title: Relationship of cerebral blood flow to aortic-to-pulmonary collateral/shunt flow in single ventricles.
abstract: OBJECTIVE
  Patients with single ventricle can develop aortic-to-pulmonary collaterals (APCs). Along with systemic-to-pulmonary artery shunts, these structures represent a direct pathway from systemic to pulmonary circulations, and may limit cerebral blood flow (CBF). This study investigated the relationship between CBF and APC flow on room air and in hypercarbia, which increases CBF in patients with single ventricle.
  
  
  METHODS
  106 consecutive patients with single ventricle underwent 118 cardiac magnetic resonance (CMR) scans in this cross-sectional study; 34 prior to bidirectional Glenn (BDG) (0.50±0.30 years old), 50 prior to Fontan (3.19±1.03 years old) and 34 3-9 months after Fontan (3.98±1.39 years old). Velocity mapping measured flows in the aorta, cavae and jugular veins. Analysis of variance (ANOVA) and multiple linear regression were used. Significance was p<0.05.
  
  
  RESULTS
  A strong inverse correlation was noted between CBF and APC/shunt both on room air and with hypercarbia whether CBF was indexed to aortic flow or body surface area, independent of age, cardiopulmonary bypass time, Po2 and Pco2 (R=-0.67--0.70 for all patients on room air, p<0.01 and R=-0.49--0.90 in hypercarbia, p<0.01). Correlations were not different between surgical stages. CBF was lower, and APCs/shunt flow was higher prior to BDG than in other stages.
  
  
  CONCLUSIONS
  There is a strong inverse relationship between CBF and APC/shunt flow in patients with single ventricle throughout surgical reconstruction on room air and in hypercarbia independent of other factors. We speculate that APC/shunt flow may have a negative impact on cerebral development and neurodevelopmental outcome. Interventions on APC may modify CBF, holding out the prospect for improving neurodevelopmental trajectory.
  
  
  BACKGROUND
  NCT02135081.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Li
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Felice
authors.initials: F
authors.lastname: Wilson
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Pawlowski
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Diaz Berenstein
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fuller
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.affiliation: Department of Neurology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Clancy
authors.affiliation: Westat, Rockville, Maryland, USA.
authors.forename: Okan
authors.initials: O
authors.lastname: Elci
authors.affiliation: Westat, Rockville, Maryland, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Bethel
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.affiliation: Department of Neurology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D002490:Central Nervous System / Q000098:blood supply / Q000254:growth & development; D002560:Cerebrovascular Circulation; D002675:Child, Preschool; D003097:Collateral Circulation; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019990:Perioperative Care; D011651:Pulmonary Artery / Q000503:physiopathology; D011652:Pulmonary Circulation; D016896:Treatment Outcome