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Pulsatility Index in Different Modifications of Fontan Palliation: An Echocardiographic Assessment Publisher



Shabanian R1 ; Asbagh PA2 ; Sedaghat A1 ; Dadkhah M3 ; Esmaeeli Z1 ; Nikdoost A4 ; Ahani M5 ; Rahimzadeh M6 ; Dehestani A5 ; Navabi MA5
Authors
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Authors Affiliations
  1. 1. Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Pediatric Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Pediatric Cardiology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Pediatric Cardiology, Payambar Azam Hospital, Kerman University of Medical Sciences, Kerman, Iran
  5. 5. Department of Pediatric Cardiac Surgery, Children's Medical Center, Tehran University of Medical Sciences, 63 Gharib Street, Tehran, 1419733151, Iran
  6. 6. Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran

Source: Journal of Cardiovascular Imaging Published:2022


Abstract

BACKGROUND: Adding pulsation to the Fontan circulation might change the fate of patients palliated by this procedure. Our aim was to compare the pulsatility index (PI) of the pulmonary artery (PA) between the various modifications of Fontan palliation. METHODS: Doppler-derived PI was measured in PA branches of a cohort of 28 patients palliated by 6 modifications of Fontan procedure. A group of normal individuals was included for comparison. RESULTS: Atriopulmonary connection (APC) group had the highest PA branches PI and statistically was close to the PI of the normal individuals (right pulmonary artery [RPA] PI of 1.58 vs. 1.63; p = 0.99 and left pulmonary artery [LPA] PI of 1.54 vs. 1.68; p = 0.46, respectively). The lowest PA branches PI was seen in the group of extracardiac total cavopulmonary connection (RPA PI of 0.62 and LPA PI of 0.65). Other 4 modifications including the extracardiac conduit with oversewn pulmonary valve, extracardiac conduit with preserved adjusted antegrade flow, extracardiac conduit from inferior vena cava onto the rudimentary right ventricle and lateral tunnel had a mean “RPA and LPA” PI of “1.19 and 1.17”, “1.16 and 1.11”, “1.13 and 1.11”, “0.82 and 0.84”, respectively. The modified Dunnett's post hoc test has shown a significant statistical decline in PI of all modifications compared to the normal individuals except for the APC group. CONCLUSIONS: Fontan palliated patients in different groups of surgical modification showed a spectrum of Doppler-derived PI with the highest amounts belong to the groups of pulsatile Fontan. © 2022 Korean Society of Echocardiography.