Author + information
- Received November 28, 2010
- Revision received January 12, 2011
- Accepted January 19, 2011
- Published online May 1, 2011.
- Matthew A. Harris, MD⁎,†,⁎ (, )
- Kevin K. Whitehead, MD, PhD⁎,†,
- Matthew J. Gillespie, MD⁎,†,
- Timothy Y. Liu, BS†,
- Michael T. Cosulich, BS†,
- David C. Shin, BA†,
- Elizabeth Goldmuntz, MD⁎,†,
- Paul M. Weinberg, MD⁎,† and
- Mark A. Fogel, MD⁎,†
- ↵⁎Reprint requests and correspondence:
Dr. Matthew A. Harris, Department of Pediatrics and Radiology, Divisions of Pediatric Cardiology and Cardiac MRI, Children's Hospital of Philadelphia of the University of Pennsylvania School of Medicine, Office 8NW-48, 34th and Civic Center Boulevard, Philadelphia, Pennsylvania 19104
Objectives We sought to investigate whether differential branch pulmonary artery (BPA) regurgitation correlates with differences in BPA anatomy and physiology.
Background Patients with repaired conotruncal anomalies such as Tetralogy of Fallot frequently have residual BPA stenosis or BPA size differences. Previous reports have demonstrated an increased left pulmonary artery (LPA) regurgitant fraction (RF) in these patients.
Methods We retrospectively reviewed 76 consecutive cardiac magnetic resonance (CMR) studies for BPA size and phase-contrast magnetic resonance data, including 13 consecutive patients who underwent both CMR and catheterization.
Results Thirty of the 76 patients had either BPA stenosis or significant size discrepancy. Whereas previous studies had shown an increased RF in the LPA, patients with BPA stenosis or size discrepancy showed no significant difference between right and left BPA RF (30% vs. 30%, p = 0.985). However, there was a significantly increased RF of the larger versus smaller BPA (39% vs. 21%, p < 0.001), resulting in an insignificant deviation from normal fractional flow distribution (RPA 63% vs. LPA 37%; normal net fractional flow distribution RPA 55% vs. LPA 45%). Retrospective review of patients who underwent both CMR and catheterization provides support for the preceding findings and validates differential BPA RF as strongly correlating with differential pulmonary vascular resistance (PVR) (r = 0.8364, p < 0.001).
Conclusions BPA RF is a function of the relative PVR and the presence of BPA stenosis or size discrepancy. Contrary to prior reports, the LPA RF is only elevated in patients with relatively equal sized BPAs. In the setting of BPA stenosis or size discrepancy the larger BPA has a relatively increased RF and PVR. Therefore, the differential RF is an important tool for screening patients with unilateral stenosis for contralateral increases in PVR that cannot be identified with net flows alone. This can affect the indication and timing for BPA intervention.
- differential branch pulmonary regurgitation
- pulmonary vascular disease
- right ventricular dilation
- tetralogy of Fallot
This research was supported by a grant from the National Heart, Lung, and Blood Institute (P50 HL74731) to Drs. Fogel and Goldmuntz. All authors report that they have no relationships to disclose. Drs. Fogel and Whitehead are joint senior authors of this work.
- Received November 28, 2010.
- Revision received January 12, 2011.
- Accepted January 19, 2011.
- American College of Cardiology Foundation