Berthusen Alexander J, Saucedo Jochen Gerstner, Schäfer Michal, O'Callaghan Barry, Fujiwara Takashi, Browne Lorna P, Morgan Gareth, Barker Alex J
Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Department of Modern Human Anatomy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Pediatr Cardiol. 2025 Aug 7. doi: 10.1007/s00246-025-03983-6.
Pulmonary hemodynamics are necessary to measure for lifelong surveillance of cardiovascular function in children with tetralogy of Fallot (TOF). To measure cardiac index, invasive cardiac catheterization using the Fick principle or phase-contrast MRI (PC-MRI) can be used. However, estimates of oxygen consumption and other assumptions used in the Fick method may lead to significant inaccuracy, which are further exacerbated by disease characteristics such as pulmonary regurgitation. By comparison, PC-MRI can directly measure blood flow and regurgitant fraction. To investigate the potential complications of using the Fick principle, flow hemodynamics in 33 repaired TOF patients (7.6 ± 3.9 years) were investigated in patients who underwent cardiac catheterization and cardiac MRI. Pulmonary blood flow (Q) measured by catheterization and PC-MRI showed poor agreement with an absolute bias of 0.80 ± 0.910 L/min/m. Q by Fick was significantly higher than PC-MRI (3.15 ± 0.60 L/min/m vs. 2.35 ± 0.95 L/min/m [p < 0.001]). Patients were also stratified by the presence of severe pulmonary regurgitant fraction (RF > 40%). A mean difference of 1.18L/min/m in Q was found in patients with RF over 40% (n = 18), while patients with RF under 40% (n = 15) had a mean Q difference of 0.34 L/min/m (p = 0.013). PC-MRI may address errors associated with oxygen consumption as well as assumptions affecting Fick in all patient populations. Additional advantages may exist when assessing children with repaired TOF, especially given the common presence of regurgitant pulmonary flow in this population.
为了对法洛四联症（TOF）患儿的心血管功能进行终身监测，测量肺血流动力学是必要的。为了测量心指数，可以使用基于菲克原理的有创心导管检查或相位对比磁共振成像（PC-MRI）。然而，菲克法中使用的氧耗量估计值和其他假设可能导致显著的不准确，而诸如肺反流等疾病特征会进一步加剧这种不准确。相比之下，PC-MRI可以直接测量血流和反流分数。为了研究使用菲克原理的潜在并发症，对33例接受心导管检查和心脏MRI的TOF修复患者（7.6±3.9岁）的血流动力学进行了研究。通过导管检查和PC-MRI测量的肺血流量（Q）一致性较差，绝对偏差为0.80±0.910L/min/m。菲克法测得的Q显著高于PC-MRI（3.15±0.60L/min/m对2.35±0.95L/min/m [p<0.001]）。患者还根据严重肺反流分数（RF>40%）的存在进行分层。RF超过40%的患者（n=18）Q的平均差异为1.18L/min/m，而RF低于40%的患者（n=15）Q的平均差异为0.34L/min/m（p=0.013）。PC-MRI可以解决与氧耗量相关的误差以及影响所有患者群体中菲克法的假设。在评估TOF修复患儿时可能存在其他优势，特别是考虑到该人群中常见的反流性肺血流。
