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Elevated Low-Shear Blood Viscosity is Associated with Decreased Pulmonary Blood Flow in Children with Univentricular Heart Defects

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Abstract

After the Fontan procedure, patients with univentricular hearts can experience long-term complications due to chronic low-shear non-pulsatile pulmonary blood flow. We sought to evaluate hemorheology and its relationship to hemodynamics in children with univentricular hearts. We hypothesized that low-shear blood viscosity and red blood cell (RBC) aggregation would be associated with increased pulmonary vascular resistance (PVR) and decreased pulmonary blood flow (PBF). We performed a cross-sectional analysis of 62 children undergoing cardiac catheterization—20 with isolated atrial septal defect (ASD), 22 status post Glenn procedure (Glenn), and 20 status post Fontan procedure (Fontan). Shear-dependent blood viscosity, RBC aggregation and deformability, complete blood count, coagulation panel, metabolic panel, fibrinogen, and erythrocyte sedimentation rate were measured. PVR and PBF were calculated using the Fick equation. Group differences were analyzed by ANOVA and correlations by linear regression. Blood viscosity at all shear rates was higher in Glenn and Fontan, partially due to normocytic anemia in ASD. RBC aggregation and deformability were similar between all groups. Low-shear viscosity negatively correlated with PBF in Glenn and Fontan only (R 2 = 0.27, p < 0.001); it also negatively correlated with pulmonary artery pressure in Glenn (R 2 = 0.15, p = 0.01), and positively correlated with PVR in Fontan (R 2 = 0.28, p = 0.02). Our data demonstrate that elevated low-shear blood viscosity is associated with negative hemodynamic perturbations in a passive univentricular pulmonary circulation, but not in a pulsatile biventricular pulmonary circulation.

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Acknowledgments

This work was supported by a Grant-in-Aid (Section on Cardiology and Cardiac Surgery Research Fellowship Award) from the American Academy of Pediatrics (A.L.C.), a University of Southern California Provost’s Postdoctoral Scholar Research Grant (A.L.C.), a K12 award (2 K12 HD 52954-6 A1) and K23 award (1 K23 HL 119627-01 A1) from the National Institutes of Health (J.A.D.), and an institutional grant (NIH #RR00043-43) from the Children’s Hospital Los Angeles General Clinical Research Center (J.A.D.). The authors acknowledge Hesham Mahmoud for assistance with obtaining informed consents, as well as Honglei Liu, Iris Xu, and Israel Orta for assistance with the rheology experiments.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd., Mailstop #34, Los Angeles, CA, 90036, USA

    Andrew L. Cheng, Cheryl M. Takao, John C. Wood & Jon A. Detterich

  2. Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Rosalinda B. Wenby, Herbert J. Meiselman & Jon A. Detterich

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  1. Andrew L. Cheng
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  2. Cheryl M. Takao
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  3. Rosalinda B. Wenby
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  4. Herbert J. Meiselman
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  5. John C. Wood
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  6. Jon A. Detterich
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Correspondence to Andrew L. Cheng.

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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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Cheng, A.L., Takao, C.M., Wenby, R.B. et al. Elevated Low-Shear Blood Viscosity is Associated with Decreased Pulmonary Blood Flow in Children with Univentricular Heart Defects. Pediatr Cardiol 37, 789–801 (2016). https://doi.org/10.1007/s00246-016-1352-4

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