摘要
Objectives This study was designed to determine if a subset of patients who ha ve undergone bidirectional cavopulmonary anastomosis could be identified in whic h catheterization was of little benefit before completion of the Fontan procedur e. Background Diagnostic evaluation before Fontan procedure has typically includ ed cardiac catheterization. However, the overall management strategy for patient s with functional single ventricle has evolved to include staging bidirectional cavopulmonary anastomosis in most, and it has become uncommon to exclude patient s from Fontan based on catheterization data. Methods Patients who underwent bidi rectional cavopulmonary anastomosis and had complete echocardiograms and cathete rizations within three months of each other between January 1992 and October 199 7 were evaluated with a series of clinical and echocardiographic characteristics to identify a subset in whom catheterization was predicted to be of little adde d value (“no-cath”group). The predictive value and sensitivity of these crite ria in excluding patients who required additional intervention, were excluded fr om Fontan, or died within 30 days of Fontan was determined. Results A total of 9 9 patients who underwent bidirectional cavopulmonary anastomosis at 6.7 months ( range 2.9 months to 14 years) were studied; 46 met criteria for the “no-cath” group. Noninvasive criteria stratified all patients who died (n=5) or did not pr oceed to Fontan (n =1) and 9 of 11 who required additional interventions to the “cath”group. Thus, the negative predictive value of these criteria was 93%. C onclusions Our data suggest that catheterization before Fontan could be avoided in a large percentage of patients without adversely affecting outcome; prospecti ve evaluation of this strategy is warranted.
Objectives This study was designed to determine if a subset of patients who ha ve undergone bidirectional cavopulmonary anastomosis could be identified in whic h catheterization was of little benefit before completion of the Fontan procedur e. Background Diagnostic evaluation before Fontan procedure has typically includ ed cardiac catheterization. However, the overall management strategy for patient s with functional single ventricle has evolved to include staging bidirectional cavopulmonary anastomosis in most, and it has become uncommon to exclude patient s from Fontan based on catheterization data. Methods Patients who underwent bidi rectional cavopulmonary anastomosis and had complete echocardiograms and cathete rizations within three months of each other between January 1992 and October 199 7 were evaluated with a series of clinical and echocardiographic characteristics to identify a subset in whom catheterization was predicted to be of little adde d value (“no-cath”group). The predictive value and sensitivity of these crite ria in excluding patients who required additional intervention, were excluded fr om Fontan, or died within 30 days of Fontan was determined. Results A total of 9 9 patients who underwent bidirectional cavopulmonary anastomosis at 6.7 months ( range 2.9 months to 14 years) were studied; 46 met criteria for the “no-cath” group. Noninvasive criteria stratified all patients who died (n=5) or did not pr oceed to Fontan (n =1) and 9 of 11 who required additional interventions to the “cath”group. Thus, the negative predictive value of these criteria was 93%. C onclusions Our data suggest that catheterization before Fontan could be avoided in a large percentage of patients without adversely affecting outcome; prospecti ve evaluation of this strategy is warranted.
