title: The role of cardiovascular magnetic resonance in candidates for Fontan operation: proposal of a new algorithm.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Clinical Physiology - National Research Council, Ospedale del cuore "G.Pasquinucci", Massa, Italy.
authors.forename: Lamia
authors.initials: L
authors.lastname: Ait-Ali
authors.forename: Daniele
authors.initials: D
authors.lastname: De Marchi
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Luigi
authors.initials: L
authors.lastname: Scebba
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.forename: Bruno
authors.initials: B
authors.lastname: Murzi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Festa
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019564:Unnecessary Procedures; D055815:Young Adult
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