Advances in Diagnostic and Interventional Catheterization in Adults with Fontan Circulation

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Hemodynamics

Background:

• The Fontan procedure, developed over 50 years, enhances survival in patients with single-ventricle congenital heart defects.
• Fontan circulation redirects systemic venous return to pulmonary circulation, but its fragile physiology leads to long-term complications.
• Hemodynamic assessment via cardiac catheterization is crucial but complex for understanding Fontan circulation's function.

Purpose of the Study:

• To review cardiac catheterization tools used in Fontan circulation management.
• To analyze percutaneous treatment strategies for Fontan-related issues.
• To discuss recent advancements in the field.

Main Methods:

• Review of existing literature on cardiac catheterization and percutaneous interventions in Fontan patients.
• Analysis of hemodynamic assessment techniques, including combined catheterization with cardiopulmonary exercise testing.
• Examination of percutaneous treatments for obstructive problems, shunts, lymphatic disorders, and valve repair.

Main Results:

• Cardiac catheterization, especially combined with cardiopulmonary exercise testing, offers improved hemodynamic insights.
• Percutaneous treatments address various complications, including Fontan pathway obstruction, collateral shunts, lymphatic issues, and atrioventricular valve defects.
• Advancements provide new options for managing complex Fontan physiology.

Conclusions:

• Cardiac catheterization and evolving percutaneous techniques are vital for managing Fontan circulation.
• Continuous innovation in diagnostic and therapeutic tools improves long-term outcomes for Fontan patients.
• A comprehensive understanding of hemodynamics and interventional options is key to optimizing care.