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Does superior caval vein pressure impact head growth in Fontan circulation?

Published online by Cambridge University Press:  15 January 2016

Tina Trachsel ,
Christian Balmer ,
Håkan Wåhlander ,
Roland Weber ,
Hitendu Dave ,
Andrea Poretti ,
Oliver Kretschmar  and
Anna Cavigelli-Brunner
Tina Trachsel
Affiliation:
Division of Pediatric Cardiology, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
Christian Balmer
Affiliation:
Division of Pediatric Cardiology, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
Håkan Wåhlander
Affiliation:
Division of Pediatric Cardiology, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
Roland Weber
Affiliation:
Division of Pediatric Cardiology, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
Hitendu Dave
Affiliation:
Division of Congenital Cardiovascular Surgery, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
Andrea Poretti
Affiliation:
Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, United States of America
Oliver Kretschmar
Affiliation:
Division of Pediatric Cardiology, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
Anna Cavigelli-Brunner*
Affiliation:
Division of Pediatric Cardiology, University Children’s Hospital Zurich, Switzerland Children’s Research Centre, University Children’s Hospital Zurich, Switzerland
*
Correspondence to: Dr A. Cavigelli-Brunner, MD, University Children’s Hospital, Division of Pediatric Cardiology, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. Tel+41 44 2667111; Fax +41 44 2667981; E-mail: anna.cavigelli@kispi.uzh.ch
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Abstract

Background

Patients with bidirectional cavopulmonary anastomosis have unphysiologically high superior caval vein pressure as it equals pulmonary artery pressure. Elevated superior caval vein pressure may cause communicating hydrocephalus and macrocephaly. This study analysed whether there exists an association between head circumference and superior caval vein pressure in patients with single ventricle physiology.

Methods

We carried out a retrospective analysis of infants undergoing Fontan completion at our institution from 2007 to 2013. Superior caval vein pressures were measured during routine catheterisation before bidirectional cavopulmonary anastomosis and Fontan completion as well as head circumference, adjusted to longitudinal age-dependent percentiles.

Results

We included 74 infants in our study. Median ages at bidirectional cavopulmonary anastomosis and Fontan were 4.8 (1.6–12) and 27.9 (7–40.6) months, respectively. Head circumference showed significant growth from bidirectional cavopulmonary anastomosis until Fontan completion (7th (0–100th) versus 20th (0–100th) percentile). There was no correlation between superior caval vein pressure and head circumference before Fontan (R2=0.001). Children with lower differences in superior caval vein pressures between pre-bidirectional cavopulmonary anastomosis and pre-Fontan catheterisations showed increased growth of head circumference (R2=0.19).

Conclusions

Patients with moderately elevated superior caval vein pressure associated with single ventricle physiology did not have a tendency to develop macrocephaly. There is no correlation between superior caval vein pressure before Fontan and head circumference, but between bidirectional cavopulmonary anastomosis and Fontan head circumference increases significantly. This may be explained by catch-up growth of head circumference in patients with more favourable haemodynamics and concomitant venous pressures in the lower range. Further studies with focus on high superior caval vein pressures are needed to exclude or prove a correlation.

Keywords

Single ventricleFontansuperior caval vein pressurehead circumference percentile
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1327 - 1332
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Copyright
© Cambridge University Press 2016 

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