Advances in Diagnostic and Interventional Catheterization in Adults with Fontan Circulation

TL;DR

This paper reviews recent advances in catheterization techniques and treatments for adults with Fontan circulation, a complex heart condition.

Contribution

The paper provides a detailed review of diagnostic and interventional catheterization tools and strategies for managing Fontan circulation complications.

Findings

Combined catheterization with cardiopulmonary exercise testing improves hemodynamic profiling in Fontan patients.

Percutaneous treatments now address obstructive issues and lymphatic disorders in Fontan circulation.

Transcatheter edge-to-edge repair is a novel strategy for managing atrioventricular valve issues.

Abstract

Over the past five decades, the Fontan procedure has been developed to improve the life expectancy of patients with congenital heart defects characterized by a functionally single ventricle. The Fontan circulation aims at redirecting systemic venous return to the pulmonary circulation in the absence of an impelling subpulmonary ventricle, which makes this physiology quite fragile and leads to several long-term complications. Despite the importance of hemodynamic assessment through cardiac catheterization in the management and follow-up of these patients, a thorough understanding of the ultimate functioning of this type of circulation is lacking, and the interpretation of the hemodynamic data is often complex. In recent years, new tools such as combined catheterization with cardiopulmonary exercise testing have been incorporated to improve the understanding of the hemodynamic profile of these patients. Furthermore, extensive percutaneous treatment options have been developed, addressing issues ranging from obstructive problems in Fontan pathway and acquired shunts through compensatory collaterals to the percutaneous treatment of lymphatic circulation disorders and transcatheter edge-to-edge repair of atrioventricular valves. The aim of this review is to detail the various tools used in cardiac catheterization for patients with Fontan circulation, analyze different percutaneous treatment strategies, and discuss the latest advancements in this field.

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