Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T16:36:02.803Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary artery wall thickness in children with Fontan physiology: an optical coherence tomography case control study

Published online by Cambridge University Press:  08 April 2019

Eimear McGovern ,
Christine Voss ,
Nathan W. Brunner ,
Stephanie Duncombe ,
Kevin C. Harris  and
Martin H. Hosking
Eimear McGovern*
Affiliation:
Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
Christine Voss
Affiliation:
Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
Nathan W. Brunner
Affiliation:
Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
Stephanie Duncombe
Affiliation:
Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
Kevin C. Harris
Affiliation:
Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
Martin H. Hosking
Affiliation:
Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
*
Author for correspondence: Eimear McGovern, MB, BCh, BAO, Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, British Columbia Children’s Hospital, 1F3 - 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. Tel: +1 604 875 2345; Fax number +1 604 875 3463; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation.

Materials and Methods:

Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry.

Results:

There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10–0.14) and for controls was 0.11 mm (IQR, 0.10–0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12–0.16) and for controls was 0.13 (IQR, 0.11–0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients.

Discussion:

OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.

Keywords

optical coherence tomographypaediatric cardiologyFontanpulmonary artery
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 524 - 527
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

d’Udekem, Y, Iyengar, AJ, Galati, JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 2014; 130: S32–8.CrossRefGoogle ScholarPubMed
Gewillig, M, Goldberg, DJ Failure of the Fontan circulation. Heart Fail Clin 2014; 10: 105–16.CrossRefGoogle ScholarPubMed
Khambadkone, S, Li, J, de Leval, MR, Cullen, S, Deanfield, JE, Redington, AN. Basal pulmonary vascular resistance and nitric oxide responsiveness late after Fontan-type operation. Circulation 2003; 107: 3204–8.CrossRefGoogle Scholar
Zongtao, Y, Huishan, W, Zengwei, W, et al. Experimental study of nonpulsatile flow perfusion and structural remodeling of pulmonary microcirculation vessels. Thorac Cardiovasc Surg 2010; 58; 468–72.CrossRefGoogle Scholar
Gewillig, MH, Lundstrom, UR, Deanfield, JE, et al. Impact of Fontan operation on left ventricular size and contractility in tricuspid atresia. Circulation 1990; 81: 118–27.CrossRefGoogle ScholarPubMed
Harris, KC, Manouzi, A, Fung, AY, et al. Feasibility of optical coherence tomography in children with Kawasaki disease and pediatric heart transplant recipients. Circ Cardiovasc Imaging 2014; 7: 671–8.CrossRefGoogle ScholarPubMed
Ulrich, SM, Lehner, A, Birnbaum, A, et al. Safety of optical coherence tomography in pediatric heart transplant patients. Int J Cardiol 2017; 228: 205–208.CrossRefGoogle ScholarPubMed
Karanasos, A, Ligthart, A, Witberg, J, van Soest, G, Bruining, N, Regar, E. Optical coherence tomography: potential clinical applications. Curr Cardiovasc Imaging Rep 2012; 5: 206–220.CrossRefGoogle ScholarPubMed
Tearney, GJ, Regar, E, Akasaka, T, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 2012; 59: 1058–1072.CrossRefGoogle Scholar
Jorge, E, Baptista, R, Calisto, J, et al. Pulmonary vascular remodeling in mitral valve disease: An optical coherence tomography study. Int J Cardiol 2016; 203: 576–578.CrossRefGoogle Scholar
Li, N, Zhang, S, Hou, J, Jang, IKK, Yu, B. Assessment of pulmonary artery morphology by optical coherence tomography. Heart Lung Circ 2012; 21: 778–781.CrossRefGoogle ScholarPubMed
Hayabuchi, Y, Sakata, M, Kagami, S. Optical coherence tomography can visualize the pulmonary artery in Williams-Beuren syndrome. Eur Heart J Cardiovasc Imaging 2015; 16: 967.Google ScholarPubMed
Homma, Y, Hayabuchi, Y, Ono, A, Kagami, S. Pulmonary artery wall thickness assessed by optical coherence tomography correlates with pulmonary hemodynamics in children with congenital heart disease. Circ J 2018; 82: 2350–2357.CrossRefGoogle ScholarPubMed
Kurotobi, S, Sano, T, Kogaki, S, et al. Bidirectional cavopulmonary shunt with right ventricular outflow patency: the impact of pulsatility on pulmonary endothelial function. J Thorac Cardiovasc Surg 2001; 121: 1161–1168.CrossRefGoogle ScholarPubMed
Lévy, M, Danel, C, Tamisier, D, Vouhé, P, Leca, F. Histomorphometric analysis of pulmonary vessels in single ventricle for better selection of patients for the Fontan operation. J Thorac Cardiovasc Surg 2002; 123: 263–270.CrossRefGoogle ScholarPubMed
Adachi, I, Ueno, T, Hori, Y, Sawa, Y. Alterations in the medial layer of the main pulmonary artery in a patient with longstanding Fontan circulation. Interact Cardiovasc Thorac Surg 2010; 11: 682–683.CrossRefGoogle Scholar
Maeda, K, Yanaki, S, Kado, H, Asou, T, Murakami, A, Takamoto, S. Reevaluation of histomorphometric analysis of lung tissue in decision making for better patient selection for Fontan-type operations. Ann Thorac Surg 2004; 78: 1371–1381.CrossRefGoogle ScholarPubMed
Ridderbos, FJ, Wolf, D, Timmer, A, et al. Adverse pulmonary vascular remodeling in the Fontan circulation. J Heart Lung Transplant 2015; 34: 404–413.CrossRefGoogle ScholarPubMed
Ishida, H, Kogaki, S, Ichimori, H, et al. Overexpression of endothelin-1 and endothelin receptors in the pulmonary arteries of failed Fontan patients. Int J Cardiol 2012; 159: 34–39.CrossRefGoogle ScholarPubMed
Jorge, E, Baptista, R, Calisto, J, et al. Optical coherence tomography of the pulmonary arteries: a systematic review. J Cardiol 2016; 67: 6–14.CrossRefGoogle ScholarPubMed
Dai, Z, Fukumoto, Y, Tatebe, S, et al. OCT imaging for the management of pulmonary hypertension. JACC Cardiovasc Imaging 2014; 7: 843–845.CrossRefGoogle ScholarPubMed
Domingo, E, Grignola, JC, Aguilar, R, et al. In vivo assessment of pulmonary arterial wall fibrosis by intravascular optical coherence tomography in pulmonary arterial hypertension: a new prognostic marker of adverse clinical follow-up. Open Respir Med J 2013; 7: 26–32.CrossRefGoogle ScholarPubMed
Brunner, NW, Zamanian, RT, Ikeno, F, et al. Optical coherence tomography of pulmonary arterial walls in humans and pigs (Sus scrofa domesticus). Comp Med 2015; 65: 217–224.Google Scholar