 17 months. The FFC tool provided accurate predictions of Qp distribution, with a median absolute error of 3%. In 76% of cases, the predicted flow split was within 5% of the LPS measurement, and all cases were within 7%. Bland-Altman analysis revealed a minimal bias of +0.3%, with no systematic bias at the extremes of the flow-split distribution.
The FFC tool shows promise in estimating Qp distribution during cardiac catheterization in PVS patients. Further research is needed to refine the FFC method, particularly incorporating segmental lung information, and to evaluate its real-time use during catheterization.
小儿肺静脉狭窄（PVS）中的再狭窄很常见，需要仔细监测。肺灌注闪烁扫描（LPS）经常被使用，但存在辐射过量、资源密集且会导致患者不适的问题，并且没有实时数据可用。本研究评估了荧光透视血流计算器（FFC）作为一种在导管插入术期间使用血管造影来估计肺血流量（Qp）的实时工具，其有可能替代或补充LPS。
对2023年4月1日至2024年3月31日期间在费城儿童医院接受心脏导管插入术的PVS患者进行了一项回顾性横断面研究。该研究纳入了进行了右心室血管造影且有可用LPS数据的患者。使用FFC工具分析血管造影并估计Qp分布。通过使用中位数绝对误差和布兰德 - 奥特曼分析将FFC预测结果与LPS测量结果进行比较来评估准确性。
该研究包括涉及18名患者的21例手术，中位年龄为17个月。FFC工具对Qp分布提供了准确的预测，中位数绝对误差为3%。在76%的病例中，预测的血流分流在LPS测量值的5%以内，所有病例均在7%以内。布兰德 - 奥特曼分析显示最小偏差为 +0.3%，在血流分流分布的极端情况下无系统偏差。
FFC工具在估计PVS患者心脏导管插入术期间的Qp分布方面显示出前景。需要进一步研究来完善FFC方法，特别是纳入肺段信息，并评估其在导管插入术期间的实时应用。
