Faculty Collaboration Database

Clinical Variables Associated with Pre-Fontan Aortopulmonary Collateral Burden. Pediatr Cardiol 2023 Jan;44(1):228-236

Date

09/27/2022

Pubmed ID

36156171

Pubmed Central ID

PMC10155213

DOI

10.1007/s00246-022-03014-8

Scopus ID

2-s2.0-85138742613 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

Aortopulmonary collaterals (APCs) develop universally, but to varying degrees, in patients with single ventricle congenital heart disease (CHD). Despite their ubiquitous presence, APCs remain poorly understood. We sought to evaluate the association between APC burden and common non-invasive clinical variables. We conducted a single center, retrospective study of patients with single ventricle CHD and previous Glenn palliation who underwent pre-Fontan cardiac magnetic resonance (CMR) imaging from 3/2018 to 3/2021. CMR was used to quantify APC flow, which was normalized to aortic (APC/Q_Ao) and pulmonary vein (APC/Q_PV) blood flow. Univariate, multivariable, and classification and regression tree (CART) analyses were done to investigate the potential relationship between CMR-quantified APC burden and clinical variables. A total of 29 patients were included, all of whom had increased APC flow (APC/Q_Ao: 26.9, [22.0, 39.1]%; APC/Q_PV: 39.4 [33.3, 46.9]%), but to varying degrees (APC/Q_Ao: range 11.9-44.4%; APC/Q_PV: range 17.7-60.0%). Pulmonary artery size (Nakata index, at pre-Fontan CMR) was the only variable associated with APC flow on multivariable analysis (APC/Q_Ao: p = 0.020, R² = 0.19; APC/Q_PV: p = 0.0006, R² = 0.36) and was the most important variable associated with APC burden identified by CART analysis (size inversely related to APC flow). APC flow is universally increased but highly variable in patients with single ventricle CHD and Glenn circulation. Small branch pulmonary artery size is a key factor associated with increased APC burden; however, the pathogenesis of APCs is likely multifactorial. Further research is needed to better understand APC pathogenesis, including predisposing and mitigating factors.

Author List

Segar DE, Pan AY, McLennan DI, Kindel SJ, Handler SS, Ginde S, Woods RK, Goot BH, Spearman AD

Authors

Salil Ginde MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
Ben Goot MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Stephanie S. Handler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Steven J. Kindel MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Amy Y. Pan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Andrew Spearman MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Collateral Circulation
Fontan Procedure
Heart Defects, Congenital
Heart Ventricles
Humans
Pulmonary Artery
Pulmonary Circulation
Retrospective Studies
Treatment Outcome