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Echocardiographic Identification of Pulmonary Artery Flow Reversal: An Indicator of Adverse Outcomes in Single

Andrew D Spearman1,2, Salil Ginde3,4,5, Benjamin H Goot3,4

  • 1Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. aspearman@mcw.edu.

Pediatric Cardiology
|July 26, 2020
PubMed

Insights

Retrograde pulmonary artery flow in single ventricle heart disease patients after surgery indicates higher risk for adverse outcomes, including longer hospital stays and reduced transplant-free survival. This finding highlights a critical indicator for monitoring patient health post-palliation.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Echocardiography

Background:

  • Single ventricle congenital heart disease (CHD) requires staged surgical palliation, including superior cavopulmonary connection (SCPC) and Fontan procedures.
  • Successful palliation depends on unobstructed pulmonary blood flow and healthy pulmonary vasculature.

Purpose of the Study:

  • To investigate the association between echocardiographic identification of retrograde flow in branch pulmonary arteries (PAs) and adverse outcomes in single ventricle CHD patients.
  • To determine if PA flow reversal is a risk indicator following SCPC and Fontan palliation.

Main Methods:

  • Retrospective chart review of single ventricle CHD patients who underwent SCPC palliation between 1999 and 2019.
  • Patients were categorized into two cohorts: those with PA flow reversal and those with normal anterograde flow, identified via transthoracic echocardiography with color Doppler.
  • Comparison of clinical outcomes including hospital length of stay, transplant-free survival, overall survival, and progression to Fontan palliation.

Main Results:

  • The PA reversal cohort (21 patients) experienced significantly longer hospital stays post-SCPC (p < 0.001) and reduced transplant-free survival (p = 0.032) compared to the non-reversal cohort (539 patients).
  • No significant difference in overall survival was observed between cohorts (p = 0.099).
  • Patients with PA flow reversal were less likely to progress to Fontan palliation (p = 0.005), with no difference in hospital length of stay post-Fontan.

Conclusions:

  • Echocardiographic identification of branch PA flow reversal in single ventricle physiology is a significant high-risk indicator.
  • This finding suggests potential for earlier identification of patients at risk for adverse outcomes following staged palliation.
  • PA flow reversal may impact the feasibility or timing of subsequent palliative stages, such as the Fontan procedure.

Keywords:
Bidirectional GlennCavopulmonary connectionCongenital heart diseaseFontanPulmonary vasculatureSingle ventricle

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