Document Detail

Blood flow distribution in a large series of patients having the Fontan operation: a cardiac magnetic resonance velocity mapping study.
MedLine Citation:
PMID:  19577063     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Our goal was to determine flow distribution in the cavopulmonary connections of patients with and without bilateral superior venae cavae who had the Fontan procedure. No large series exists that establishes the flow distributions in Fontan patients, which would be an important resource for everyday clinical use and may affect future surgical reconstruction.
METHODS: We studied 105 Fontan patients (aged 2-24 years) with through-plane phase contrast velocity mapping to determine flow rates in the inferior and superior venae cavae and left and right pulmonary arteries. Superior caval anastomosis type included 40 bidirectional Glenn shunts (of which 15 were bilateral) and 53 hemi-Fontan anastomoses; Fontan type included 69 intra-atrial baffles, 28 extracardiac conduits, and 4 atriopulmonary connections.
RESULTS: Total caval flow was 2.9 +/- 1.0 L x min(-1) x m(-2), with an inferior vena cava contribution of 59% +/- 15%. Total pulmonary flow was 2.5 +/- 0.8 L x min(-1) x m(-2), statistically less than caval flow and not explained by fenestration presence. The right pulmonary artery contribution (55% +/- 13%) was statistically greater than the left. In patients with bilateral superior cavae, the right cava accounted for 52% +/- 14% of the flow, with no difference in pulmonary flow splits (50% +/- 16% to the right). Age and body surface area correlated with percent inferior caval contribution (r = 0.60 and 0.74, respectively). Superior vena cava anastomosis and Fontan type did not significantly affect pulmonary flow splits.
CONCLUSIONS: Total Fontan cardiac index was 2.9 L x min(-1) x m(-2), with normal pulmonary flow splits (55% to the right lung). Inferior vena caval contribution to total flow increases with body surface area and age, consistent with data from healthy children.
Kevin K Whitehead; Kartik S Sundareswaran; W James Parks; Matthew A Harris; Ajit P Yoganathan; Mark A Fogel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-04-25
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-06     Completed Date:  2009-07-28     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  96-102     Citation Subset:  AIM; IM    
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MeSH Terms
Blood Flow Velocity*
Body Surface Area
Child, Preschool
Fontan Procedure*
Heart Defects, Congenital / surgery
Magnetic Resonance Imaging*
Pulmonary Artery / physiopathology*,  surgery
Regional Blood Flow
Venae Cavae / physiopathology*,  surgery
Young Adult
Grant Support
5U01HL68279-03/HL/NHLBI NIH HHS; K23 HL089647/HL/NHLBI NIH HHS; K23 HL089647-01A1/HL/NHLBI NIH HHS; R01 HL 67622/HL/NHLBI NIH HHS; R01 HL067622/HL/NHLBI NIH HHS; R01 HL067622-05/HL/NHLBI NIH HHS; T32 HL007915/HL/NHLBI NIH HHS; T32 HL007915-07/HL/NHLBI NIH HHS

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