Diagnostic assessment before fontan operation in patients with bidirectional cavopulmonary anastomosis: are noninvasive methods sufficient?

Cath still standard: Much info can be obtained from advanced imaging like cardiac MRI & ct angiography. Yet cardiac cath remains the standard of care for a pre-fontan evaluation, allowing an assessment of pulmonary vascular resistance and ventricular end-diastolic pressures, important criteria not otherwise obtainable. Collateral circulation & pa anatomy can be assessed-->cath intervention also possible in some cases.

Not traditionally: I don't believe so. There may be some programs that will experiment with noninvasive pre-fontan imaging, but i believe that this is risky. The pressures are obtainable only by catheterization and this data may change the operation (e.g., whether or not to fenestrate the fontan to allow a pop-off of blue blood to increase the cardiac output.) catheterization also allows presurgical interventions.