Cardiac output measurement in Fontan circulation: Challenges and potential emerging solutions

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Accurate cardiac output (CO) assessment is crucial for managing Fontan patients' hemodynamic status.
• Established CO measurement techniques (Fick, thermodilution, echocardiography, MRI) have significant limitations in Fontan physiology.
• Noninvasive impedance cardiography (ICG) presents a potential alternative but requires validation in Fontan patients.

Purpose of the Study:

• To review the limitations of current CO assessment methods in Fontan patients.
• To highlight the potential of impedance cardiography (ICG) as a noninvasive CO monitoring tool.
• To emphasize the need for further research and validation of ICG in pediatric and adult Fontan populations.

Main Methods:

• Literature review of existing cardiac output assessment methodologies.
• Analysis of Fontan-specific anatomical and physiological challenges impacting CO measurement.
• Evaluation of the current evidence and limitations of impedance cardiography in Fontan patients.

Main Results:

• Traditional CO methods face significant challenges due to Fontan's unique anatomy and physiology.
• Impedance cardiography (ICG) offers a promising noninvasive approach but lacks extensive validation in this cohort.
• There is a critical need for refining and validating ICG for reliable CO monitoring in Fontan patients.

Conclusions:

• Existing CO measurement techniques are inadequate for Fontan patients.
• Impedance cardiography (ICG) requires rigorous validation to become a reliable tool for Fontan CO assessment.
• Further research is essential to improve hemodynamic management in Fontan patients through validated noninvasive monitoring.