Lund University Publications

Preoperative myocardial strain, mesenteric resistance, and aortopulmonary collateral flow are associated with pleural effusion duration after fontan completion

• Mark

Alsafi, Z. ^LU ; Dangardt, Frida ; Frieberg, Peter ^LU ; De Lange, Charlote ; Hanséus, K. ^LU ; Synnergren, M. ; Tran, K. ^LU ; Odermarsky, M. ^LU ; Carlsson, Marcus and Liuba, P. ^LU

Abstract

Introduction: The contribution of aortopulmonary collateral (APC) flow to pleural effusion (PE) after total cavopulmonary connection (TCPC) remains unclear. Excessive APC flow may alter mesenteric perfusion and increase ventricular volume load. We evaluated echocardiographic and mesenteric flow parameters as predictors of PE duration and their association with magnetic resonance imaging (MRI)-derived APC flow.Methods: We prospectively studied patients with single ventricle (SV) physiology referred for TCPC at the Children's Heart Centers in Lund and Gothenburg, the two referral centers for pediatric cardiac surgery in Sweden. Preoperative assessment included 2D longitudinal strain from four-chamber (4CH) view and 3D global longitudinal... (More)

Introduction: The contribution of aortopulmonary collateral (APC) flow to pleural effusion (PE) after total cavopulmonary connection (TCPC) remains unclear. Excessive APC flow may alter mesenteric perfusion and increase ventricular volume load. We evaluated echocardiographic and mesenteric flow parameters as predictors of PE duration and their association with magnetic resonance imaging (MRI)-derived APC flow.Methods: We prospectively studied patients with single ventricle (SV) physiology referred for TCPC at the Children's Heart Centers in Lund and Gothenburg, the two referral centers for pediatric cardiac surgery in Sweden. Preoperative assessment included 2D longitudinal strain from four-chamber (4CH) view and 3D global longitudinal strain (GLS), Doppler derived resistance index (RI) in the superior mesenteric artery (SMA) and cardiac MRI. APC flow was quantified using two MRI-based methods: (A) pulmonary venous minus arterial flow, and (B) aortic flow minus total caval flow, both indexed to body surface area.Results: Thirty-four patients (median age at TCPC 2.8 (range:1.8–8.2) years; female: 44%; dominant right ventricle: 56%) were included. PE duration was significantly associated with higher 4CH-longitudinal strain (r = 0.34, p = 0.045). Pre-TCPC SMA RI was not significantly associated with PE duration but was correlated with APC flow. Although 3D GLS was not directly associated with PE duration, it correlated with APC flow quantified by both MRI methods (method A: r = 0.58, p = 0.006; method B: r = 0.48, p = 0.03). APC flow calculated using method B, and lower IVC flow (r = 0.73, p < 0.001) were associated with longer PE (r = 0.53, p = 0.004).Discussion: Prolonged pleural effusion after TCPC is associated with APC burden, echocardiographic markers of ventricular volume loading, and impaired mesenteric perfusion. GLS and SMA resistance index may reflect APC-related hemodynamic disturbance and serve as accessible, non-invasive surrogates to help identify patients at risk for adverse early TCPC outcomes.
PE duration after TCPC is associated with echocardiographic markers of volume overload and impaired mesenteric perfusion. GLS and SMA RI may serve as non-invasive surrogates for APC burden measured via MRI. (Less)