COMPLETE ECHOCARDIOGRAPHIC ASSESSMENT OF THE POSTOPERATIVE FONTAN PATIENT

Postoperative echocardiographic assessment of the Fontan patient shoul d include both anatomical and physiological parameters. Anatomical fea tures to be defined with two-dimensional (2-D) imaging should include a detailed demonstration, of the atriopulmonary connection, the pulmon ary arterial tree, and the pulmonary venous return. Color flow imaging should be included to provide visual clues for abnormal flow patterns to suggest obstruction or residual shunts. Intracardiac thrombi, peri cardial, and pleural effusions should be excluded. Inadequate transtho racic images should mandate the use of transesophageal imaging to adeq uately detail the extracardiac anatomy and connections. Physiological parameters should include M-mode and 2-D studies to assess ventricular systolic function. and the degrees of ventricular hypertrophy. Additi onally, extensive pulsed Doppler examination should be performed to de termine the systemic venous, pulmonary arterial, pulmonary venous, and atrioventricular (AV) valve inflow patterns. Significant information, detailing abnormalities of pulmonary artery flow and ventricular dias tolic function parameters can be obtained. Doppler color flow imaging should be obtained to assess competency of AV and semilunar valves. Co ntinuous-wave Doppler should be utilized to determine the presence and severity of aortic outflow obstruction. Complete echocardiographic ev aluation should include all facets of echocardiographic study as detai led previously.