ArticleJTCVS open2026
Changes in pulmonary artery size during and after staged extracardiac total cavopulmonary connection.
Article in JTCVS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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13 authors.
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Abstract
Background: Optimal development of the pulmonary arteries (PAs) is crucial for Fontan circulation. This study investigated longitudinal changes in PA size in patients who underwent staged Fontan palliation and analyzed their impact on outcomes. Methods: Serial PA angiograms at bidirectional cavopulmonary shunt (BCPS), extracardiac total cavopulmonary connection (TCPC), and after TCPC were reviewed. PA index (PAI), right and left PAI, and PA symmetry index were calculated, and serial changes were compared. Results: Among 391 patients, right BCPS was performed in 328 (83.9%). The median age at TCPC was 2.1 years (interquartile range: 1.7-2.6 years). The most frequent diagnosis was hypoplastic left heart syndrome, in 148 patients (37.9%). PAI did not change between BCPS and TCPC ( Conclusions: During the staged Fontan procedure, the left PAI decreased, whereas the PAI and right PAI remained stable or increased. A PA symmetry index <0.61 predicts mortality following TCPC. This progressive asymmetry in left-to-right PA size affects in-hospital morbidity and emphasizes the importance of achieving balanced PA growth prior to Fontan completion.
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