MRI shows limited mixing between systemic and pulmonary circulations in foetal transposition of the great arteries: a potential cause of in utero pulmonary vascular disease

Prashob Porayette; Joshua F P van Amerom; Shi-Joon Yoo; Edgar Jaeggi; Christopher K Macgowan; Mike Seed

doi:10.1017/S1047951114000870

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MRI shows limited mixing between systemic and pulmonary circulations in foetal transposition of the great arteries: a potential cause of in utero pulmonary vascular disease

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Peer reviewed

MRI shows limited mixing between systemic and pulmonary circulations in foetal transposition of the great arteries: a potential cause of in utero pulmonary vascular disease

Prashob Porayette, Joshua F P van Amerom, Shi-Joon Yoo, Edgar Jaeggi, Christopher K Macgowan and Mike Seed

Cardiology in the young, Vol.25(4), pp.737-744

04/2015

DOI: 10.1017/S1047951114000870

PMCID: PMC4411741

PMID: 24932863

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Abstract

To investigate the relationship between foetal haemodynamics and postnatal clinical presentation in patients with transposition of the great arteries using phase-contrast cardiovascular magnetic resonance. A severe and irreversible form of persistent pulmonary hypertension of the newborn occurs in up to 5% of patients with transposition and remains an important cause of morbidity and mortality in these infants. Restriction at the foramen ovale and ductus arteriosus has been identified as a risk factor for the development of pulmonary hypertension, and this can now be studied with magnetic resonance imaging using a new technique called metric optimised gating. Blood flow was measured in the major vessels of four foetuses with transposition with intact ventricular septum (gestational age range: 35-38 weeks) and compared with values from 12 normal foetuses (median gestational age: 37 weeks; range: 34-40 weeks). We found significantly reduced flows in the ductus arteriosus (p<0.01) and foramen ovale (p=0.03) and increased combined ventricular output (p=0.01), ascending aortic (p=0.001), descending aortic (p=0.03), umbilical vein (p=0.03), and aorto-pulmonary collateral (p<0.001) flows in foetuses with transposition compared with normals. The foetus with the lowest foramen ovale shunt and highest aorto-pulmonary collateral flow developed fatal pulmonary vascular disease. We found limited mixing between the systemic and pulmonary circulations in a small group of late-gestation foetuses with transposition. We propose that the resulting hypoxia of the pulmonary circulation could be the driver behind increased aorto-pulmonary collateral flow and contribute to the development of pulmonary vascular disease in some foetuses with transposition.

Case-Control Studies

Female

Gestational Age

Hemodynamics

Humans

Hypertension, Pulmonary - complications

Hypertension, Pulmonary - congenital

Infant, Newborn

Magnetic Resonance Imaging

Ontario

Pregnancy

Pulmonary Artery - abnormalities

Pulmonary Artery - physiopathology

Pulmonary Circulation - physiology

Pulmonary Veno-Occlusive Disease - complications

Pulmonary Veno-Occlusive Disease - congenital

Regional Blood Flow - physiology

Transposition of Great Vessels - complications

Transposition of Great Vessels - physiopathology

Transposition of Great Vessels - surgery

Treatment Outcome

Details

Title: Subtitle: MRI shows limited mixing between systemic and pulmonary circulations in foetal transposition of the great arteries: a potential cause of in utero pulmonary vascular disease
Creators: Prashob Porayette - University of Toronto
Joshua F P van Amerom - University of Toronto
Shi-Joon Yoo - University of Toronto
Edgar Jaeggi - University of Toronto
Christopher K Macgowan - University of Toronto
Mike Seed - University of Toronto
Resource Type: Journal article
Publication Details: Cardiology in the young, Vol.25(4), pp.737-744
DOI: 10.1017/S1047951114000870
PMID: 24932863
PMCID: PMC4411741
NLM abbreviation: Cardiol Young
ISSN: 1047-9511
eISSN: 1467-1107
Language: English
Date published: 04/2015
Academic Unit: Cardiology; Stead Family Department of Pediatrics; Internal Medicine
Record Identifier: 9984353927202771

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30 Times Cited - Web of Science