title: MR assessment of abdominal circulation in Fontan physiology.
abstract: The Fontan operation allows for longer survival of those born with functionally single ventricle physiology. Although it effectively eliminates cyanosis, increased systemic venous pressure is an unavoidable consequence and low cardiac output is frequent. The abdomen is particularly vulnerable to these alterations in hemodynamics because the hepatic blood flow consists predominantly of portal venous flow, which relies on a low pressure gradient between the portal and hepatic veins. Therefore, any subtle increase in systemic venous pressure will adversely affect the hemodynamic balance of the liver as well as the intestine. As the clinical manifestations and routine laboratory findings of abdominal complications can lag behind the hemodynamic and pathologic changes in the abdominal organs, regular imaging surveillance is critical. Magnetic resonance (MR) provides excellent visualization of both cardiovascular and abdominal systems. It provides robust anatomic and hemodynamic data which can be used for timely implementation of treatment options. In this review paper, we discuss the pathogenesis and MR findings of abdominal complications following the Fontan operation. Specifically we explore the utility of phase-contrast MR for assessment of the abdominal circulation in children following the Fontan palliation.
authors.affiliation: Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5J2L4, Canada, shi-joon.yoo@sickkids.ca.
authors.forename: Shi-Joon
authors.initials: SJ
authors.lastname: Yoo
authors.forename: Milan
authors.initials: M
authors.lastname: Prsa
authors.forename: Daryl
authors.initials: D
authors.lastname: Schantz
authors.forename: Lars
authors.initials: L
authors.lastname: Grosse-Wortmann
authors.forename: Mike
authors.initials: M
authors.lastname: Seed
authors.forename: Tae Kyoung
authors.initials: TK
authors.lastname: Kim
authors.forename: Rachel
authors.initials: R
authors.lastname: Wald
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chaturvedi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D008279:Magnetic Resonance Imaging; D008297:Male; D010166:Palliative Care; D055420:Perfusion Imaging / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D013152:Splanchnic Circulation; D016896:Treatment Outcome; D014690:Venous Pressure
references.citation: J Magn Reson Imaging. 2009 Mar;29(3):588-94
references.pmid: 19243041
references.citation: Clin Nucl Med. 1995 Dec;20(12):1070-3
references.pmid: 8674293
references.citation: Cardiol Young. 2010 Dec;20 Suppl 3:113-9
references.pmid: 21087567
references.citation: Congenit Heart Dis. 2007 Sep-Oct;2(5):288-300
references.pmid: 18377444
references.citation: Pediatr Cardiol. 2000 Mar-Apr;21(2):104-10
references.pmid: 10754076
references.citation: Herz. 2014 Feb;39(1):98-104
references.pmid: 23649317
references.citation: J Magn Reson Imaging. 2013 Jun;37(6):1419-26
references.pmid: 23172846
references.citation: N Engl J Med. 2013 May 2;368(18):1756-7
references.pmid: 23635071
references.citation: Congenit Heart Dis. 2008 Jul-Aug;3(4):262-8
references.pmid: 18715460
references.citation: Cardiol Young. 2008 Jun;18(3):275-81
references.pmid: 18325142
references.citation: Radiographics. 2002 May-Jun;22(3):651-71
references.pmid: 12006694
references.citation: Circ Cardiovasc Imaging. 2013 Nov;6(6):1092-101
references.pmid: 24254479
references.citation: Clin Nucl Med. 1992 Oct;17(10):787-8
references.pmid: 1424352
references.citation: J Magn Reson Imaging. 2012 Sep;36(3):511-28
references.pmid: 22903653
references.citation: Eur J Gastroenterol Hepatol. 2013 Jun;25(6):669-75
references.pmid: 23411868
references.citation: Radiology. 2012 Mar;262(3):862-73
