Influence of Respiration on Collateral Flow in the Fontan Population Using Real-time Phase-contrast Cardiovascular Magnetic Resonance Collateral Flow Does Not Protect the Ventricle From Volume Deficiency and Diastolic Dysfunction

Purpose:The clinical significance of collateral flow for the ventricular function of patients with univentricular hearts is often debated. This study evaluates the impact of collateral flow on respiration-dependent preload modification and diastolic function in Fontan patients assessed by systemic and pulmonary vein (PV) flow patterns. Materials and Methods:Real-time phase-contrast cardiovascular magnetic resonance was performed in the right upper PV, ascending aorta, superior, and inferior vena cava (IVC) in 21 Fontan patients and 11 healthy individuals. The patients' respiratory cycle was divided into 4 periods to generate respiratory-dependent stroke volumes (SVi). Conventional quantitative blood flow measurements were used to quantify and differentiate between low (group A) and high (group B) collateral flow. Results:Group B showed significantly lower SVi IVC in inspiration, end-inspiration, expiration, and SVi & UDelta;IVC compared with group A (23.6 & PLUSMN;4.8 mL/m(2) to 33.4 & PLUSMN;8.0; P=0.005). PV flow resulted in a lower mean SVi PV (11.6 & PLUSMN;7.6 mL/m(2), vs. 14.0 & PLUSMN;11.4 mL/m(2)) as well as a significantly lower peak systolic S-wave velocity (S-max) (P=0.005), S/D-ratio (S-max/peak diastolic wave velocity) (P=0.015), and shorter diastolic deceleration time (DTD; P=0.030; median DTD=134 ms) compared with group A (DTD=202 ms). Conclusions:This study demonstrates the incapability of Fontan patients to properly increase preload by inspiration in the presence of significant collateral flow. The results further show that collateral flow is associated with a volume-deprived ventricle and impaired diastolic function.