Advertisement

Integrating Novel Physiologic Data into Decision-Making in Congenital Heart Surgery

  • Osami Honjo
    Correspondence
    Address correspondence to: Osami Honjo, MD, PhD, Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1 × 8, Canada
    Affiliations
    Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
      Optimal decision-making to determine the type and timing of surgical intervention for various congenital heart disease (CHD) requires adequate understanding and interpretation of anatomic and physiologic data obtained from various imaging modalities. Cardiac magnetic resonance (CMR) has revolutionized the way we evaluate the anatomy and physiology of CHD. In addition to 2- and 3-dimensional anatomic data and volumetry, phase-contrast CMR allows quantitative measurements of cardiac output, pulmonary blood flow, pulmonary-to-systemic flow ratio, the amount of intracardiac shunt, valve regurgitation, and aortopulmonary collateral flows. This review article describes the utilization of CMR-derived flow data in surgical decision-making in three distinct subgroups: (1) patients with borderline left ventricle (LV) with emphasis on the ascending aortic flow and other physiologic parameters, (2) single ventricle patients who undergo bidirectional cavopulmonary shunt with emphasis on the impact of superior vena cava blood flow on postoperative physiology, and (3) patients with pulmonary atresia and major aortopulmonary collateral arteries with emphasis on the impact of total pulmonary blood flow and systemic-to-pulmonary flow ratio on clinical outcomes.

      Keywords

      Abbreviations:

      ASD (Atrial Septal Defect), AV (Atrioventricular), BCPS (Bidirectional Cavopulmonary Shunt), CHD (Congenital Heart Disease), CMR (Contrast Magnetic Resonance), EFE (Endocardial Fibroelastosis), LV (Left Ventricle), LVEDVi (LV end-diastolic volume index), LVESVi (LV end-systolic volume index), MAPCA (Major aortopulmonary collateral arteries), PA (Pulmonary Atresia), PVR (Pulmonary Vascular Resistance), Qp:Qs (Pulmonary-to-systemic flow ratio), Qpa (Total pulmonary artery blood flow), Qpv (Total pulmonary vein blood flow), RVSP (Right Ventricular Systolic Pressure), SVC (Superior Vena Cava), TNPAI (Total neopulmonary artery index), VSD (Ventricular Septal Defect)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      REFERENCES

