サカイ　シユウジ   SAKAI Shiyuuji   坂井　修二    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Prediction of Fontan-Associated Liver Disease Using a Novel Cine Magnetic Resonance Imaging "Vortex Flow Map" in the Right Atrium.
掲載誌名	正式名：Circulation journal : official journal of the Japanese Circulation Society 略　 称：Circ J ISSNコード：13469843/13474820
掲載区分	国内
出版社	Japanese Circulation Society
巻・号・頁	82(8),pp.2143-2151
著者・共著者	ISHIZAKI Umiko†, NAGAO Michinobu*,, SHIINA Yumi, FUKUSHIMA Kenji, TAKAHASHI Tatsunori, SHIMOMIYA Yamato, MATSUO Yuka, INAI Kei, SAKAI Shuji
担当区分	最終著者
発行年月	2018/07
概要	BACKGROUND: Long-term hepatic dysfunction is an increasingly recognized complication of the Fontan operation for univentricular hearts. The purpose of this study was to determine whether Fontan-associated liver disease (FALD) could be predicted by flow dynamics in the right atrium (RA) of Fontan circulation.Methods and Results:Cardiac MRI and the serum levels of total bilirubin (TBil) and hyaluronic acid (HA) were analyzed in 36 patients who underwent an atriopulmonary connection type of Fontan operation. The mean follow-up period was 53 months. Three views (axial, coronal, and sagittal) of the cine images were scanned for the maximum cross-section of the RA obtained with1.5-Tesla scanner. We developed a "vortex flow map" to demonstrate the ratio of the circumferential voxel movement in each phase to the total movement throughout a cardiac cycle towards the center of the RA. The maximum ratio was used as the magnitude of vortex flow (MVF%) in the 3 views of the RA cine imaging. Patients with coronal MVF ≥13.6% had significantly lower free rates of TBil ≥1.8 mg/dL than those with coronal MVF <13.6% (log-rank value=4.50; P<0.05; hazard ratio=4.54). Patients with sagittal MVF ≥14.0% had significantly lower free rates of HA ≥50 ng/mL than those with coronal MVF <14.0% (log-rank value=4.40; P<0.05; hazard ratio=4.12). CONCLUSIONS: A reduced vortex flow in the RA during the late phase of the Fontan operation was associated with the development of FALD. MVF can be used as an imaging biomarker to predict FALD.
DOI	10.1253/circj.CJ-17-1260
PMID	29780065