Skip to main content Accessibility help

Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

  • Arianna Di Molfetta (a1), Roberta Iacobelli (a2), Silvia Rotella (a3), Maria G. Gagliardi (a2), Antonio Amodeo (a2), Roberto Formigari (a2), Luciano Pasquini (a2), Salvatore F. Iorio (a2) and Paolo Guccione (a2)...



Some authors advocate the use of a dedicated formula to predict the Fontan pressure starting from pre-Fontan catheterisation data. This paper aims at testing the predictive value of the mentioned formula through a retrospective clinical study.

Methods and Results:

Pre-Fontan catheterisation data and Fontan pressure measured at the completion were retrospectively collected. Pre-Fontan data were used to calculate the predicted pressure in the Fontan system. The predicted values were compared to the Fontan pressure measured at the Fontan completion and with the needs for fenestration. One hundred twenty-four Fontan patients were retrospectively enrolled (At Fontan: median age 30.73 [24.70–37.20] months, median weight 12.00 [10.98–14.15] kg). Fontan conduit was fenestrated in 78 patients. A poor correlation (r2 = 0.05128) between the measured and predicted data for non-fenestrated patients was observed. In the case of Fontan-predicted pressure <17.59 mmHg, the formula identified a good short-term clinical outcome with a sensitivity of 92%.


The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. As the pressure into the Fontan system is determined by multiple factors, the tested formula could be an additional data in a multi-parametric approach.


Corresponding author

Author for correspondence: Arianna Di Molfetta, MScBME, MD, PhD, Department of Cardiac Surgery, Policlinico Agostino Gemelli, Largo Agostino Gemelli, 8, Rome, Italy. Tel: 0039-3496775951; Fax: +39 0630155818; E-mail:


Hide All

All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.



Hide All
1. Choussat, A, Fontan, F, Cesse, P, et al. Selection criteria for Fontan’s procedure. In: Anderson, RH, Shinebourne, ES (eds). Paediatric Cardiology, 1977. Churchill Livingstone, Edinburgh, 1978: 559566.
2. Park, I, Nakazawa, M, Imai, Y, Sawatari, K, Momma, K. Prediction of quality of life at long-term follow-up after Fontan operation by scoring risk factors. Jpn Circ J 1994; 58: 646652.
3. Prakash, A, Khan, MA, Hardy, R, et al. A new diagnostic algorithm for assessment of patients with single ventricle before a Fontan operation. J Thorac Cardiovasc Surg 2009; 138: 917923.
4. Planché, C, Serraf, A, Bruniaux, J, et al. Preoperative evaluation of pulmonary vascular resistance by cavo-pulmonary bypass. Value of atrio- and cavo-pulmonary diversions. Petit J Arch Mal Coeur Vaiss 1992; 85: 577581.
5. Nicoson, SC, Steven, JM. Anesthesia for the patient with a single ventricle. In: Anesthesia for Congenital Heart Disease. DOI: 10.1002/9781118768341.ch25.
6. Mendoza, A, Albert, L, Ruiz, E, et al. Fontan operation. Hemodynamic factors associated with postoperative outcomes. Rev Esp Cardiol 2012; 65: 356362.
7. Gentles, TL, Mayer, JE Jr., Gauvreau, K, et al. Fontan operation in five hundred consecutive patients: factors influencing early and late outcome. J Thorac Cardiovasc Surg 1997; 114: 376391.
8. Driscoll, DJ, Offord, KP, Feldt, RH, et al. Five to fifteen year follow-up after Fontan operation. Circulation 1992; 85: 469496.
9. Kaulitz, R, Ziemer, G, Luhmer, I, Kallfelz, H-C. Modified Fontan operation in functionally univentricular hearts: preoperative risk factors and intermediate results. J Thorac Cardiovasc Surg 1996; 112: 658664.
10. Cazzaniga, M, Fernández Pineda, L, Villagrá, F, et al. Operación modificada de Fontan o variantes efectuadas en un solo tiempo quirúrgico. Determinantes de la mortalidad. Rev Esp Cardiol 2002; 55: 391412.
11. Trezzi, M, Cetrano, E, Giannico, S, et al. Long-term outcomes after extracardiac Fontan takedown to an intermediate palliative circulation. Ann Thorac Surg 2018; 105: 599605
12. Salvin, JW, Scheurer, MA, Laussen, PC, et al. Factors associated with prolonged recovery alter the Fontan operation. Circulation 2008; 118: S171S176.
13. Banka, P, McElhinney, DB, Bacha, EA, et al. What is the clinical utility of routine cardiac catheterization before a Fontan operation? Pediatr Cardiol 2010; 31: 977985. doi: 10.1007/s00246-010-9736-3.
14. Uemura, H, Yagihara, T, Kawashima, Y, et al. What factors affect ventricular performance after a Fontan-type operation? J Thorac Cardiovasc Surg 1995; 110: 405415.
15. Hirsch, JC, Goldberg, C, Bove, EL, et al. Fontan operation in the current era: a 15-year single institution experience. Ann Surg 2008; 248: 402410.
16. Harada, Y, Uchita, S, Sakamoto, T, et al. Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit? Interact Cardiovasc Thorac Surg 2009; 9: 5054.
17. Albert, DC, Del Cerro, MJ, Carrasco, JI, Portela, F. Actualización en cardiología pediátrica y cardiopatías congénitas: técnicas de imagen, hipertensión arterial pulmonar, tratamientos híbridos y quirúrgicos. Rev Esp Cardiol 2011; 64: 5965.
18. Senzaki, H, Isoda, T, Ishizawa, A, Hishi, T. Reconsideration of criteria for the Fontan operation. Influence of pulmonary artery size on postoperative hemodynamics of the Fontan operation. Circulation 1994; 89: 11961202.
19. Bridges, ND, Farrell, PE Jr., Pigott, JD 3rd, Norwood, WI, Chin, AJ. Pulmonary artery index. A non predictor of operative survival in patients undergoing modified Fontan repair. Circulation 1989;80: I2161221.
20. Adachi, I, Yagihara, T, Kagisaki, K. Preoperative small pulmonary artery did not affect the midterm results of Fontan operation. Eur J Cardiothorac Surg 2007; 32: 156162.


Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

  • Arianna Di Molfetta (a1), Roberta Iacobelli (a2), Silvia Rotella (a3), Maria G. Gagliardi (a2), Antonio Amodeo (a2), Roberto Formigari (a2), Luciano Pasquini (a2), Salvatore F. Iorio (a2) and Paolo Guccione (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed