Cardiology in the young · 2026
Elevated combined pulmonary vascular resistance obtained by cardiovascular magnetic resonance and cardiac catheterisation on pre-Fontan assessment is associated with adverse postoperative Fontan outcomes.
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Hsieh Nathan, Doctor Pezad N, Akam-Venkata Jyothsna, Birdsall Kevin, Erdem Sukran, Gusseva Maria, Sebastian Roby, Veeram Reddy Surendranath R, Fares Munes, Greil Gerald, Jaquiss Robert, Hussain Tarique
Аннотация
OBJECTIVE: We analysed cardiac MRI and catheterisation variables during pre-Fontan evaluations for associations with major adverse cardiac events including Fontan takedown, mechanical circulatory support, heart transplantation, or death.
METHODS: In this single-centre retrospective study, we gathered pre-operative MRI and catheterisation data for all patients who underwent Fontan operation at Children's Medical Center, Dallas, from April 2017 to November 2022. Patients were grouped according to the presence or absence of adverse events, and MRI and catheterisation parameters were compared between groups. We used the Mann-Whitney U Test for non-parametric data, Student's T-test for parametric continuous variables, and Fisher's Exact Test for categorical variables.
RESULTS: Of the 119 combined evaluations, 81 proceeded with Fontan palliation. Adverse events were recorded in 10% of patients (n = 8). One had a Fontan takedown, one underwent transplant, one required mechanical circulatory support, and five died in a median 21-month follow-up. Factors significantly associated with adverse events included heterotaxy syndrome (p = 0.04), higher combined pulmonary vascular resistance (p = 0.03), and moderate-severe (≥30%) atrioventricular valve regurgitation (p = 0.046). While combined pulmonary vascular resistance calculated from both catheterisation and MRI data predicted outcome, pulmonary vascular resistance calculated using data solely from catheterisation showed no discriminative ability.
CONCLUSIONS: Post-Fontan major adverse cardiac events were associated with heterotaxy syndrome, higher combined pulmonary vascular resistance, and moderate-severe atrioventricular valve regurgitation identified on pre-Fontan MRI and catheterisation. Combined pulmonary vascular resistance using transpulmonary gradient from catheterisation data and effective pulmonary blood flow from MRI data may help predict outcome.
METHODS: In this single-centre retrospective study, we gathered pre-operative MRI and catheterisation data for all patients who underwent Fontan operation at Children's Medical Center, Dallas, from April 2017 to November 2022. Patients were grouped according to the presence or absence of adverse events, and MRI and catheterisation parameters were compared between groups. We used the Mann-Whitney U Test for non-parametric data, Student's T-test for parametric continuous variables, and Fisher's Exact Test for categorical variables.
RESULTS: Of the 119 combined evaluations, 81 proceeded with Fontan palliation. Adverse events were recorded in 10% of patients (n = 8). One had a Fontan takedown, one underwent transplant, one required mechanical circulatory support, and five died in a median 21-month follow-up. Factors significantly associated with adverse events included heterotaxy syndrome (p = 0.04), higher combined pulmonary vascular resistance (p = 0.03), and moderate-severe (≥30%) atrioventricular valve regurgitation (p = 0.046). While combined pulmonary vascular resistance calculated from both catheterisation and MRI data predicted outcome, pulmonary vascular resistance calculated using data solely from catheterisation showed no discriminative ability.
CONCLUSIONS: Post-Fontan major adverse cardiac events were associated with heterotaxy syndrome, higher combined pulmonary vascular resistance, and moderate-severe atrioventricular valve regurgitation identified on pre-Fontan MRI and catheterisation. Combined pulmonary vascular resistance using transpulmonary gradient from catheterisation data and effective pulmonary blood flow from MRI data may help predict outcome.