references.pmid: 22357888
references.citation: J Thorac Cardiovasc Surg. 2013 Jul;146(1):140-5
references.pmid: 23072704
references.citation: Heart. 2010 Nov;96(21):1750-5
references.pmid: 20956491
references.citation: Cardiol Young. 2011 Dec;21 Suppl 2:77-9
references.pmid: 22152532
references.citation: World J Gastroenterol. 2010 Dec 28;16(48):6046-57
references.pmid: 21182219
references.citation: Cardiol Young. 2002 May;12(3):308-10
references.pmid: 12365185
references.citation: Pediatr Cardiol. 2013 Jan;34(1):135-42
references.pmid: 22695765
references.citation: Ann Thorac Surg. 2011 Feb;91(2):600-1
references.pmid: 21256326
references.citation: AJR Am J Roentgenol. 2002 Apr;178(4):877-83
references.pmid: 11906867
references.citation: Hepatology. 1995 Sep;22(3):983-93
references.pmid: 7657307
references.citation: Acad Radiol. 2013 Jun;20(6):699-704
references.pmid: 23510798
references.citation: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2010;13(1):96-100
references.pmid: 20307870
references.citation: Am J Cardiol. 2002 Sep 15;90(6):672-4
references.pmid: 12231106
references.citation: J Thorac Cardiovasc Surg. 2005 Jun;129(6):1348-52
references.pmid: 15942576
references.citation: Pediatr Radiol. 2013 Mar;43(3):330-8
references.pmid: 23052733
references.citation: Lymphology. 2008 Sep;41(3):111-5
references.pmid: 19013878
references.citation: Ann Thorac Surg. 2008 Jul;86(1):177-82
references.pmid: 18573420
references.citation: Congenit Heart Dis. 2011 May-Jun;6(3):190-201
references.pmid: 21443554
references.citation: Clin Nucl Med. 1995 Nov;20(11):969-72
references.pmid: 8565376
references.citation: Int J Cardiol. 2013 Mar 20;164(1):77-81
references.pmid: 21788088
references.citation: Nutr Clin Pract. 2012 Jun;27(3):375-84
references.pmid: 22516942
references.citation: J Pediatr. 2013 Jul;163(1):201-6
references.pmid: 23391043
references.citation: N Engl J Med. 2013 Aug 1;369(5):490
references.pmid: 23902510
references.citation: J Thorac Cardiovasc Surg. 2013 Apr;145(4):e39-e41
references.pmid: 23380512
references.citation: J Thorac Cardiovasc Surg. 1998 May;115(5):1063-73
references.pmid: 9605076
references.citation: Magn Reson Med. 2014 Aug;72(2):477-84
references.pmid: 24018798
references.citation: Heart. 2007 May;93(5):579-84
references.pmid: 17005713
references.citation: Int J Cardiol. 2011 Sep 15;151(3):268-72
references.pmid: 20557964
references.citation: Eur J Cardiothorac Surg. 2013 Mar;43(3):e49-57
references.pmid: 23396878
references.citation: Hepatology. 2012 Sep;56(3):1160-9
references.pmid: 22383293
references.citation: Eur J Gastroenterol Hepatol. 2010 Jul;22(7):889-91
references.pmid: 19550346
references.citation: J Thorac Cardiovasc Surg. 2008 Mar;135(3):560-7
references.pmid: 18329470
references.citation: J Magn Reson Imaging. 2014 Apr;39(4):819-26
references.pmid: 24395121
references.citation: Pediatr Radiol. 2012 Feb;42(2):233-41
references.pmid: 21863291
references.citation: Pediatr Cardiol. 2012 Oct;33(7):1001-12
references.pmid: 22534759
references.citation: Cardiol Young. 2011 Aug;21(4):363-77
references.pmid: 21349233
references.citation: Int J Cardiol. 2013 Oct 9;168(4):3764-9
references.pmid: 23849105
references.citation: Acta Radiol. 2013 Jul;54(6):663-71
references.pmid: 23486562
references.citation: Radiology. 2013 Apr;267(1):67-75
references.pmid: 23297331
references.citation: Congenit Heart Dis. 2014 Jan-Feb;9(1):7-14
references.pmid: 24134059
references.citation: AJR Am J Roentgenol. 2009 Dec;193(6):1556-60
references.pmid: 19933647
references.citation: Hepatology. 2014 Jan;59(1):251-60
references.pmid: 23913702
references.citation: J Am Coll Cardiol. 2012 Sep 11;60(11):1018-25
references.pmid: 22818071