Document Detail


One and a Half Ventricle Repair in Adults: Postoperative Hemodynamic Assessment Using Phase-Contrast Magnetic Resonance Imaging.
MedLine Citation:
PMID:  21620369     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: One and a half ventricle repair (1½ repair) strategy has been used for patients with a hypoplastic or dysfunctional right ventricle (RV), or both. We sought to assess the postoperative hemodynamics of 1½ repair using phase-contrast magnetic resonance imaging (PC-MRI). METHODS: Ten adults, 9 with Ebstein's anomaly and 1 with tricuspid stenosis, underwent 1½ repair (median age at operation, 42.4 years). The azygos vein was left open in all patients on 1½ repair to prevent severe postoperative central venous hypertension. Postoperative PC-MRI studies were performed to measure blood flow to the ascending aorta (Q(Asc-Ao)), the main pulmonary artery (Q(MPA)), the superior vena cava (SVC) (Q(SVC)), and the branch pulmonary arteries and veins. From these values, blood flow to the upper compartment of the body (Q(UC)), right ventricular volume unloading effect (Q(MPA)/Q(Asc-Ao)), proportion of blood flow to the upper compartment of the body (Q(UC)/Q(Asc-Ao)), and venous return to arterial forward flow ratio of the upper compartment of the body (Q(SVC)/Q(UC)) were calculated. Two patients also underwent preoperative PC-MRI. RESULTS: On PC-MRI, Q(MPA)/Q(Asc-Ao), Q(UC)/Q(Asc-Ao), and Q(SVC)/Q(UC) were 0.58 to 0.84 (median, 0.67), 0.19 to 0.36 (median, 0.27), and 0.47 to 1.57 (median, 0.93, lower than 1.0 in 7 patients), respectively. In 2 patients who had preoperative and postoperative PC-MRI, Q(UC)/Q(Asc-Ao) decreased from 0.26, 0.32 to 0.21, 0.28, respectively. CONCLUSIONS: After 1½ repair, right ventricular volume unloading was effective in all patients, but intercaval collateral veins (ie. Q(SVC)/Q(UC) < 1) appeared to develop in most of the patients. Furthermore blood flow to the upper compartment of the body appeared to diminish, presumably due to postoperative elevation of central venous pressure.
Authors:
Jin Woo Chung; Hyun Woo Goo; Yu-Mi Im; Hong-Ju Shin; Won Kyoung Jhang; Jae- Kon Ko; Tae-Jin Yun
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-25
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
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