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The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection

Congenital heart disease is the most common birth defect and functionally univentricular heart defects represent the most severe end of this spectrum. The Fontan circulation provides an unique solution for single ventricle patients, by connecting both caval veins directly to the pulmonary arteries....

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Autores principales: van der Woude, Séline F. S., Rijnberg, Friso M., Hazekamp, Mark G., Jongbloed, Monique R. M., Kenjeres, Sasa, Lamb, Hildo J., Westenberg, Jos J. M., Roest, Arno A. W., Wentzel, Jolanda J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374887/
https://www.ncbi.nlm.nih.gov/pubmed/34422920
http://dx.doi.org/10.3389/fcvm.2021.683849
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author van der Woude, Séline F. S.
Rijnberg, Friso M.
Hazekamp, Mark G.
Jongbloed, Monique R. M.
Kenjeres, Sasa
Lamb, Hildo J.
Westenberg, Jos J. M.
Roest, Arno A. W.
Wentzel, Jolanda J.
author_facet van der Woude, Séline F. S.
Rijnberg, Friso M.
Hazekamp, Mark G.
Jongbloed, Monique R. M.
Kenjeres, Sasa
Lamb, Hildo J.
Westenberg, Jos J. M.
Roest, Arno A. W.
Wentzel, Jolanda J.
author_sort van der Woude, Séline F. S.
collection PubMed
description Congenital heart disease is the most common birth defect and functionally univentricular heart defects represent the most severe end of this spectrum. The Fontan circulation provides an unique solution for single ventricle patients, by connecting both caval veins directly to the pulmonary arteries. As a result, the pulmonary circulation in Fontan palliated patients is characterized by a passive, low-energy circulation that depends on increased systemic venous pressure to drive blood toward the lungs. The absence of a subpulmonary ventricle led to the widely believed concept that respiration, by sucking blood to the pulmonary circulation during inspiration, is of great importance as a driving force for antegrade blood flow in Fontan patients. However, recent studies show that respiration influences pulsatility, but has a limited effect on net forward flow in the Fontan circulation. Importantly, since MRI examination is recommended every 2 years in Fontan patients, clinicians should be aware that most conventional MRI flow sequences do not capture the pulsatility of the blood flow as a result of the respiration. In this review, the unique flow dynamics influenced by the cardiac and respiratory cycle at multiple locations within the Fontan circulation is discussed. The impact of (not) incorporating respiration in different MRI flow sequences on the interpretation of clinical flow parameters will be covered. Finally, the influence of incorporating respiration in advanced computational fluid dynamic modeling will be outlined.
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spelling pubmed-83748872021-08-20 The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection van der Woude, Séline F. S. Rijnberg, Friso M. Hazekamp, Mark G. Jongbloed, Monique R. M. Kenjeres, Sasa Lamb, Hildo J. Westenberg, Jos J. M. Roest, Arno A. W. Wentzel, Jolanda J. Front Cardiovasc Med Cardiovascular Medicine Congenital heart disease is the most common birth defect and functionally univentricular heart defects represent the most severe end of this spectrum. The Fontan circulation provides an unique solution for single ventricle patients, by connecting both caval veins directly to the pulmonary arteries. As a result, the pulmonary circulation in Fontan palliated patients is characterized by a passive, low-energy circulation that depends on increased systemic venous pressure to drive blood toward the lungs. The absence of a subpulmonary ventricle led to the widely believed concept that respiration, by sucking blood to the pulmonary circulation during inspiration, is of great importance as a driving force for antegrade blood flow in Fontan patients. However, recent studies show that respiration influences pulsatility, but has a limited effect on net forward flow in the Fontan circulation. Importantly, since MRI examination is recommended every 2 years in Fontan patients, clinicians should be aware that most conventional MRI flow sequences do not capture the pulsatility of the blood flow as a result of the respiration. In this review, the unique flow dynamics influenced by the cardiac and respiratory cycle at multiple locations within the Fontan circulation is discussed. The impact of (not) incorporating respiration in different MRI flow sequences on the interpretation of clinical flow parameters will be covered. Finally, the influence of incorporating respiration in advanced computational fluid dynamic modeling will be outlined. Frontiers Media S.A. 2021-08-05 /pmc/articles/PMC8374887/ /pubmed/34422920 http://dx.doi.org/10.3389/fcvm.2021.683849 Text en Copyright © 2021 van der Woude, Rijnberg, Hazekamp, Jongbloed, Kenjeres, Lamb, Westenberg, Roest and Wentzel. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
van der Woude, Séline F. S.
Rijnberg, Friso M.
Hazekamp, Mark G.
Jongbloed, Monique R. M.
Kenjeres, Sasa
Lamb, Hildo J.
Westenberg, Jos J. M.
Roest, Arno A. W.
Wentzel, Jolanda J.
The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection
title The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection
title_full The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection
title_fullStr The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection
title_full_unstemmed The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection
title_short The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection
title_sort influence of respiration on blood flow in the fontan circulation: insights for imaging-based clinical evaluation of the total cavopulmonary connection
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374887/
https://www.ncbi.nlm.nih.gov/pubmed/34422920
http://dx.doi.org/10.3389/fcvm.2021.683849
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