Differential Branch Pulmonary Artery Regurgitant Fraction Is a Function of Differential Pulmonary Arterial Anatomy and Pulmonary Vascular Resistance

Harris, Matthew A.; Whitehead, Kevin K.; Gillespie, Matthew J.; Liu, Timothy Y.; Cosulich, Michael T.; Shin, David; Goldmuntz, Elizabeth; Weinberg, Paul M.; Fogel, Mark A.

doi:10.1016/j.jcmg.2011.02.011

Cited by 21 publications

(18 citation statements)

References 27 publications

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“…By using this technique, our previous study [ 13 ] provided clues to the pathophysiology of PR in patients after TOF repair, by showing that the relative amount of blood that streams back towards the heart is derived to a greater part from the LPA. Building on hypotheses generated on the basis of previous reports [ 14 , 17 – 19 ], the key findings of this current study for better understanding of the mechanisms of PR after TOF repair are: a smaller left lung size is associated with increased diastolic flow reversal in the LPA …”

Section: Discussionmentioning

confidence: 81%

“…Therefore, in the absence of pulmonary stenosis (which was an exclusion criterion in the present study), the primary determinant of diastolic flow reversal is the peripheral pressure in the lungs or, in the absence of shunts, the PVR [ 5 ]. Indeed, combining invasive manometry during cardiac catheterization and flows from CMR, Harris et al [ 17 ] found an association between the pulmonary vascular resistance and flow reversal in the ipsilateral pulmonary artery. They concluded that the difference in pulmonary blood flow between the right and the left lung is a function of the differential PVR.…”

Section: Discussionmentioning

confidence: 99%

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Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery

Kato

Drolet

Yoo

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundThe left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well understood. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR.MethodsForty-eight Cardiovascular Magnetic Resonance (CMR) studies in patients after TOF repair were analyzed. In addition to the routine blood flow and ventricular volume quantification cardiac angle between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured on an axial image. Statistical analysis was performed to compare flow parameters between RPA and LPA and to assess correlation among right ventricular volume, pulmonary blood flow parameters and lung area.ResultsThere was no difference between LPA and RPA diameters. The LPA showed significantly less total forward flow (2.49 ± 0.87 L/min/m2 vs 2.86 ± 0.89 L/min/m2; p = 0.02), smaller net forward flow (1.40 ± 0.51 vs 1.89 ± 0.60 mL/min/m2; p = <0.001), and greater regurgitant fraction (RF) (34 ± 10 % vs 43 ± 12 %; p = 0.001) than the RPA. There was no difference in regurgitant flow volume between RPA and LPA (p = 0.29). Indexed right ventricular end-diastolic volume (RVEDVi) correlated with LPA RF (R = 0.48, p < 0.001), but not with RPA RF (p = 0.09). Larger RVEDVi correlated with a more leftward cardiac axis (R = 0.46, p < 0.001) and with smaller left lung area (R = −0.58, p < 0.001). LPA RF, but not RPA RF, correlated inversely with left lung area (R = −0.34, p = 0.02). The follow-up CMRs in 20 patients showed a correlation of the rate of RV enlargement with the rates of LPA RF worsening (R = 0.50, p = 0.03), and of increasing left lung compression (R = −0.55, p = 0.012).ConclusionAn enlarged and levorotated heart is associated with left lung compression and impaired flow into the left lung.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery

Kato

Drolet

Yoo

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…Pulmonary artery size and architecture was obtained, which can be utilized as a baseline for future assessments; branch pulmonary artery stenosis is a potentially manageable residual lesion that has deleterious effects if not addressed. 22,23 Right ventricular function was also obtained early after surgery. Better understanding of the early right ventricular remodeling after tetralogy of Fallot repair may provide insight into post-operative management strategies and guide follow-up.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative remodelling following repair of tetralogy of Fallot utilising unsedated cardiac magnetic resonance: a pilot study

