The role of cardiovascular magnetic resonance in candidates for Fontan operation: Proposal of a new Algorithm

✍ Scribed by Lamia Ait-Ali; Daniele De Marchi; Massimo Lombardi; Luigi Scebba; Eugenio Picano; Bruno Murzi; Pierluigi Festa

• Publisher: BioMed Central
• Year: 2011
• Tongue: English
• Weight: 405 KB
• Volume: 13
• Category: Article
• ISSN: 1097-6647
• DOI: 10.1186/1532-429x-13-69

✦ Synopsis

Background

To propose a new diagnostic algorithm for candidates for Fontan and identify those who can skip cardiac catheterization (CC).

Methods

Forty-four candidates for Fontan (median age 4.8 years, range: 2-29 years) were prospectively evaluated by trans-thoracic echocardiography (TTE), Cardiovascular magnetic resonance (CMR) and CC. Before CC, according to clinical, echo and CMR findings, patients were divided in two groups: Group I comprised 18 patients deemed suitable for Fontan without requiring CC; group II comprised 26 patients indicated for CC either in order to detect more details, or for interventional procedures.

Results

In Group I ("CC not required") no unexpected new information affecting surgical planning was provided by CC. Conversely, in Group II new information was provided by CC in three patients (0 vs 11.5%, p = 0.35) and in six an interventional procedure was performed. During CC, minor complications occurred in one patient from Group I and in three from Group II (6 vs 14%, p = 0.7). Radiation Dose-Area product was similar in the two groups (Median 20 Gycm^2^, range: 5-40 vs 26.5 Gycm^2^, range: 9-270 p = 0.37). All 18 Group I patients and 19 Group II patients underwent a total cavo-pulmonary anastomosis; in the remaining seven group II patients, four were excluded from Fontan; two are awaiting Fontan; one refused the intervention.

Conclusion

In this paper we propose a new diagnostic algorithm in a pre-Fontan setting. An accurate non-invasive evaluation comprising TTE and CMR could select patients who can skip CC.