Computed Tomography in the Evaluation of Fontan Circulation

Area of Science:

• Cardiology
• Radiology
• Pediatric Surgery

Background:

• The Fontan procedure is a vital surgical intervention for patients with univentricular heart disease, significantly enhancing survival rates.
• Modifications have evolved the technique to the modern total cavopulmonary connection, leading to increased life expectancy.
• With improved survival, long-term complications of the Fontan procedure are increasingly prevalent and require careful monitoring.

Purpose of the Study:

• To highlight the role of computed tomography (CT) in evaluating the Fontan procedure's outcomes and complications.
• To emphasize the importance of understanding normal Fontan anatomy and potential postoperative issues for accurate radiologic interpretation.
• To guide radiologists in identifying and reporting clinically significant findings related to Fontan-associated complications.

Main Methods:

• Review of computed tomography (CT) imaging protocols for Fontan patients.
• Analysis of common Fontan anatomy and typical postoperative complications.
• Discussion of interpretive pitfalls in CT imaging of Fontan circulation.

Main Results:

• CT can reliably depict normal Fontan anatomy and various postoperative complications.
• Common complications include atrial and conduit issues, shunts, hepatic congestion, and lymphovascular problems.
• Familiarity with single-ventricle palliation stages and Fontan pathophysiology aids targeted imaging.

Conclusions:

• Computed tomography (CT) is indispensable for assessing Fontan procedure patients, enabling visualization of normal anatomy and complications.
• Radiologists must possess a thorough understanding of Fontan physiology and imaging features to accurately diagnose complications.
• Effective CT interpretation facilitates timely clinical management and improves outcomes for individuals with Fontan circulation.