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Pulmonary artery wall thickness in children with Fontan physiology: an optical coherence tomography case control study

  • Eimear McGovern (a1), Christine Voss (a1), Nathan W. Brunner (a2), Stephanie Duncombe (a1), Kevin C. Harris (a1) and Martin H. Hosking (a1)...

Abstract

Introduction:

Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation.

Materials and Methods:

Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry.

Results:

There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10–0.14) and for controls was 0.11 mm (IQR, 0.10–0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12–0.16) and for controls was 0.13 (IQR, 0.11–0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients.

Discussion:

OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.

Copyright

Corresponding author

Author for correspondence: Eimear McGovern, MB, BCh, BAO, Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, British Columbia Children’s Hospital, 1F3 - 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. Tel: +1 604 875 2345; Fax number +1 604 875 3463; E-mail: emcgovern1987@gmail.com

References

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