et al. 2018

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Introduction The right ventricular adaptations early after surgery in infants with tetralogy of Fallot are important to understand the changes that occur later on in life; this physiology has not been fully delineated. We sought to assess early post-operative right ventricular remodeling in patients with tetralogy of Fallot by cardiac magnetic resonance imaging. Materials and Method Subjects with tetralogy of Fallot under 1 year of age were recruited following complete surgical repair for tetralogy of Fallot. Protocol-based cardiac magnetic resonance imaging to assess anatomy, function, and flows was performed before hospital discharge using the Feed and Sleep technique, an unsedated imaging technique. Results Magnetic resonance imaging was completed in 16 subjects at a median age of 77 days (Interquartile range 114). There was normal ventricular ejection fraction and indexed right ventricular end-diastolic volume (48 ± 13 cc/m2), but elevated right ventricular mass (Z-score 6.2 ± 2.4). Subjects requiring a transannular patch or right ventricle to pulmonary artery conduit had moderate pulmonary insufficiency (Regurgitant fraction 27 ± 16. Discussion Early right ventricular remodeling after surgical repair for tetralogy of Fallot is characterized by significant pulmonary regurgitation, right ventricular hypertrophy, and lack of dilation. Performing cardiac magnetic resonance imaging using the Feed and Sleep technique is feasible in infants younger than five months. These results might open new avenues to study longitudinal right ventricular changes in tetralogy of Fallot and to further explore the utility of unsedated magnetic resonance imaging in patients with other types of congenial heart defects.

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“…Retrospective electrocardiogramgated through-plane phase contrast MRI images were acquired for the aortic valve and descending aorta at the level of the diaphragm. The typical parameters we use to acquire velocity mapping sequences are listed in Table 1 [13][14][15].…”

Section: Methodsmentioning

confidence: 99%

Holodiastolic Flow Reversal at the Descending Aorta on Cardiac Magnetic Resonance is Neither Sensitive Nor Specific for Significant Aortic Regurgitation in Patients with Congenital Heart Disease

et al. 2016

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Holodiastolic flow reversal in the descending aorta on echocardiogram suggests significant aortic regurgitation. The study aim was to determine whether the presence of holodiastolic flow reversal on cardiac magnetic resonance imaging (MRI) correlates with aortic valve regurgitant fraction. We retrospectively reviewed 166 cardiac MRIs (64 % male, age 14.1 ± 9.5 years) from January 2011 to May 2012 where velocity mapping was acquired at both the aortic valve and the descending aorta at the level of the diaphragm. Descending aorta velocity maps were checked for baseline offset using a static reference region. Holodiastolic flow reversal was defined as flow reversal throughout diastole both before and after baseline correction. Significant aortic regurgitation was defined as regurgitant fraction >10 %. Aortic valve regurgitant fraction was <10 % in 144 patients (Group A), 10-20 % inclusive in 7 patients (Group B), and >20 % in 15 patients (Group C). Though the aortic valve regurgitant fraction was significantly higher for patients with holodiastolic flow reversal versus those without (8.5 ± 14.2 vs. 3.8 ± 6.6 %, p = 0.02), holodiastolic flow reversal was present in 32 Group A patients (22 %). In comparison, 4 Group B patients (57 %) and 7 Group C patients (47 %) had holodiastolic flow reversal. The sensitivity (Groups B and C) was 0.5, and the specificity (Group A) was 0.78. Holodiastolic flow reversal in the descending aorta on cardiac MRI was neither sensitive nor specific for predicting significant aortic regurgitation in this study population. Holodiastolic flow reversal in the absence of significant aortic regurgitation may be a relatively common finding in patients with congenital heart disease.

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Differential Branch Pulmonary Artery Regurgitant Fraction Is a Function of Differential Pulmonary Arterial Anatomy and Pulmonary Vascular Resistance

Cited by 21 publications

References 27 publications

Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery

Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery

Early postoperative remodelling following repair of tetralogy of Fallot utilising unsedated cardiac magnetic resonance: a pilot study

Holodiastolic Flow Reversal at the Descending Aorta on Cardiac Magnetic Resonance is Neither Sensitive Nor Specific for Significant Aortic Regurgitation in Patients with Congenital Heart Disease

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