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. 2024 Oct 12.
doi: 10.1007/s00246-024-03651-1. Online ahead of print.

Comparison of Echocardiographically-Calculated Fontan Fenestration Gradient and Catheter-Based Measurement

Emily Noel Sanders  1 , Jim Zhongning Chen  2 , Timothy Nissen  3 , Joshua Daily  3 , Dala Zakaria  3 , Stephen Dalby  3 , Elijah Bolin  3
Affiliations

Comparison of Echocardiographically-Calculated Fontan Fenestration Gradient and Catheter-Based Measurement

Emily Noel Sanders et al. Pediatr Cardiol. .

Abstract

Background: Patients born with single ventricle anatomy typically undergo surgical palliation in three stages, culminating in the Fontan procedure. Assessment of flow across a Fontan fenestration by Doppler ultrasound theoretically allows for non-invasive estimation of the transpulmonary gradient (TPG). Our objective was to determine the relationship between Doppler-derived mean fenestration gradient (mFG) and direct catheter-based measurements of TPG in patients with fenestrated Fontans.

Methods: We performed a single-center retrospective cohort study of 59 patients with fenestrated Fontans completed between 2000 and 2022. The primary outcome was catheter-based measurement of TPG and the primary predictor was mFG from echo performed within 6 months of the catheterization. Linear regression and R2 were used to determine the relationship between predictors and outcomes.

Results: Catheter-based measurements of TPG and mFG were weakly correlated (R2 = 0.382, p < 0.001); the regression coefficient was 0.550, with a standard error of 0.09 for every increase in mFG (Cath TPG = 0.55 [mFG] + 1.92). mFG had a slightly better predictive relationship with cath-derived TPG in patients with systemic left ventricles with R2 of 0.47, p < 0.004.

Conclusion: mFG accounts for approximately 38% of the variance in catheter-derived TPG. Although mFG is non-invasive and intuitive, mFG in Fontan patients should be interpreted with caution and direct measurement by cardiac catheterization should be considered.

Keywords: Echocardiogram; Fontan; Pulmonary vascular resistance; Transpulmonary gradient.

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