Cardiac catheterization is necessary before bidirectional Glenn and Fontan procedures in single ventricle physiology

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Single ventricle physiology presents significant mortality and morbidity risks with staged surgical palliation (bidirectional Glenn and Fontan procedures).
• Pre-operative and post-operative evaluation is essential to identify factors contributing to adverse outcomes.

Purpose of the Study:

• To highlight the necessity of comprehensive evaluation for hemodynamic and anatomical abnormalities in single ventricle patients undergoing staged palliation.
• To emphasize the role of cardiac catheterization in identifying treatable conditions and improving surgical outcomes.

Main Methods:

• Review of diagnostic modalities including echocardiography, magnetic resonance imaging (MRI), and cardiac catheterization.
• Assessment of specific abnormalities: ventricular function, coarctation of the aorta, pulmonary artery distortion, pulmonary resistance, and aortopulmonary collateral vessels.

Main Results:

• Echocardiography and MRI have limitations in visualizing pulmonary artery distortion and collateral vessels.
• Cardiac catheterization is essential for measuring pulmonary resistance (threshold > 3 Wood units/m2 indicates high risk for Glenn operation).
• Abnormal collateral vessels may require interventional treatment like coil embolization.

Conclusions:

• Cardiac catheterization is indispensable for evaluating critical abnormalities prior to and following bidirectional Glenn and Fontan procedures.
• Interventional catheterization offers treatment options for identified abnormalities.
• Accurate pre-procedural assessment via cardiac catheterization can significantly reduce mortality and morbidity associated with single ventricle palliation.