Background-Cardiac catheterization is routinely used as a diagnostic tool in single ventricle patients with superior cavopulmonary connection. This physiology presents inherent challenges in applying the Fick principle to estimate flow. We sought to quantitatively define the error in oximetry-derived flow parameters using phase-contrast cardiac MRI (CMR) as a reference. Methods and Results-Thirty patients with superior cavopulmonary connection who underwent combined CMR and catheterization between July 2008 and June 2012 were retrospectively analyzed. Estimates of flow and resistance calculated using the Fick equation were compared with CMR measurements. Oximetry underestimated CMR-measured pulmonary blood flow (Qp) by an average of 1.1 L/min per m2 or 32% of the CMR value (P<0.0001). Oximetry overestimated systemic blood flow (Qs) by an average of 0.5 L/min per m2 or 15% of the CMR value (P=0.009). There was no correlation between the Q p:Qs ratio derived by Fick and that measured by CMR (ρc=0.01). The error in the Fick Qp correlated moderately with the measured systemic-to-pulmonary arterial collateral flow (r=0.39). The median total oxygen consumption calculated using combined CMR and oximetry data was 173 mL/min per m2, higher than the assumed values used to calculate flows by the Fick equation. The upper body circulation received on average 51% of systemic blood flow while conducting only 39% of total body metabolism. Conclusions-Fick-derived estimates of flow are inherently unreliable in patients with superior cavopulmonary connections. Integrating flows measured by CMR and pressures measured by catheter will provide the best characterization of superior cavopulmonary connection physiology.
|Number of pages||7|
|Journal||Circulation: Cardiovascular Imaging|
|State||Published - Nov 2013|
- Bidirectional cavopulmonary shunt
- Collateral circulation
- Congenital heart defects
- Magnetic resonance imaging