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Original Articles

Aortopulmonary Collaterals After Bidirectional Cavopulmonary Connection or Fontan Completion

Quantification With MRI

Lars Grosse-Wortmann, MD; Abdulmajeed Al-Otay, MD and Shi-Joon Yoo, MD

From The Labatt Family Heart Center and the Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada.

Correspondence to Shi-Joon Yoo, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail shi-joon.yoo{at}sickkids.ca

Received November 8, 2008; accepted March 23, 2009.

Background— Aortopulmonary collaterals (APCs) have been associated with increased morbidity after the Fontan operation. We aimed to quantify APC flow after bidirectional cavopulmonary connections and Fontan completions, using phase-contrast MRI, and to identify risk factors for the development of APCs.

Methods and Results— APC blood flow was quantifiable in 24 of 36 retrospectively analyzed MRI studies. Sixteen studies were performed after the bidirectional cavopulmonary connections (group A) and 8 after the Fontan operation (group B). APC blood flow was calculated by subtracting the blood flow volume through the pulmonary arteries from that through the pulmonary veins. The ratio of pulmonary to systemic blood flow (Qp/Qs) was 0.93±0.26 in group A and 1.27±0.16 in group B. APC flow was 1.42 (0.58 to 3.83) L/min/m² and 0.82 (0.50 to 1.81) L/min/m² in groups A and B, respectively. The mean inaccuracies corresponded to 7.9±14.5% and 7.1±13.6% of ascending aortic flow in groups A and B, respectively. Qp/Qs was negatively correlated with a younger age at the time of the bidirectional cavopulmonary connections operation (r=0.62, P=0.01) and positively correlated with the age at the time of the Fontan completion (r=0.81, P=0.01). Patients with a previous right-sided modified Blalock-Taussig shunt had more collateral flow to the right lung than those without.

Conclusions— APC blood flow can be noninvasively measured in bidirectional cavopulmonary connections and Fontan patients, using MRI in the majority of patients and results in a significant left-to-right shunt.

Key Words: collateral circulation • Fontan procedure • MRI

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CLINICAL PERSPECTIVE

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