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