Utility of Balloon Occlusion Testing in Determining Fontan Suitability Among Patients with Elevated Pulmonary Artery Pressure and Additional Antegrade Pulmonary Blood Flow

AbstractIn individuals with a single ventricle undergoing evaluation before Fontan surgery, the presence of excessive pulmonary blood flow can contribute to increased pulmonary artery pressure, notably in those who had a Glenn procedure with antegrade pulmonary flow. 28 patients who had previously undergone Glenn anastomosis with antegrade pulmonary blood flow (APBF) and with elevated mean pulmonary artery (mPAP) pressure  >  15 mmHg in diagnostic catheter angiography were included in the study. After addressing other anatomical factors that could affect pulmonary artery pressure, APBF was occluded with semi-compliant, Wedge or sizing balloons to measure pulmonary artery pressure accurately. 23 patients (82% of the c ohort) advanced to Fontan completion. In this group, median mPAP dropped from 20.5 (IQR 19–22) mmHg to 13 (IQR 12–14) mmHg post-test (p <  0.001). Median PVR post-test was 1.8 (IQR 1.5–2.1) WU m2. SpO2 levels decreased from a median of 88% (IQR 86% –93%) pre-test to 80% (IQR 75%–84%) post-test (p <  0.001). In five patients, elevated mPAP post-test occlusion on diagnostic catheter angiography led to non-completion of Fontan circulation. In this group, median pre- and post-test mPAP were 23 mmHg (IQR 21.5–23.5) and 19 mmHg (IQR 18.5–20), respectively (p = 0.038). Median post-test PVR was 3.8 (IQR 3.6–4.5) WU m2. SpO2 levels decreased from a median of 79% (IQR 76% –81%) pre-test to 77% (IQR 73.5%-80%) post-test (p =...
Source: Mammalian Genome - Category: Genetics & Stem Cells Source Type: research