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Role of cardiac MRI in the prediction of pre-Fontan end-diastolic ventricular pressure

Published online by Cambridge University Press:  28 December 2021

Alessandra Pizzuto*
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Lamia Ait-Ali
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy Institute of Clinical Physiology, National Research Council (NRC), Massa, Italy
Chiara Marrone
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Stefano Salvadori
Institute of Clinical Physiology, National Research Council (NRC), Massa, Italy
Magdalena Cuman
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Vitali Pak
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Giuseppe Santoro
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Pierluigi Festa
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Author for correspondence: A. Pizzuto, MD, Foundation “G. Monasterio”, Pediatric Cardiology and GUCH Unit, Heart Hospital “G. Pasquinucci”, Via Aurelia Sud, Massa 54100, Italy. Tel: +3933341596865; Fax: +390585493616. E-mail:



Growing evidence has emphasised the importance of ventricular performance in functionally single-ventricle patients, particularly concerning diastolic function. Cardiac MRI has been proposed as non-invasive alternative to pre-Fontan cardiac catheterisation in selected patients.

Aim of the study:

To identify clinical and cardiac magnetic resonance predictors of high pre-Fontan end-diastolic ventricular pressure.


In a retrospective single-centre study, 38 patients with functionally univentricular heart candidate for Fontan intervention, who underwent pre-Fontan cardiac catheterisation, beside a comprehensive cardiac MRI, echocardiographic, and clinical assessment were included. Medical and surgical history, cardiac magnetic resonance, cardiac catheterisation, echocardiographic, and clinical data were recorded. We investigated the association between non-invasive parameters and cardiac catheterisation pre-Fontan risk factors, in particular with end-diastolic ventricular pressure. Moreover, the impact of conventional invasive pre-Fontan risk factor on post-operative outcome as also assessed.


Post-operative complications were associated with higher end-diastolic ventricular pressure and Mayo Clinic indexes (p < 0.01 and p = 0.05, respectively). At receiver operating characteristic curve analysis end-diastolic ventricular pressure ≥ 10.5 mmHg predicted post-operative complications with a sensitivity of 75% and specificity of 88% (AUC: 0.795, 95% CI 0.576;1.000, p < 0.05). At multivariate analysis, both systemic right ventricle (OR: 23.312, 95% CI: 2.704–200.979, p < 0.01) and superior caval vein indexed flow (OR: 0.996, 95% CI: 0.993–0.999, p < 0.05) influenced end-diastolic ventricular pressure ≥ 10.5 mmHg.


A reduced superior caval vein flow, evaluated at cardiac magnetic resonance, is associated with higher end-diastolic ventricular pressure a predictor of early adverse outcome in post-Fontan patients.

Original Article
© The Author(s), 2022. Published by Cambridge University Press

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Alessandra Pizzuto and Lamia Ait-Ali have equally collaborated to the work.


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