Regular circulation TO LUNGS
Fontan circulation
“ Form improves function : the importance of a well-constructed neoaortic arch ” and “ The perfect arch : A pipe dream that may be achievable !”
“ To achieve the ideal Norwood arch reconstruction , we will need to tailor the arch to patient-specific anatomic variations and dimensions ,” mused one ( 4 ). “ Use of 4-dimensional flow MRI , … may help determine preoperatively the size and shape of an ideal aortic arch reconstruction for a specific patient subtype .”
“ Ultimately , the importance of any new medical technology is measured by its influence on clinical care ,” enthused another ( 5 ). Given the persistent clinical vulnerability of patients with singleventricle congenital heart disease , 4D-MRI has the potential for significant influence on their outcomes .”
Four have been published altogether — so far .
“ That kind of response ,” Dr . Schäfer says , “ it ’ s kind of unheard of .” •
1 . Schäfer M , Frank BS , Humphries SM , Hunter KS , Carmody KL , Jacobsen R , Mitchell MB , Jaggers J , Stone ML , Morgan GJ , Barker AJ , Browne LP , Ivy DD , Younoszai A , Di Maria MV . Flow profile characteristics in Fontan circulation are associated with the single ventricle dilation and function : principal component analysis study . Am J Physiol Heart Circ Physiol . 2020 May 1 ; 318 ( 5 ): H1032-H1040 .
2 . Schäfer M , Frank BS , Jacobsen R , Rausch CM , Mitchell MB , Jaggers J , Stone
ML , Morgan GJ , Browne LP , Barker AJ , Hunter KS , Ivy DD , Younoszai A , Di Maria MV . Patients with Fontan circulation have abnormal aortic wave propagation patterns : A wave intensity analysis study . Int J Cardiol . 2021 Jan 1 ; 322:158-167 .
3 . Schäfer M , Di Maria MV , Jaggers J , Mitchell MB . Suboptimal neoaortic arch geometry correlates with inefficient flow patterns in hypoplastic left heart syndrome . J Thorac Cardiovasc Surg . 2019 Sep ; 158 ( 3 ): e113-e116 .
4 . Kavarana MN . Commentary : Will the fourth dimension guide us toward the ‘ perfect ’ Norwood arch reconstruction ? J Thorac Cardiovasc Surg . 2019 Mar ; 158 ( 3 ): e119-120 .
MICHAEL DI MARIA , MD
Director , Single Ventricle Program Director , Echocardiography Lab , Children ’ s Hospital Colorado
Associate professor , Pediatrics-Cardiology , University of Colorado School of Medicine
MICHAL SCHÄFER , PHD
Affiliate researcher , Cardiology , Children ’ s Hospital Colorado Medical student , University of Colorado School of Medicine
5 . Hornik CP . Commentary : Advanced assessments of flow velocity to optimize surgical repair and clinical outcomes in single-ventricle congenital heart disease . J Thorac Cardiovasc Surg . 2021 Mar ; online .
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