Comparison of Echocardiographically-Calculated Fontan Fenestration Gradient and Catheter-Based Measurement.

Autor: Sanders EN; Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA. esanders@uams.edu., Chen JZ; Department of Internal Medicine (Hematology/Oncology), University of Arkansas for Medical Sciences, Little Rock, AR, USA., Nissen T; Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA., Daily J; Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA., Zakaria D; Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA., Dalby S; Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA., Bolin E; Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2024 Oct 12. Date of Electronic Publication: 2024 Oct 12.
DOI: 10.1007/s00246-024-03651-1
Abstrakt: Background: Patients born with single ventricle anatomy typically undergo surgical palliation in three stages, culminating in the Fontan procedure. Assessment of flow across a Fontan fenestration by Doppler ultrasound theoretically allows for non-invasive estimation of the transpulmonary gradient (TPG). Our objective was to determine the relationship between Doppler-derived mean fenestration gradient (mFG) and direct catheter-based measurements of TPG in patients with fenestrated Fontans.
Methods: We performed a single-center retrospective cohort study of 59 patients with fenestrated Fontans completed between 2000 and 2022. The primary outcome was catheter-based measurement of TPG and the primary predictor was mFG from echo performed within 6 months of the catheterization. Linear regression and R 2 were used to determine the relationship between predictors and outcomes.
Results: Catheter-based measurements of TPG and mFG were weakly correlated (R 2  = 0.382, p < 0.001); the regression coefficient was 0.550, with a standard error of 0.09 for every increase in mFG (Cath TPG = 0.55 [mFG] + 1.92). mFG had a slightly better predictive relationship with cath-derived TPG in patients with systemic left ventricles with R 2 of 0.47, p < 0.004.
Conclusion: mFG accounts for approximately 38% of the variance in catheter-derived TPG. Although mFG is non-invasive and intuitive, mFG in Fontan patients should be interpreted with caution and direct measurement by cardiac catheterization should be considered.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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