Diagnostic assessment before Fontan operation in patients with bidirectional cavopulmonary anastomosis: are noninvasive methods sufficient?

Journal of the American College of Cardiology
Pamela S RoJonathan J Rome

Abstract

This study was designed to determine if a subset of patients who have undergone bidirectional cavopulmonary anastomosis could be identified in which catheterization was of little benefit before completion of the Fontan procedure. Diagnostic evaluation before Fontan procedure has typically included cardiac catheterization. However, the overall management strategy for patients with functional single ventricle has evolved to include staging bidirectional cavopulmonary anastomosis in most, and it has become uncommon to exclude patients from Fontan based on catheterization data. Patients who underwent bidirectional cavopulmonary anastomosis and had complete echocardiograms and catheterizations within three months of each other between January 1992 and October 1997 were evaluated with a series of clinical and echocardiographic characteristics to identify a subset in whom catheterization was predicted to be of little added value ("no-cath" group). The predictive value and sensitivity of these criteria in excluding patients who required additional intervention, were excluded from Fontan, or died within 30 days of Fontan was determined. A total of 99 patients who underwent bidirectional cavopulmonary anastomosis at 6.7 months (range 2.9...Continue Reading

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