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

  • Osami Honjo
    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
    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
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      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.



      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)
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