Related Experiment Video
Updated: Feb 17, 2026
Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Role of Doppler echocardiography for cardiac output assessment in Fontan patients
Alexander Egbe1, Arooj R Khan1, Sana F Khan1
1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Insights
Doppler stroke volume index (SVI) correlates with cardiac magnetic resonance imaging (CMRI) SVI in Fontan patients. Low Doppler SVI and cardiac index are associated with Fontan-associated diseases and Fontan failure in patients with a systemic left ventricle.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Cardiology
Background:
- The Fontan procedure is a palliative surgery for complex congenital heart defects.
- Fontan-associated diseases (FAD) and Fontan failure significantly impact long-term outcomes.
- Accurate assessment of cardiac function is crucial for managing Fontan patients.
Purpose of the Study:
- To evaluate the correlation between Doppler stroke volume index (SVI) and cardiac magnetic resonance imaging (CMRI) SVI.
- To determine the association between Doppler SVI and the development of FAD and Fontan failure.
Main Methods:
- Retrospective review of Fontan patients who underwent same-day CMRI and transthoracic echocardiography (TTE) between 2005 and 2015.
- FAD defined by cardiac thrombus, protein-losing enteropathy, arrhythmia, or heart failure hospitalization.
- Fontan failure defined by revision surgery, heart transplantation, or death.
Main Results:
- Doppler SVI demonstrated strong correlation with CMRI SVI in patients with systemic left ventricle (LV) (r=0.68) and systemic right ventricle (RV) (r=0.75).
- In patients with systemic LV, lower Doppler SVI (<39 mL/m²) was associated with FAD (OR, 2.11).
- Lower cardiac index (CI) (<2.5 L min⁻¹ m⁻²) was associated with Fontan failure in a subset of systemic LV patients.
Conclusions:
- Doppler SVI is a reliable non-invasive measure correlating with CMRI SVI in Fontan patients.
- Doppler-derived hemodynamic parameters show potential for identifying patients at risk for FAD and Fontan failure.
- Further studies are needed to assess these associations in systemic RV patients due to limited sample size.
Background:
To determine (1) correlation between Doppler stroke volume index (SVI) and cardiac magnetic resonance imaging (CMRI) SVI and (2) association between Doppler SVI and Fontan-associated diseases (FAD) and Fontan failure.
Methods:
Review of Fontan patients who underwent same-day CMRI and transthoracic echocardiography (TTE), 2005 to 2015. We defined FAD as cardiac thrombus, protein-losing enteropathy, arrhythmia, and hospitalization for heart failure. Fontan failure was defined as Fontan conversion or revision, heart transplantation or listing, or death.
Results:
Fifty-three patients with systemic left ventricle (LV) underwent 86 sets of TTE/CMRI. Mean (SD) age 31 (6) years. SVI (45 [16] vs 42 [13] mL/m2), CI (3.0 [1.1] vs 2.8 [0.8] L min-1 m-2), and ejection fraction (53 [4]% vs 51 [5]%) were similar for both modalities (P>.05 for all). Doppler SVI correlated with CMRI (r=0.68; P<.001). Sixteen patients had cirrhosis, and these patients had a higher CI (3.9 [0.9] vs 2.8 [1.0] L min-1 m-2; P<.01). Among the 37 patients without cirrhosis, Doppler SVI <39 mL/m2 was associated with FAD (odds ratio [OR], 2.11; 95% confidence limit, 1.26-3.14; P=.02); Fontan failure was more common in patients with CI was <2.5 L min-1 m-2 (3/9 [33%] vs 0/28 [0%], P=.01). Another 11 patients with systemic right ventricle (RV) underwent 17 sets of TTE/CMRI, mean (SD) age 17 (3) years, and CMRI SVI also correlated with Doppler SVI (r=0.75; P<.001).
Conclusion:
Doppler SVI correlated with CMRI SVI in patients with systemic LV and systemic RV. The association between output measures (SVI and CI) and FAD were seen only in single LV patients (single RV patients not assessed for this outcome due to small numbers). An association between low Doppler CI and Fontan failure was suggested in a small number of single LV patients.
Related Concept Videos
01:11Cardiac Output and Stroke Volume
In an average resting adult male, the typical cardiac...
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...