title: Cardiac magnetic resonance and the need for routine cardiac catheterization in single ventricle patients prior to Fontan: a comparison of 3 groups: pre-Fontan CMR versus cath evaluation.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiology, University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. fogel@email.chop.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Pawlowski
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.forename: Winnie
authors.initials: W
authors.lastname: Zhu
authors.forename: David
authors.initials: D
authors.lastname: Shore
authors.forename: Laura K
authors.initials: LK
authors.lastname: Diaz
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods / Q000592:standards*; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods; D006352:Heart Ventricles / Q000002:abnormalities* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods / Q000592:standards*; D008297:Male; D011300:Preoperative Care / Q000379:methods / Q000592:standards*