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Differences in Pulmonary and Systemic Flow Measurements by Cardiac Magnetic Resonance vs Cardiac Catheterization and Relation to Collateral Flow in Single Ventricle Patients

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Abstract

Both cardiac magnetic resonance (CMR) and cardiac catheterization (cath) may assess patients with single ventricle physiology prior to stage II or Fontan palliation. However, development of significant aortopulmonary collaterals may invalidate assumptions of the Fick method. We compared CMR and cath flow measurements and evaluated the relation to collateral flow. This single-center study included all pre-stage II and pre-Fontan patients between 2010 and 2017 with CMR and cath within 1 month. Pulmonary (Qp) and systemic flow (Qs) by cath were calculated by Fick method. CMR Qp was calculated by total pulmonary venous flow, and Qs by total vena caval flow. Collateral flow by CMR was the difference of pulmonary vein and pulmonary artery flow. In 26 studies (16 pre-stage II and 10 pre-Fontan) in 21 patients, collateral flow was higher in pre-Fontan patients (1.8 ± 0.6 vs 0.9 ± 0.8 L/min/m2, p = 0.01). Overall, CMR and cath had good agreement for Qs and Qp:Qs, with moderate correlation (r = 0.44, p = 0.02 for Qs, r = 0.48, p = 0.02 for Qp:Qs). In pre-Fontan but not in pre-stage II patients, CMR had higher Qp (mean difference − 1.71 L/min/m2) and Qp:Qs (mean difference − 0.36). The underestimation of cath Qp correlated with amount of collateral flow (r = − 0.47, p = 0.02). Neither cath nor CMR flow measurements correlated with outcomes in this small cohort. In conclusion, collaterals lead to systematically higher Qp and Qp:Qs measurements by CMR vs cath in single ventricle patients. Measurements may not be used interchangeably, with potential clinical significance in estimating pulmonary vascular resistance. Further study is necessary to evaluate possible relation to clinical outcomes.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Maine Medical Center, Portland, ME, USA

    Michael R. Hart

  2. Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Wendy Whiteside, Sunkyung Yu, Ray Lowery, Adam L. Dorfman & Jimmy C. Lu

  3. Section of Pediatric Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Adam L. Dorfman, Maryam Ghadimi Mahani & Jimmy C. Lu

  4. Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Maryam Ghadimi Mahani & Prachi P. Agarwal

  5. C.S. Mott Children’s Hospital, University of Michigan Congenital Heart Center, 11th floor, 1540 E. Hospital Dr., Ann Arbor, MI, 48109, USA

    Jimmy C. Lu

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  1. Michael R. Hart
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Correspondence to Jimmy C. Lu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hart, M.R., Whiteside, W., Yu, S. et al. Differences in Pulmonary and Systemic Flow Measurements by Cardiac Magnetic Resonance vs Cardiac Catheterization and Relation to Collateral Flow in Single Ventricle Patients. Pediatr Cardiol 41, 885–891 (2020). https://doi.org/10.1007/s00246-020-02327-w

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  • DOI: https://doi.org/10.1007/s00246-020-02327-w

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