Another role of imaging could be to decide if the ventricular volumes and functions still support the patient proceeding down the single ventricle pathway or if the patient is a candidate for a 1.5-ventricle or 2-ventricle repair. A crucial role of imaging in this setting is to demonstrate the pulmonary arterial anatomy, including the distal branches, to evaluate for anatomic obstruction that may impact the Glenn circulation. Knowledge of branch pulmonary artery anatomy adds significantly to the surgical planning process. A complete anatomic assessment of the branch pulmonary arteries to detect stenoses should be performed in all patients undergoing stage 2 repair. Arteriography Coronary with Ventriculography Direct cardiac catheterization and angiography has historically been the standard of care for assessing hemodynamic and anatomic suitability before stage 2 repair. Its routine use is decreasing since the advent of advanced CMR and CT methods. The use of catheter angiography is supported in the literature [41]; for example, in patients with pulmonary atresia and intact ventricular septum, the diagnosis of RV dependent coronary circulation is established by RV and selective coronary angiography and has an important impact upon surgical approach. Congenital or Acquired Heart Disease One of the advantages of cardiac catheterization before bidirectional Glenn operation is that anomalies such as systemic-to-pulmonary collateral vessels and aortic coarctation can be palliated using transcatheter techniques. It particularly pertinent for those who have undergone prior stage 1 palliation with aortic arch reconstruction, which is associated with a 10% to 15% incidence of recurrent coarctation at the distal end of the arch reconstruction [42]. Arteriography Pulmonary Cardiac catheterization is useful for the imaging evaluation before stage 2 repair to assess pulmonary arterial anatomy before surgical repair [41].
Congenital or Acquired Heart Disease. Another role of imaging could be to decide if the ventricular volumes and functions still support the patient proceeding down the single ventricle pathway or if the patient is a candidate for a 1.5-ventricle or 2-ventricle repair. A crucial role of imaging in this setting is to demonstrate the pulmonary arterial anatomy, including the distal branches, to evaluate for anatomic obstruction that may impact the Glenn circulation. Knowledge of branch pulmonary artery anatomy adds significantly to the surgical planning process. A complete anatomic assessment of the branch pulmonary arteries to detect stenoses should be performed in all patients undergoing stage 2 repair. Arteriography Coronary with Ventriculography Direct cardiac catheterization and angiography has historically been the standard of care for assessing hemodynamic and anatomic suitability before stage 2 repair. Its routine use is decreasing since the advent of advanced CMR and CT methods. The use of catheter angiography is supported in the literature [41]; for example, in patients with pulmonary atresia and intact ventricular septum, the diagnosis of RV dependent coronary circulation is established by RV and selective coronary angiography and has an important impact upon surgical approach. Congenital or Acquired Heart Disease One of the advantages of cardiac catheterization before bidirectional Glenn operation is that anomalies such as systemic-to-pulmonary collateral vessels and aortic coarctation can be palliated using transcatheter techniques. It particularly pertinent for those who have undergone prior stage 1 palliation with aortic arch reconstruction, which is associated with a 10% to 15% incidence of recurrent coarctation at the distal end of the arch reconstruction [42]. Arteriography Pulmonary Cardiac catheterization is useful for the imaging evaluation before stage 2 repair to assess pulmonary arterial anatomy before surgical repair [41].