Cardiac Magnetic Resonance and the Need for Routine Cardiac Catheterization in Single Ventricle Patients Prior to Fontan: A Comparison of 3 Groups

Objectives This study investigated whether cardiac magnetic resonance (CMR) and echocardiography (echo) can replace catheterization (cath) for routine evaluation prior to Fontan and under what circumstances CMR and cath are used together. Background Routine cath prior to Fontan has been utilized for...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2012-09, Vol.60 (12), p.1094-1102
Main Authors: Fogel, Mark A., MD, Pawlowski, Thomas W., BA, Whitehead, Kevin K., MD, Harris, Matthew A., MD, Keller, Marc S., MD, Glatz, Andrew C., MD, Zhu, Winnie, PhD, Shore, David, BS, Diaz, Laura K., MD, Rome, Jonathan J., MD
Format: Article
Language:English
Subjects:
bidirectional Glenn
cardiac catheterization
cardiac magnetic resonance
Cardiology
Cardiovascular
Defects
echocardiography
Fontan
Hypotheses
Intensive care
Internal Medicine
Intubation
Pulmonary arteries
single ventricle
Veins & arteries
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Summary:Objectives This study investigated whether cardiac magnetic resonance (CMR) and echocardiography (echo) can replace catheterization (cath) for routine evaluation prior to Fontan and under what circumstances CMR and cath are used together. Background Routine cath prior to Fontan has been utilized for years; noninvasive methods, however, may be sufficient. Methods This study reviews clinical data in 119 consecutive patients investigating 3 groups: those who underwent CMR alone (MR; n = 41), cath alone (C; n = 41), or both cath and CMR (C+M; n = 37) prior to Fontan. Results No clinically significant differences were noted in patient characteristics, hemodynamics, or clinical status prior to or after surgery between the C and MR groups. CMR added information in 82%. There were no discrepant findings between CMR and cath data in the C+M group. Diagnostic success was ≥95% in all groups. Of those undergoing Fontan completion, the C+M group had similar outcomes to C and MR; C and CMR were utilized in combination to assess aortopulmonary collaterals or the need for an intervention or evaluate its success. Echo could not delineate pulmonary arterial anatomy in 46% to 53% of patients. The C+M and C groups were exposed to 6.8 ± 4.1 mSv of radiation. Conclusions Single ventricle patients not requiring an intervention can undergo successful Fontan completion with CMR and echo alone with similar short-term outcomes to C, which was used as a control, preventing an invasive test and exposure to radiation. CMR can add information in a significant number of patients. Cath and CMR are utilized together for interventions and assessment of aortopulmonary collaterals.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2012.06.021