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Comparison of 2D and 4D Flow MRI Measurements for Hemodynamic Evaluation of the Fontan Palliation

Congenital Heart Disease 2023年第6期18卷 627-638页

作者： Elisa Listo Nicola Martini Stefano Salvadori Elisa Valenti Nicola Stagnaro Gianluca Trocchio Chiara Marrone Alberto Clemente Francesca Raimondi Pierluigi Festa Lamia Ait Ali Department of Radiology IRCCS Istituto Giannina GasliniGenovaItaly U.O.C.Bioingegneria Gabriele Monasterio CNR-Tuscany FoundationPisaItaly Institute of Clinical Physiology CNR PisaItaly cardiology unit IRCCS Istituto Giannina GasliniGenovaItaly pediatric cardiology and guch unit massa Gabriele Monasterio CNR-Tuscany FoundationMassaItaly Gabriele Monasterio CNR-Tuscany Foundation PisaItaly Department of cardiology Azienda Ospedaliero-Universitaria MeyerFlorenceItaly Institute of Clinical Physiology CNR MassaItaly

Background:The assessment of Fontan circuit’sﬂow is traditionally evaluated by multiple through-plane phase-contrast MRI acquisitions(2Dﬂow),while recently,a single volumetric 4D-ﬂow MRI acquisition is emerging as a comprehensive tool for the hemodynamic evaluation in congenital heart ***:To compare 2D and 4D-ﬂow MRI measurements in patients after Fontan palliation and to evaluate parameters affecting potential ***:39 patients after Fontan palliation(23 males,age 22±11 years)who underwent cardiac MRI with 2D and 4D-ﬂow MRI acquisition were included in the *** all patients,bloodﬂow quantiﬁcation in the Fontan circuit and aorta by 2Dﬂow and by 4Dﬂow MRI acquisition blinding to the 2D results was *** agreement between 2D and 4D-ﬂow MRI was calculated as the intraclass correlation coefﬁcient(ICC).The mean absolute differences between 4D and 2Dﬂows were analyzed using linear regression ***:4D-ﬂow MRI acquisition time was slightly lower than 2D(7.6±1.8 min vs.9.4±3.3 min,p=0.03).Flow was slightly predominant in the right pulmonary artery(58%of total pulmonaryﬂow).Conduit/tunnel-pul-monary arteriesﬂow accounted for 60%of the Fontan *** between 2D and 4D was overall good-to-excellent from ICC:0.81795%CI:0.637–0.907 to 0.93295%CI:0.866–*** was no signiﬁcant inﬂu-ence of evaluated parameters on the agreement on 4D and 2Dﬂ***:4D-ﬂow MRI represents a valid tool in Fontan’sﬂow quantiﬁ*** larger studies are needed to conﬁrm our results and to evaluate the impact of advanced 4D-ﬂow MRI parameters on the prognostic stratiﬁcation in patients after Fontan palliation.

关键词： Fontan palliation fontanﬂows 4Dﬂow MRI 2Dﬂow MRI cardiac magnetic resonance

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先天性心脏病成年患者患感染性心内膜炎的临床病程和并发症

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世界核心医学期刊文摘（心脏病学分册） 2005年第10期1卷 53-54页

作者： Knirsch W. Haas N. A. Uhlemann F. 刘少伟 Univ. Children' s Hospital Zurich Department of Pediatric Cardiology Steinweisster. 75 CH 8032 Zurich Switzerland

Although a high mumber of patients with congenital heart disease(CHD) undergo surgical palliation or definite correction up to adolescence, adult congenital heart disease(ACHD) may remain a potential lifelong risk factor for infective endocarditis(IE) in patients growing up with congenital heart disease(guch). Methods: In a retrospective case study of a tertiary care center long-term clinical course and complications of patients with IE and guch were analysed. Results: Data of 52 patients with CHD, who fulfilled the Saiman criteria for infective endocarditis and were treated between April 1986 and March 2001, were identified: Risk factors for infective endocarditis were previous cardiovascular operation(51.9% ), use of foreign material(38.5% ), dental or other surgical procedures without recommended antibiotic prophylaxis(25.0% ), or cardiac catheterization(5.8% ). Staphylococcal(38.9% ) or streptococcal species(35.2% ) were cultivated in most cases as causative microorganisms. Complications were: recurrence of IE(7.7% ), septic embolisms(30.8% ) leading to central nervous complications(7.7% ), embolism of pulmonary arteries(7.7% ), renal arteries(1.9% ), arteries of the extremities(9.6% ), or infarction of spleen(1.9% ). Other cardiac(23.1% ) or extracardiac(13.5% ) complications were frequent. The need of re-operations during or after IE was high(67.3% ). The hospital mortality was 1.9% , late mortality was 7.7% . Conclusions: Patients with IE and CHD show a broad clinical spectrum of cardiac and extracardiac complications. They may lead to a complicative short-and long-term course with the potential risk of death and a high number of re-operation. Efforts have to be made to improve long-term outcome of patients with ACHD by an interdisciplinary cooperation.

关键词：感染性心内膜炎先天性心脏病临床病程心血管手术中枢神经系统三级医疗住院死亡率心导管诊断标准再手术率

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