Assessment of ductal blood flow in newborns with obstructive left heart lesions by cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance

Lars Grosse-Wortmann¹  Ashley Ho¹  Luc Mertens¹  Shi-Joon Yoo¹  Marcelo Felipe Kozak¹ 

[1] Labatt Family Heart Centre in the Department of Paediatrics and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

关键词: Congenital heart disease;    Newborn;    Obstructive;    Cardiovascular magnetic resonance;    Flow;    Patent ductus arteriosus;   

Others  :  829260
DOI  :  10.1186/1532-429X-15-45

 received in 2013-01-15, accepted in 2013-05-17,  发布年份 2013

【 摘 要 】

Background

Newborns with obstructive left heart lesions often depend on a patent ductus arteriosus to sustain the systemic circulation. Our aims were to validate the direct measurement of ductal flow, and to characterize the magnitude, determinants and hemodynamic effects of patent ductus arteriosus in newborns with obstructive left heart lesions by cardiovascular magnetic resonance (CMR).

Methods

In this retrospective study, the CMR and clinical information of newborns with obstructive left heart lesions were reviewed. The feasibility and validity of measuring ductal flow and the correlations between ductal flow and ventricular volumes, ascending aortic flow, post-ductal oxygen saturation and Qp:Qs were assessed.

Results

The CMR examinations of 32 newborns were included. It was possible to measure the ductal flow in all of them, with moderate-to-good agreement between measured and calculated ductal flow volume. The flow was bidirectional in all patients, with a net right-to-left shunt in 72%. Net ductal flow correlated inversely with ascending aortic flow (Rho −0.63; p 0.0002), post-ductal oxygen saturation (Rho −0.58; p 0.0004), Qp:Qs (Rho −0.43; p 0.02), and with left ventricular end-diastolic volume index (Rho −0.38; p 0.04). There was no correlation with the diameter of the ductus. The contribution of ductus flow to the systemic circulation correlated with the left ventricular end-diastolic volume index (Rho −0.47; p 0.02).

Conclusions

Direct measurement of ductal flow in newborns with obstructive left heart lesions is feasible. From these measurements, we were able to demonstrate that patients with smaller left ventricles and lower ascending aortic flow have a greater contribution of ductal flow to the systemic circulation. The size of the ductus arteriosus does not predict net ductal flow. Phase-contrast CMR can be an adjunct method for the assessment of the physiology for very ill neonate patients.

【 授权许可】

   
2013 Kozak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

Figure 1.

