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J Thorac Cardiovasc Surg 1997;114:1032-1041
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

THE NATURE OF FLOW IN THE SYSTEMIC VENOUS PATHWAY MEASURED BY MAGNETIC RESONANCE BLOOD TAGGING IN PATIENTS HAVING THE FONTAN OPERATION

Received for publication ov. 21, 1996 Revisions requested Jan. 6, 1997 Revisions received June 12, 1997 Accepted for publication June 12, 1997 Address for reprints: Mark A. Fogel, MD, Wyeth-Ayerst Research, Cardiovascular Division, C-2, 145 King of Prussia Rd., Radnor, PA 19087.

Abstract

Objectives: Our objectives were twofold: (1) to determine cardiac and respiratory dependency of systemic venous pathway flow of patients having the Fontan operation with a total cavopulmonary connection and (2) to describe the velocity profile. Systemic venous pathway flow is hypothesized to be mostly respiratory dependent, to be laminar, and to have a smooth velocity profile. Methods: Twenty-two patients having the Fontan operation (aged 8.6 ± 4.7 years) underwent magnetic resonance blood tagging (bolus tagging). Systemic venous pathway spin-echo images parallel to the blood flow were used as a localizer. A saturation pulse labeled the blood, and a cine image was acquired at the inferior and superior venae cavae and midportion of the baffle in the systemic venous pathway, triggered to the electrocardiogram and gated to both end-expiration and end-inspiration. Repetition time was 50 msec. Results: Flow in the systemic venous pathway was laminar throughout its course and was found to be phasic to both cardiac and respiratory cycles. Approximately 70% of flow was cardiac dependent, and the rest was respiratory. Highest flow occurred near end-systole and early diastole and in inspiration. Lowest flow occurred in diastasis. Velocity was highest and flow least "pluglike" in the mid-baffle area during cardiac or respiratory imaging (45 ± 17 and 32 ± 11 cm/sec, respectively). Conclusion: A substantial amount of pulmonary blood flow in patients who have undergone a total cavopulmonary connection type of Fontan operation has a cardiac component. Furthermore, we confirm that this flow is laminar but nonuniform across the systemic venous pathway. Highest flows occurred near end-systole and early diastole, as well as in inspiration, and the lowest flow occurred in diastasis. This information may help in designing the systemic venous pathway and optimizing medical management.

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