Maria Restrepo, BS, Elaine Tang, BEng, Christopher M

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Energetic Implications of Vessel Growth and Flow Changes Over Time in Fontan Patients Maria Restrepo, BS, Elaine Tang, BEng, Christopher M. Haggerty, PhD, Reza H. Khiabani, PhD, Lucia Mirabella, PhD, James Bethel, PhD, Anne Marie Valente, MD, Kevin K. Whitehead, MD, PhD, Doff B. McElhinney, MD, Mark A. Fogel, MD, Ajit P. Yoganathan, PhD The Annals of Thoracic Surgery Volume 99, Issue 1, Pages 163-170 (January 2015) DOI: 10.1016/j.athoracsur.2014.08.046 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (Top) Absolute and (bottom) normalized vessel diameters as a function of measurement time (T1 [initial time point], white bars; T2 [follow-up time point], gray bars). * indicates p < 0.05. (FP = Fontan pathway; LPA = left pulmonary artery; Max = maximum; Min = minimum; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (Left) Absolute and (right) normalized mean vessel flows at T1 (initial time point; white bars) and T2 (follow-up time point; gray bars). * indicates p < 0.05. (CI = cardiac index; CO = cardiac output; FP = Fontan pathway; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Correlation between (left) minimum and (right) mean absolute diameter with mean vessel flow rate for the LPA and RPA (left [top] and right [bottom] pulmonary arteries) for extracardiac (red symbols) and lateral tunnel (blue symbols) patients. Correlation (R) and probability values are reported. (LPA = left pulmonary artery; min = minimum; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Correlation between changes in power loss (PL, in mW) and changes in body surface are (BSA, in m2); Correlation (R) and probability values are displayed. The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Anterior view of the cases presenting the largest decrease (Patient A) and the largest increase (Patient B) in indexed power loss (iPL) between T1 (initial time point) and T2 (follow-up time point). Tables show the anatomic and flow variables for each vessel at two time points, and the demographic and hemodynamic variables. Velocity magnitude scale in cm/s. (BSA = body surface area; FP = Fontan pathway; LPA = left pulmonary artery; Min = minimum; PL = power loss; RPA = right pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Axial cardiac magnetic resonance images showing the pulmonary arteries for Patient B at initial (T1; left) and follow-up (T2; right) time points. Measurements are diameters in cm. The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Changes in normalized minimum left pulmonary artery (min LPA) diameter (in mm/m) versus the changes in indexed power loss (iPL) from initial to follow-up time points for extracardiac (red symbols) and lateral tunnel (blue symbols) patients. Correlation and probability values are displayed. The Annals of Thoracic Surgery 2015 99, 163-170DOI: (10.1016/j.athoracsur.2014.08.046) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions