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In vivo Structural Assessments of Ocular Disease in Rodent Models using Optical Coherence Tomography
Published on: July 24, 2020
Pulmonary artery wall thickness in children with Fontan physiology: an optical coherence tomography case control
Eimear McGovern1, Christine Voss1, Nathan W Brunner2
1Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4,Canada.
Insights
Optical coherence tomography (OCT) is safe for evaluating pulmonary arteries in Fontan circulation patients. Childhood pulmonary artery dimensions appear normal in Fontan patients with stable hemodynamics.
Area of Science:
- Cardiovascular Research
- Pediatric Cardiology
- Medical Imaging
Background:
- Fontan circulation failure is poorly understood, with potential links to pulmonary vascular resistance and structural pulmonary artery changes.
- Investigating these structural changes is crucial for understanding Fontan circulation failure.
- Optical coherence tomography (OCT) offers a novel approach to assess pulmonary artery structure.
Purpose of the Study:
- To evaluate structural changes in the pulmonary arteries of Fontan patients using OCT.
- To compare pulmonary artery structure between Fontan patients and healthy controls.
- To assess the feasibility and safety of pulmonary artery OCT in Fontan patients.
Main Methods:
- Pulmonary artery OCT was performed in 12 Fontan patients and 11 controls.
- Wall thickness and wall-to-vessel cross-sectional area (CSA) ratio were calculated using digital planimetry.
- Safety and feasibility of the OCT procedure were assessed.
Main Results:
- No significant differences in pulmonary artery wall thickness or wall:vessel CSA ratio were found between Fontan patients and controls.
- Pulmonary artery wall dimensions in Fontan patients showed no association with hemodynamic parameters or clinical factors.
- The vessel media layer was less consistently visualized in Fontan patients compared to controls.
Conclusions:
- Pulmonary artery OCT is a safe and feasible imaging modality for Fontan patients.
- Fontan children with reassuring hemodynamics exhibit normal pulmonary artery wall dimensions during childhood.
- Further research is needed to determine OCT's utility in identifying early structural changes in Fontan patients with abnormal hemodynamics and into adulthood.
Introduction:
Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation.
Materials And Methods:
Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry.
Results:
There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10-0.14) and for controls was 0.11 mm (IQR, 0.10-0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12-0.16) and for controls was 0.13 (IQR, 0.11-0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients.
Discussion:
OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.
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