Clinical Variables Associated with Pre-Fontan Aortopulmonary Collateral Burden

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease Research

Background:

• Aortopulmonary collaterals (APCs) are common in single ventricle congenital heart disease (CHD).
• The degree of APC development varies significantly among patients.
• Understanding factors influencing APC burden is crucial for managing single ventricle physiology.

Purpose of the Study:

• To investigate the association between APC burden and non-invasive clinical variables in patients with single ventricle CHD.
• To identify predictors of increased APC flow in patients with Glenn circulation.

Main Methods:

• Retrospective single-center study of 29 patients with single ventricle CHD and prior Glenn palliation.
• Cardiac magnetic resonance (CMR) imaging used to quantify APC flow (normalized to aortic and pulmonary vein flow).
• Univariate, multivariable, and Classification and Regression Tree (CART) analyses performed.

Main Results:

• All patients exhibited increased APC flow, with significant variability (APC/Q_Ao range: 11.9-44.4%).
• Pulmonary artery size (Nakata index) was the sole variable associated with APC flow on multivariable analysis (p < 0.020).
• CART analysis identified smaller pulmonary artery size as the most significant factor inversely related to APC burden.

Conclusions:

• APC flow is universally elevated but highly variable in single ventricle CHD with Glenn circulation.
• Reduced pulmonary artery size is a key predictor of increased APC burden.
• APC pathogenesis is likely multifactorial, necessitating further research into contributing factors.