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Ann Thorac Surg 2006;82:1267-1277
© 2006 The Society of Thoracic Surgeons


Original Articles: Cardiovascular

Impaired Power Output and Cardiac Index With Hypoplastic Left Heart Syndrome: A Magnetic Resonance Imaging Study

Kartik S. Sundareswaran, BSa, Kirk R. Kanter, MDb, Hiroumi D. Kitajima, MSa, Resmi Krishnankutty, BSa, Jennifer F. Sabatier, MSc, W. James Parks, MDd, Shiva Sharma, MDe, Ajit P. Yoganathan, PhDa,*, Mark Fogel, MDf

a Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
b Department of Surgery, Emory University, Atlanta, Georgia
c Biostatistics Consulting Center, Emory University, Atlanta, Georgia
d Sibley Heart Center and Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
e Pediatric Cardiology Services, Lawrenceville, Georgia
f Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Accepted for publication May 5, 2006.

* Address correspondence to Dr Yoganathan, Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology and Emory University, Room 2119, U.A. Whitaker Bldg, 313 Ferst Dr, Atlanta, GA 30332-0535 (Email: ajit.yoganathan{at}bme.gatech.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: Unfavorable cardiac mechanics in children with hypoplastic left heart syndrome (HLHS) when compared with other single-ventricle defects may affect long-term morbidity and outcome. Using noninvasive phase contrast magnetic resonance imaging (PC MRI), we examined cardiac mechanics in children with HLHS and compared the results to other single-ventricle defects.

METHODS: Eighteen children with HLHS and 18 children with other single-ventricle defects were studied after the Fontan operation. Phase contrast MRI scans were obtained perpendicular to the ascending aorta, and flow was quantified using an in-house segmentation and reconstruction scheme. The total power output was determined using the modified Bernoulli equation along with cardiac output and systemic vascular resistance index.

RESULTS: Compared with non-HLHS congenital heart defects, children with HLHS had significantly lower power output (1.40 ± 0.39 versus 1.78 ± 0.38 W/m2, p < 0.004) and cardiac index (3.15 ± 0.97 versus 4.09 ± 1.23 L · Min–1 · m–2, p < 0.009) with a concomitant higher systemic vascular resistance index (28.94 ± 11.5 versus 22.7 ± 8.53 WU, p < 0.03) despite generating similar systolic blood pressures (112.9 ± 22.4 versus 115.2 ± 23 mm Hg, p > 0.05).

CONCLUSIONS: Minimally invasive measurements with PC MRI in children with HLHS showed significantly lower power output and cardiac index when compared with other single-ventricle physiologies. Abnormal aortic flow patterns may contribute to power loss and may have long-term survival and morbidity implications associated with the Fontan procedure. Elevated systemic vascular resistance index despite similar blood pressure opens avenues for therapeutic intervention for afterload reduction.







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