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

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Abstract

In 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 cohort) 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 = 0.039). Our study presents a specialized approach for patients initially deemed unsuitable for Fontan due to elevated pulmonary artery pressures. We were able to successfully complete the Fontan procedure in the majority of these high-risk cases after temporary balloon occlusion test.

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Funding

This study was not funded by any internal or external funds.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey

    Ibrahim Halil Demir, Ahmet Celebi, Dursun Muhammed Ozdemir, Emine Hekim Yilmaz, Mustafa Orhan Bulut, Murat Surucu & Ilker Kemal Yucel

  2. Department of Pediatric Cardiovascular Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Oktay Korun

  3. Department of Pediatric Cardiovascular Surgery, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Numan Ali Aydemir

Authors
  1. Ibrahim Halil Demir
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  2. Ahmet Celebi
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  3. Dursun Muhammed Ozdemir
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  4. Emine Hekim Yilmaz
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  5. Mustafa Orhan Bulut
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  6. Murat Surucu
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  9. Ilker Kemal Yucel
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Contributions

IHD, IKY, DMO, and AC: conceptualization; IHD, IKY, and AC: methodology; IHD, IKY, EHY, and OK: formal analysis and investigation; IHD, IKY, DMO, MS, OK, and MOB: writing—original draft preparation; IHD, MS, IKY, OK, and DMO: writing—review and editing; IKY, IHD, NAA, and AC: supervision.

Corresponding author

Correspondence to Ilker Kemal Yucel.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written and informed consent were taken from the parents before the interventional procedures.

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Demir, I.H., Celebi, A., Ozdemir, D.M. et al. Utility of Balloon Occlusion Testing in Determining Fontan Suitability Among Patients with Elevated Pulmonary Artery Pressure and Additional Antegrade Pulmonary Blood Flow. Pediatr Cardiol 45, 632–639 (2024). https://doi.org/10.1007/s00246-023-03380-x

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