        • Nakanishi T.
        Cardiac catheterization is necessary before bidirectional Glenn and Fontan procedures in single ventricle physiology.
        Pediatr Cardiol. 2005; 26: 159-161https://doi.org/10.1007/s00246-004-0955-3
        • Yoo SJ
        • Lo Rito M
        • Seed M
        • Grosse-Wortmann L
        Magnetic resonance imaging as a decision-making tool in congenital heart disease surgery.
        Oper Tech Thorac Cardiovasc Surg. 2014; 19: 152-163https://doi.org/10.1053/j.optechstcvs.2014.06.002
        • Nayak KS
        • Nielsen JF
        • Bernstein MA
        • et al.
        Cardiovascular magnetic resonance phase contrast imaging.
        J Cardiovasc Magn Reson. 2015; 17https://doi.org/10.1186/s12968-015-0172-7
        • Chan FP
        MR and CT imaging of the pediatric patient with structural heart disease.
        Semin Thorac Cardiovasc Surg. 2008; 20: 393-399https://doi.org/10.1053/j.semtcvs.2008.11.006
        • Hickey EJ
        • Caldarone CA
        • Blackstone EH
        • et al.
        Biventricular strategies for neonatal critical aortic stenosis: high mortality associated with early reintervention.
        J Thorac Cardiovasc Surg. 2012; 144: 409-417.e1https://doi.org/10.1016/j.jtcvs.2011.09.076
        • Kaplinski M
        • Cohen MS.
        Characterising adequacy or inadequacy of the borderline left ventricle: what tools can we use?.
        Cardiol Young. 2015; 25: 1482-1488https://doi.org/10.1017/S1047951115002267
        • Rhodes LA
        • Colan SD
        • Perry SB
        • Jonas RA
        • Sanders SP
        Predictors of survival in neonates with critical aortic stenosis.
        Circulation. 1991; 84: 2325-2335https://doi.org/10.1161/01.cir.84.6.2325
        • Lofland GK
        • McCrindle BW
        • Williams WG
        • et al.
        Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors.
        J Thorac Cardiovasc Surg. 2001; 121: 10-27https://doi.org/10.1067/mtc.2001.111207
        • Grosse-Wortmann L
        • Yun TJ
        • Al-Radi O
        • et al.
        Borderline hypoplasia of the left ventricle in neonates: Insights for decision-making from functional assessment with magnetic resonance imaging.
        J Thorac Cardiovasc Surg. 2008; 136: 1429-1436https://doi.org/10.1016/j.jtcvs.2008.04.027
        • Banka P
        • Schaetzle B
        • Komarlu R
        • Emani S
        • Geva T
        • Powell AJ.
        Cardiovascular magnetic resonance parameters associated with early transplant-free survival in children with small left hearts following conversion from a univentricular to biventricular circulation.
        J Cardiovasc Magn Reson. 2014; 16https://doi.org/10.1186/s12968-014-0073-1
        • Emani SM.
        Staged left ventricular recruitment and biventricular conversion for patients with borderline left heart.
        Oper Tech Thorac Cardiovasc Surg. 2016; 21: 112-123https://doi.org/10.1053/j.optechstcvs.2017.02.003
        • Haller C
        • Honjo O
        • Caldarone CA
        • Van Arsdell GS.
        Growing the borderline hypoplastic left ventricle: hybrid approach.
        Oper Tech Thorac Cardiovasc Surg. 2016; 21https://doi.org/10.1053/j.optechstcvs.2017.03.001
        • Brown DW
        • Gauvreau K
        • Powell AJ
        • et al.
        Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis in infants with functional single ventricle: a prospective randomized trial.
        Circulation. 2007; 116: 2718-2725https://doi.org/10.1161/CIRCULATIONAHA.107.723213
        • Kotani Y
        • Honjo O
        • Shani K
        • Merklinger SL
        • Caldarone C
        • Van Arsdell G.
        Is indexed preoperative superior vena cava blood flow a risk factor in patients undergoing bidirectional cavopulmonary shunt?.
        Ann Thorac Surg. 2012; 94: 1578-1583https://doi.org/10.1016/j.athoracsur.2012.05.043
        • Luo S
        • Haranal M
        • Deng MX
        • et al.
        Low preoperative superior vena cava blood flow predicts bidirectional cavopulmonary shunt failure.
        J Thorac Cardiovasc Surg. 2020; 160: 1529-1540.e4https://doi.org/10.1016/j.jtcvs.2020.04.098
        • Lamberti JJ.
        Commentary: when is a bidirectional cavopulmonary shunt a bad idea?.
        J Thorac Cardiovasc Surg. 2020; 160: 1543-1544https://doi.org/10.1016/j.jtcvs.2020.04.144
        • Reddy VM
        • Petrossian E
        • McElhinney DB
        • et al.
        One-stage complete unifocalization in infants: when should the ventricular septal defect be closed?.
        J Thorac Cardiovasc Surg. 1997; 113: 858-868https://doi.org/10.1016/S0022-5223(97)70258-7
        • Honjo O
        • Al-Radi OO
        • MacDonald C
        • et al.
        The functional intraoperative pulmonary blood flow study is a more sensitive predictor than preoperative anatomy for right ventricular pressure and physiologic tolerance of ventricular septal defect closure after complete unifocalization in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals.
        Circulation. 2009; 120https://doi.org/10.1161/CIRCULATIONAHA.108.844084
        • Zhu J
        • Meza J
        • Kato A
        • et al.
        Pulmonary flow study predicts survival in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.
        J Thorac Cardiovasc Surg. 2016; 152: 1494-1503.e1https://doi.org/10.1016/j.jtcvs.2016.07.082
        • Grosse-Wortmann L
        • Yoo S-J
        • van Arsdell G
        • et al.
        Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries.
        J Thorac Cardiovasc Surg. 2013; 146: 1185-1190https://doi.org/10.1016/j.jtcvs.2013.01.032
      1. Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol, 31, 2021, 1160-1174, doi:10.1007/s00330-020-07210-z

        • Oudkerk MD
        • Kauw D
        • Bleijendaal H
        • et al.
        Artificial intelligence in patients with congenital heart disease: where do we stand?.
        EMJ Cardiol. 2020; 8: 70-81