Ginde Salil, Goot Benjamin H, Frommelt Peter C
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Curr Opin Cardiol. 2017 Sep;32(5):521-528. doi: 10.1097/HCO.0000000000000422.
Survival after the Fontan procedure for palliation of single ventricle congenital heart disease has improved. However, adults with Fontan circulation are at risk for several complications including heart failure, thromboembolism, and protein-losing enteropathy. This review discusses the role of noninvasive imaging for surveillance and early detection of anatomic and functional abnormalities of the Fontan circulation that can impact the risk for Fontan failure over time.
Echocardiography is the first-line imaging modality for the adult Fontan patient. Use of established techniques, such as tissue Doppler imaging, and newer techniques, such as myocardial deformation and three-dimensional imaging, has improved the ability of echocardiography to serially assess ventricular and valvular function in this population. Strain imaging, in particular, is effective for early detection of subclinical ventricular dysfunction, is reproducible and can be incorporated into a routine clinical echocardiography protocol. Cardiac magnetic resonance (CMR) imaging complements echocardiography and overcomes the limitation of poor acoustic windows in adult patients, especially with regards to visualizing the cavopulmonary anastomoses and pulmonary arteries. High resolution imaging with CMR provides reliable assessment of ventricular size and function. Novel techniques utilizing CMR, such as computational fluid dynamics, have provided important insights into Fontan fluid dynamics, and the impact of Fontan geometry on flow efficiency through the circulation.
Recent advances in echocardiography and CMR have improved detection of structural and functional abnormalities in adults with Fontan circulation and are essential in monitoring for complications in this growing population.
用于单心室先天性心脏病姑息治疗的Fontan手术的术后生存率已有所提高。然而，处于Fontan循环的成人有发生多种并发症的风险，包括心力衰竭、血栓栓塞和蛋白丢失性肠病。本综述讨论了无创成像在监测和早期发现Fontan循环的解剖和功能异常方面的作用，这些异常可能会随着时间的推移影响Fontan手术失败的风险。
超声心动图是成年Fontan患者的一线成像方式。使用组织多普勒成像等成熟技术以及心肌变形和三维成像等新技术，提高了超声心动图对该人群心室和瓣膜功能进行系列评估的能力。特别是应变成像，对于早期发现亚临床心室功能障碍有效、可重复，并且可以纳入常规临床超声心动图检查方案。心脏磁共振（CMR）成像补充了超声心动图，并克服了成年患者声窗不佳的局限性，尤其是在观察腔肺吻合口和肺动脉方面。CMR的高分辨率成像可提供对心室大小和功能的可靠评估。利用CMR的新技术，如计算流体动力学，为Fontan流体动力学以及Fontan几何形状对循环血流效率的影响提供了重要见解。
超声心动图和CMR的最新进展改善了对处于Fontan循环的成人结构和功能异常的检测，对于监测这一不断增长的人群中的并发症至关重要。
