Correlation between Quantitative Morphometric Pulmonary Vascular Structures and Postoperative Transpulmonary Pressure Gradient following Fontan Procedure

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Park, Seung II; Kim, Yong Jin
Issue Date
Seoul National University College of Medicine
Seoul J Med 1994;35(4):281-288
Percentage Medial Thickness
The prognosis of Fontan operation mainly depends on the pulmonary
vascular resistance, but it is difficult to know it preoperatively. According as the
pulmonary vascular resistance is proportional to the transpulmonary pressure
gradient, we measured transpulmonary pressure gradient and percentage medial
thickness with lung biopsy tissues, and examined the correlation between them.
Thirty four patients who had undergone Fontan operation from Feb. 1989 to Dec.
1991 were subject to lung biopsy in order to measure Heath-Edward grade and the
pulmonary arterial percentage medial thickness by quantitative morphometric
analysis. And we examined the correlation between the postoperative transpulmonary
pressure gradient and the pulmonary arterial percentage medial thickness. The
difference of percentage medial thickness depending on age or shunt operation was
also examined. Data showed no difference between Heath-Edward grade 0 and other
grades in the transpulmonary pressure gradient. The patients undergone shunt
operation did not show any difference in the percentage medial thickness compared
to ones who did not.
However, the study showed significant correlation between postoperative second
day transpulmonary pressure gradient and percentage medial thickness in pulmonary
arterial diameter of 20-50,LIM with the correlation coefficient of 0.445 (p=0.03).
We conclude that pulmonary vascular resistance is generated mainly by diameter
20-50IlM pulmonary arteries, and it partly depends on their percentage medial
thickness. This result suggests that assessment of the percentage medial thickness of
20-5011M pulmonary arteries on lung biopsy is helpful in prediction of postoperative
transpulmonary pressure gradient and prognosis following Fontan operation.
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)The Seoul Journal of MedicineThe Seoul Journal of Medicine Vol. 35 No.4 (1994)
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