Magnetic resonance imaging catheter stress haemodynamics post-Fontan in hypoplastic left heart syndrome

Kuberan Pushparajah, James K. Wong, Hannah R. Bellsham-Revell, Tarique Hussain, Israel Valverde, Aaron Bell, Aphrodite Tzifa, Gerald Greil, John M. Simpson, Shelby Kutty, Reza Razavi

Research output: Contribution to journalArticle

Abstract

Aims Exercise limitation is common post-Fontan. Hybrid X-ray and magnetic resonance imaging (XMR) catheterization allows haemodynamic assessment by means of measurement of ventricular volumes and flow in major vessels with simultaneous invasive pressures.We aim to assess haemodynamic response to stress in patients with hypoplastic left heart syndrome (HLHS) post-Fontan. Methods and results Prospective study of 13 symptomatic children (NHYA 2) with HLHS post-Fontan using XMR catheterization. Three conditions were applied: baseline (Stage 1), dobutamine at 10 mg/kg/min (Stage 2), and dobutamine at 20 μg/kg/min (Stage 3). Seven consecutive patients received inhaled nitric oxide (iNO) at peak stress. Control MRI data were from normal healthy adults. In the HLHS patients, baseline mean pulmonary vascular resistance (PVR) was 1.51±0.59WU m2 and aortopulmonary collateral flow was 17.7±13.6% of systemic cardiac output. Mean right ventricular end-diastolic pressure was 6.7±2.5 mmHg which did not rise with stress. Cardiac index (CI) increased at Stage 2 in HLHS (40%) and controls (61%) but continued to increase at Stage 3 only in controls (19%) but not in HLHS. The blunted rise in CI in HLHS was due to a continuing fall in end-diastolic volume throughout stress, with no significant change in PVR or CI at peak stress in response to iNO. Conclusion Cardiac output post-Fontan in HLHS at peak stress is blunted due to a limitation in preload which is not responsive to inhaled pulmonary vasodilators in the setting of normal PVR.

Original languageEnglish (US)
Pages (from-to)644-651
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Keywords

  • Fontan
  • MRI
  • dobutamine
  • hypoplastic left heart syndrome
  • pulmonary vascular resistance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Pushparajah, K., Wong, J. K., Bellsham-Revell, H. R., Hussain, T., Valverde, I., Bell, A., Tzifa, A., Greil, G., Simpson, J. M., Kutty, S., & Razavi, R. (2016). Magnetic resonance imaging catheter stress haemodynamics post-Fontan in hypoplastic left heart syndrome. European heart journal cardiovascular Imaging, 17(6), 644-651. https://doi.org/10.1093/ehjci/jev178