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


BACKGROUND
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.


METHODS
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.


RESULTS
A total of 99 patients who underwent bidirectional cavopulmonary anastomosis at 6.7 months (range 2.9 months to 14 years) were studied; 46 met criteria for the "no-cath" group. Noninvasive criteria stratified all patients who died (n = 5) or did not proceed to Fontan (n = 1) and 9 of 11 who required additional interventions to the "cath" group. Thus, the negative predictive value of these criteria was 93%.


CONCLUSIONS
Our data suggest that catheterization before Fontan could be avoided in a large percentage of patients without adversely affecting outcome; prospective evaluation of this strategy is warranted.
Ro
Pamela S
PS
Division of Cardiology, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Rychik
Jack
J
Cohen
Meryl S
MS
Mahle
William T
WT
Rome
Jonathan J
JJ
D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000151:congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006328:Cardiac Catheterization; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D004452:Echocardiography; D018729:Fontan Procedure; D006325:Heart Atria / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D010414:Pennsylvania; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011859:Radiography; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome