The Fontan Pathway: Change in Dimension and Catheter-Based Intervention over Time

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• The Fontan pathway is crucial for single-ventricle physiology management.
• Understanding Fontan pathway evolution and associated outcomes is vital for patient care.

Purpose of the Study:

• To compare obstruction development between extracardiac conduit (ECC) and lateral tunnel (LT) Fontan pathways.
• To assess the impact of Fontan pathway dimensions and interventions on mid-term clinical outcomes.
• To identify risk factors for Fontan pathway intervention.

Main Methods:

• Retrospective analysis of 232 Fontan cardiac catheterizations (2006-2019).
• Review of angiographic dimensions, interventions, and clinical outcomes.
• Analysis of Fontan pathway cross-sectional area (CSA) changes and correlation with clinical events.

Main Results:

• ECC Fontans had smaller minimum CSA than LTs; LTs showed dilation over time.
• 13% of patients required Fontan pathway stenting, associated with smaller CSA and lower weight at surgery (≤15 kg for ECCs).
• Fontan pathway intervention did not increase adverse clinical outcomes, but LTs had worse outcomes with liver fibrosis.

Conclusions:

• ECC Fontan pathways are prone to stenosis, while LTs may have worse long-term clinical outcomes.
• Lower weight at Fontan surgery is a risk factor for pathway intervention.
• Findings aid in optimizing post-Fontan surveillance timing and methods.