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Comprehensive MRI assessment of the cardiovascular responses to food ingestion in Fontan physiology

Hauser, JA; Jones, A; Pandya, B; Taylor, AM; Muthurangu, V; (2020) Comprehensive MRI assessment of the cardiovascular responses to food ingestion in Fontan physiology. American Journal of Physiology: Heart and Circulatory Physiology , 319 (4) H808-H813. 10.1152/ajpheart.00500.2020. Green open access

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Abstract

In univentricular (Fontan) physiology, peripheral and splanchnic vascular tone may be raised to counteract reduced cardiac output (CO) and elevated central venous pressure, and thus maintain vital organ perfusion. This could negatively affect the normal cardiovascular response to food ingestion, where mesenteric vasodilation and a concurrent rise in CO are central. We sought to elucidate this using rapid cardiovascular MRI. Thirty fasting subjects (50% controls; 40% female) ingested a standardized meal. Responses over ~50 minutes in mean arterial pressure (MAP), CO and blood flow in all major aortic branches were measured and regional vascular impedance (Z0) calculated. Differences from baseline and between groups were assessed by repeated-measures mixed models. Compared to the control group, Fontan patients had greater fasting Z0 of the legs and kidneys, resulting in greater systemic Z0 and similar MAP. They further had similar blood flow to the digestive organs at baseline, despite larger variation in mesenteric resistance. Postprandially, blood flow to the legs decreased in the control group but not in patients. Increases in CO and superior mesenteric blood flow were similar in both groups but the celiac response was blunted in patients. No significant differences in MAP responses were observed. In conclusion, alterations in vascular tone to counteract adverse hemodynamics and raised hepatic afterload may blunt vasoreactivity in the legs and the celiac axis in Fontan physiology. Further study is needed to determine whether blunted celiac or mesenteric vasoreactivity is linked to deteriorating hemodynamics and poor prognosis in Fontan patients.

Type: Article
Title: Comprehensive MRI assessment of the cardiovascular responses to food ingestion in Fontan physiology
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1152/ajpheart.00500.2020
Publisher version: https://doi.org/10.1152/ajpheart.00500.2020
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Fontan, MRI, blood flow, postprandial, vasoreactivity
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Childrens Cardiovascular Disease
URI: https://discovery.ucl.ac.uk/id/eprint/10110871
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