Interventional Cardiovascular Magnetic Resonance in Children Undergoing Pre-Operative Fontan Evaluation: One-Stop...

Area of Science:

• Pediatric Cardiology
• Interventional Cardiovascular Imaging
• Congenital Heart Disease

Background:

• Single-ventricle lesions require specialized pre-surgical assessment.
• Traditional pre-Fontan palliation evaluation often involves multiple procedures and anesthesia sessions.
• Interventional cardiovascular magnetic resonance (iCMR) integrates imaging and hemodynamic assessment.

Purpose of the Study:

• To describe the role and outcomes of iCMR in pediatric patients with single-ventricle lesions before Fontan palliation.
• To evaluate the safety, feasibility, and effectiveness of iCMR in this specific patient population.
• To compare iCMR with the traditional combined approach regarding radiation exposure and procedural efficiency.

Main Methods:

• iCMR-guided right and left heart catheterization performed using specific MRI sequences (bSSFP or T1 overlay).
• Success defined by meeting all predefined MRI imaging and catheter-based goals within the CMR scanner.
• Comparison with traditional combined approach involving separate CMR and fluoroscopy-guided catheterization.

Main Results:

• Successful iCMR pre-Fontan evaluations in 56 patients (96% without complications).
• 11 patients (20%) completed the entire study within the MRI suite with no radiation.
• Higher radiation dose observed in the traditional combined approach compared to iCMR, despite similar intervention rates.

Conclusions:

• iCMR is a safe and feasible method for comprehensive cardiovascular assessment in children before Fontan palliation.
• iCMR allows for reduced or no radiation exposure and fewer anesthetic inductions.
• The iCMR approach leads to minimal procedure-related complications and efficient single-anesthesia evaluation.