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Canadian Journal of Cardiology

Exercise Catheterisation to Unmask Fontan Pathway Obstruction

      Current practice guidelines for adults with congenital heart disease recommend serial imaging to ensure the integrity of the surgical Fontan pathway, but its visualisation by means of transthoracic echocardiography is limited. Accordingly, cross-sectional imaging is commonly performed to exclude Fontan obstruction. However, angiography (invasive or noninvasive) provides anatomic instead of functional information. Cardiac catheterisation, the gold standard method for hemodynamic evaluation, also poses challenges for assessing Fontan pathway stenosis because, as in other forms of venous obstruction, minimal pressure gradients might be recorded despite the presence of hemodynamically and anatomically significant stenosis.
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      Reference

        • Egbe A.C.
        • Miranda W.R.
        • Anderson J.H.
        • Borlaug B.A.
        Hemodynamic and clinical implications of impaired pulmonary vascular reserve in the Fontan circulation.
        J Am Coll Cardiol. 2020; 76: 2755-2763