HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kirk Kanter Mark A. Fogel Ajit P. Yoganathan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dasi, L. P. Articles by Yoganathan, A. P. Search for Related Content PubMed Articles by Dasi, L. P. Articles by Yoganathan, A. P. Related Collections Cardiac - physiology Congenital - cyanotic Great vessels

J Thorac Cardiovasc Surg 2010;139:557-561
© 2010 The American Association for Thoracic Surgery

Congenital Heart Disease

Larger aortic reconstruction corresponds to diminished left pulmonary artery size in patients with single-ventricle physiology

^a Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
^b Emory University, Atlanta, Ga
^c Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa

Received for publication February 21, 2009; revisions received June 24, 2009; accepted for publication August 10, 2009.

^_* Address for reprints: Ajit P. Yoganathan, PhD, Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology and Emory University, Room 2119 U. A. Whitaker Building, 313 Ferst Dr, Atlanta, GA 30332-0535. (Email: ajit.yoganathan{at}bme.gatech.edu).

Background: Pulmonary artery size is a crucial determinant of hemodynamic energy loss in total cavopulmonary connections. We investigated the effect of aortic arch reconstruction on left pulmonary artery size based on their anatomic proximity.

Methods: Thirty-two patients undergoing the Fontan operation, 16 with hypoplastic left heart syndrome and 16 with non–hypoplastic left heart syndrome, were selected from the multicenter Fontan magnetic resonance imaging database at the Georgia Institute of Technology. The 16 datasets were consecutive with full anatomic reconstructions of the total cavopulmonary connection and aortic arch with no artifacts. The size of the aorta along the transverse arch and left pulmonary artery size in the region below the aortic arch was quantified by using a previously validated skeletonization technique.

Results: The transverse aortic and left pulmonary artery measurements (median, maximum, and minimum, respectively) for non–hypoplastic left heart syndrome were 2.2, 3.1, and 1.5 cm/m and 1.2, 1.6, and 0.2 cm/m, respectively, compared with 2.5, 4.1, and 2.0 cm/m and 0.9, 1.5, and 0.4 cm/m for patients with hypoplastic left heart syndrome. Thus the transverse aortic diameter of patients with hypoplastic left heart syndrome was, on average, 24% greater than that for patients with non–hypoplastic left heart syndrome (P < .05), whereas the left pulmonary artery diameter of patients with hypoplastic left heart syndrome was smaller than that of patients with non–hypoplastic left heart syndrome (P < .05). Regression analysis showed a significant negative correlation (P < .05) between aortic and left pulmonary artery diameters in both the hypoplastic left heart syndrome and non–hypoplastic left heart syndrome groups. However, when the study population was regrouped into reconstructed aorta and nonreconstructed aorta groups, the negative correlation was only significant for patients with reconstructed aortas, regardless of ventricular pathology (P < .02).

Conclusions: Stage 1 aortic reconstruction procedures that result in a large aorta limit left pulmonary artery size in patients undergoing the Fontan operation.

This article has been cited by other articles:

				J. Kolcz, T. Skladzien, Z. Kordon, A. Rudzinski, and J. Skalski Impact of right ventricle-pulmonary artery conduit placement on the pulmonary arteries development after the Norwood procedure in hypoplastic left heart syndrome Eur J Cardiothorac Surg, January 18, 2012; (2012) ezr293v1. [Abstract] [Full Text] [PDF]