title: Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis: long-term follow-up of a prospective randomized trial.
abstract: OBJECTIVE
  A previously published randomized clinical trial comparing cardiac magnetic resonance (CMR) versus routine catheterization in patients with functional single ventricle before bidirectional Glenn (BDG) operation demonstrated similar short-term post-BDG outcomes. We sought to assess late outcomes in this cohort to ascertain any long-term effects of this evaluation strategy.
  
  
  METHODS
  Retrospective review of enrolled patients through most recent follow-up was performed on all 82 patients in the original cohort, at a median age of 8.8 years.
  
  
  RESULTS
  Of these, 76 (93%) underwent Fontan operation; 2 died before Fontan. Baseline demographics, anatomic factors, and age at BDG did not differ between those randomized to CMR versus catheterization. Although pre-BDG CMR patients were younger at Fontan (2.4 vs 2.7 years; P = .02), baseline weight, body surface area, oxygen saturation, ventricular function, and degree of atrioventricular valve regurgitation were similar. Catheterization before Fontan (n = 76) demonstrated similar hemodynamic parameters including pulmonary vascular resistance and mean pulmonary artery, atrial, and ventricular end-diastolic pressures. CMR patients had comparable rates of transcatheter interventions (71% vs 79%; P = .6), including coil occlusion of systemic-pulmonary collaterals (66% vs 61%; P = .29). At Fontan surgery, short-term complications, hospital length of stay, and the percent meeting a 5-part definition of successful Fontan operation were not different (71% vs 55%; P = .23).
  
  
  CONCLUSIONS
  Pre-BDG CMR and catheterization groups had equivalent clinical and hemodynamic profiles before Fontan and similar post-Fontan outcomes at a median follow-up of 8 years after BDG. For selected patients, a pre-BDG evaluation with CMR is an acceptable alternative to catheterization.
authors: Department of Cardiology, Children's Hospital Boston, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: david.brown@cardio.chboston.org.
authors: David W
authors: DW
authors: Brown
authors: Kimberlee
authors: K
authors: Gauvreau
authors: Andrew J
authors: AJ
authors: Powell
authors: Peter
authors: P
authors: Lang
authors: Pedro J
authors: PJ
authors: del Nido
authors: Kirsten C
authors: KC
authors: Odegard
authors: Tal
authors: T
authors: Geva
mesh_terms: D006328:Cardiac Catheterization; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: 20; AV; BDG; CMR; SPC; atrioventricular; bidirectional Glenn; cardiac magnetic resonance; systemic–pulmonary collateral