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【 参考文献 】

• [1]Hoshino K, Ogawa K, Hishitani T, Kitazawa R, Uehara R. Hypoplastic left heart syndrome: duration of survival without surgical intervention. Am Heart J. 1999; 137:535-42.
• [2]McGuinness JG, Elhassan Y, Lee SY, Nolke L, Oslizlok P, Walsh K, Redmond M, Wood AE. Do high-risk infants have a poorer outcome from primary repair of coarctation? Analysis of 192 infants over 20 years. Ann Thorac Surg. 2010; 90:2023-7.
• [3]Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Closed transventricular aortic valvotomy for critical aortic stenosis in neonates: Outcomes, risk factors, and reoperations. Ann Thorac Surg. 2006; 81:236-42.
• [4]Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr. 2009; 168:907-14.
• [5]Powell AJ, Geva T. Blood flow measurement by magnetic resonance imaging in congenital heart disease. Pediatr Cardiol. 2000; 21:47-58.
• [6]Chatzimavroudis GP, Oshinski JN, Franch RH, Walker PG, Yoganathan AP, Pettigrew RI. Evaluation of the precision of magnetic resonance phase velocity mapping for blood flow measurements. J Cardiovasc Magn Reson. 2001; 3:11-9.
• [7]Fratz S, Hess J, Schwaiger M, Martinoff S, Stern HC. More accurate quantification of pulmonary blood flow by magnetic resonance imaging than by lung perfusion scintigraphy in patients with Fontan circulation. Circulation. 2002; 106:1510-3.
• [8]Samyn MM. A review of the complementary information available with cardiac magnetic resonance imaging and multi-slice computed tomography (CT) during the study of congenital heart disease. Int J Cardiovasc Imag. 2004; 20:569-78.
• [9]Groves AM, Chiesa G, Durighel G, Goldring ST, Fitzpatrick JA, Uribe S, Razavi R, Hajnal JV, Edwards AD. Functional cardiac MRI in preterm and term newborns. Arch Dis Child Fetal Neonatal. 2011; 96:F86-91.
• [10]Debl K, Djavidani B, Buchner S, Heinicke N, Poschenrieder F, Feuerbach S, Riegger G, Luchner A. Quantification of left-to-right shunting in adult congenital heart disease: Phase-contrast cine MRI compared with invasive oximetry. Br J Radiol. 2009; 82:386-91.
• [11]Bell A, Beerbaum P, Greil G, Hegde S, Toschke AM, Schaeffter T, Razavi R. Noninvasive assessment of pulmonary artery flow and resistance by cardiac magnetic resonance in congenital heart diseases with unrestricted left-to-right shunt. JACC Cardiovasc Imaging. 2009; 2:1285-91.
• [12]Körperich H, Gieseke J, Barth P, Hoogeveen R, Esdorn H, Peterschröder A, Meyer H, Beerbaum P. Flow volume and shunt quantification in pediatric congenital heart disease by real-time magnetic resonance velocity mapping: a validation study. Circulation. 2004; 109:1987-93.
• [13]Grosse-Wortmann L, Al-Otay A, Yoo SJ. Aortopulmonary collaterals after bidirectional cavopulmonary connection or Fontan completion quantification with MRI. Circ Cardiovasc Imaging. 2009; 2:219-25.
• [14]Shariat M, Grosse-Wortmann L, Windram J, Yoo SJ. Pulmonary vein flow pattern in children with bidirectional cavopulmonary connection or Fontan circuit. Pediatr Radiol. 2012; 42:211-4.
• [15]Schmitt B, Steendijk P, Ovroutski S, Lunze K, Rahmanzadeh P, Maarouf N, Ewert P, Berger F, Kuehne T. Pulmonary vascular resistance, collateral flow, and ventricular function in patients with a Fontan circulation at rest and during dobutamine stress. Circ Cardiovasc Imaging. 2010; 3:623-31.
• [16]Muthurangu V, Taylor AM, Hegde SR, Johnson R, Tulloh R, Simpson JM, Qureshi S, Rosenthal E, Baker E, Anderson D, Razavi R. Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome. Circulation. 2005; 112:3256-63.
• [17]Sarikouch S, Schaeffler R, Körperich H, Dongas A, Haas NA, Beerbaum P. Cardiovascular magnetic resonance imaging for intensive care infants: safe and effective? Pediatr Cardiol. 2009; 30:146-52.
• [18]Broadhouse KM, Price AN, Durighel G, Cox DJ, Finnemore AE, Edwards AD, Hajnal JV, Groves AM. Assessment of PDA shunt and systemic blood flow in newborns using cardiac MRI. NMR Biomed. 2013. epub ahead of print
• [19]Grosse-Wortmann L, Yun TJ, Al-Radi O, Kim S, Nii M, Lee KJ, Redington A, Yoo SJ, van Arsdell G. Borderline hypoplasia of the left ventricle in neonates: insights for decision-making from functional assessment with magnetic resonance imaging. J Thorac Cardiovasc Surg. 2008; 136:1429-36.
• [20]Hammon JW, Lupinetti FM, Maples MD, Merrill WH, First WH, Graham TP, Bender HW. Predictors of operative mortality in critical valvular aortic stenosis presenting in infancy. Ann Thor Surg. 1988; 45:537-40.