Imaging adult patients with Fontan circulation

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Improved survival in adults with Fontan circulation for single ventricle congenital heart disease.
• Fontan survivors face risks of heart failure, thromboembolism, and protein-losing enteropathy.

Purpose of the Study:

• Review the role of noninvasive imaging in surveillance for Fontan circulation abnormalities.
• Discuss early detection of anatomic and functional issues impacting Fontan failure risk.

Main Methods:

• Echocardiography (including tissue Doppler, strain, and 3D imaging) as first-line modality.
• Cardiac Magnetic Resonance (CMR) imaging for detailed anatomical and functional assessment.
• Utilizing novel techniques like computational fluid dynamics with CMR.

Main Results:

• Echocardiography effectively assesses ventricular and valvular function, with strain imaging detecting subclinical dysfunction.
• CMR overcomes acoustic limitations, visualizing cavopulmonary anastomoses and pulmonary arteries.
• CMR provides reliable ventricular assessment and insights into Fontan hemodynamics.

Conclusions:

• Advances in echocardiography and CMR enhance detection of structural and functional abnormalities.
• Noninvasive imaging is essential for monitoring complications in the growing Fontan adult population.