J Cardiovasc Ultrasound.  2015 Dec;23(4):228-232. 10.4250/jcu.2015.23.4.228.

Echocardiographic Assessment of Pulmonary Arteries Pulsatility Index in Fontan Circulation

• Shabanian
• Mirzaaghayan MR
• Dadkhah M
• Hosseini M
• Rahimzadeh M
• Akbari Asbagh P
• Navabi MA

• KMID: 2144453
• DOI: http://doi.org/10.4250/jcu.2015.23.4.228

Abstract

BACKGROUND
Late complications after Fontan procedure may be due to the absence of pump and pulsatile pulmonary blood flow in this type of palliation. Our aim was to quantify the degree of pulsation by echocardiographic method in patients with extracardiac total cavopulmonary connection (ECTCPC) in comparison with biventricular circulation and few cases of pulsatile Fontan.
METHODS
In a case series study, pulsatility index (PI) derived by echocardiographic method were compared between 20 patients with ECTCPC, 6 patients with pulsatile Fontan and 18 normal individual aged 4 to 20 years old. All patients were in New York Heart Association class of I and there was no report of complication.
RESULTS
In patients with ECTCPC pulmonary artery branches Doppler flow study showed lower peak and mean velocities compared to the pulsatile Fontan and normal groups. ECTCPC patients had PI of 0.59 +/- 0.14 and 0.59 +/- 0.09 for right and left pulmonary arteries (RPA and LPA) respectively. PI was higher in patients with preserved antegrade flow (RPA PI = 0.94 +/- 0.26, LPA PI = 0.98 +/- 0.27) and in normal individuals (RPA PI = 1.59 +/- 0.12, LPA PI = 1.64 +/- 0.17) for both branches (p = 0.000).
CONCLUSION
Using a Doppler derived index for pulsatility, patients with ECTCPC had the least pulsation. The pulmonary artery flow pattern in patients with preserved antegrade flow showed higher pulsatility indices in both branches. Normal individuals had the greatest pulsatility index.

Keyword

Pulsatility index; Doppler flow velocity; Cavopulmonary connection

MeSH Terms

Echocardiography*
Fontan Procedure
Heart
Humans
Pulmonary Artery*

Figure

• 

  Fig. 1 Schematic illustration for the position of sample volume and angling the transducer for getting the optimal flow profiles in the RPA and LPA. The arrow shows the pulsatile flow in cases of pulsatile Fontan group. RPA: right pulmonary arteries, LPA: left pulmonary arteries.

• 

  Fig. 2 Doppler flow pattern of pulmonary artery in a patient with extracardiac total cavopulmonary connection Fontan (A), pulsatile Fontan (B), and a healthy child (C). Compared to the nonpulsatile Fontan, patients with maintained antegrade flow showed higher velocity and pulsatility index (PI) with augmented forward systolic pulmonary flow. The arrows show the maximum (Max) and minimum (Min) velocities. PI was calculated according to the formula: PI = (Max velocity - Min velocity) / mean velocity. The measured PIs were 0.5, 1.02, and 1.78, respectively.

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