Systemic-to-Pulmonary Collateral Flow Correlates with Clinical Condition Late After the Fontan Procedure
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ORIGINAL ARTICLE
Systemic‑to‑Pulmonary Collateral Flow Correlates with Clinical Condition Late After the Fontan Procedure Yoshihiko Kodama1,3 · Yuichi Ishikawa1 · Ayako Kuraoka1 · Makoto Nakamura1 · Shinichiro Oda2 · Toshihide Nakano2 · Hideaki Kado2 · Ichiro Sakamoto3 · Kisho Ohtani3 · Tomomi Ide3 · Hiroyuki Tsutsui3 · Koichi Sagawa1 Received: 27 April 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract In the Fontan circulation, there is a substantial degree of systemic-to-pulmonary collateral flow (SPCF), which can be measured by cardiac magnetic resonance (CMR). However, the correlation between the degree of SPCF and long-term outcomes is not fully understood. We retrospectively studied 321 patients who underwent the Fontan procedure and CMR at a single center. Using CMR, we calculated SPCF as pulmonary blood flow − systemic blood flow. %SPCF was defined as SPCF ÷ pulmonary blood flow. The mean age of patients at CMR was 14.3 ± 7.5 years. The average %SPCF was 13.0% ± 11.0%. With a multivariate analysis, %SPCF was significantly correlated with time (i.e., the longer the time period since the Fontan procedure, the lower the %SPCF) (p = 0.006), previous total anomalous pulmonary vein drainage (p = 0.007), a low pulmonary artery index (Nakata index) before the Fontan procedure (p = 0.04), and older age at the time of the Fontan procedure (p = 0.002). Regarding the findings after the Fontan procedure, %SPCF was significantly correlated with ventricular enddiastolic volume (p
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