Asymmetric calcification of the extracardiac Fontan conduit: Quantitative insights from long-term computed tomography...

The long-term structural integrity of expanded polytetrafluoroethylene (ePTFE) conduits used for extracardiac total cavopulmonary connection (EC-TCPC) is not well established. Although conduit calcification has been reported, quantitative data remain limited. We retrospectively analyzed 20 EC-TCPC patients who underwent computed tomography more than 5 years after Fontan completion (median: 13.7 years). Cross-sectional area (CSA) was measured at five sites and expressed as a percentage of the original CSA (%CSA), and calcification volume was indexed to body surface area. Median values of mean and minimum %CSA were 74.0% and 65.5%, respectively. %CSA correlated inversely with calcification volume index (ρ = -0.47, P = 0.04). Calcification was greater along the lesser curvature than the greater curvature (0.66 vs. 0.20 mm³/m², P < 0.001). These findings suggest curvature-specific vulnerability in ePTFE conduits and support the importance of long-term structural surveillance in Fontan patients.