- Oral presentation
- Open Access
Imaging insights from the bifurcated Y-graft Fontan procedure
© Slesnick et al. 2016
- Published: 27 January 2016
- Compute Tomography Angiography
- Cardiac Magnetic Resonance
- Branch Pulmonary Artery
- Pulmonary Artery Stenosis
- Gadolinium Contrast Agent
Since 2010, a novel modification to the Fontan procedure has been utilized at our institution where the inferior vena cava / hepatic veins are connected to the branch pulmonary arteries (PA) using a commercially available bifurcated Y-graft. This anatomy presents unique challenges for non-invasive imaging. We sought to evaluate our experience imaging these patients.
All patients' medical records were retrospectively reviewed. Echocardiography, cardiac magnetic resonance (CMR) and computed tomography angiography (CTA) images were analyzed by a single reviewer. Post-operative anatomy and dynamic physiologic assessments were performed.
Cross sectional imaging is essential in children undergoing bifurcated Y-graft Fontan, as the Y-arm insertions onto the branch PA's cannot be reliably visualized by echocardiography. A combination of phase contrast, time resolved CEMRA, and 3D IR GRE CMR imaging provide optimal anatomic and hemodynamic evaluation. Mild graft and PA stenoses were common, but typically had minimal affect on distribution of inferior systemic venous flow. Patients with central branch PA stenosis are more susceptible to adverse streaming of the BDG into a branch Y-arm resulting in competitive flow.
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