Key result
Cardiac CTA achieves 100% agreement with catheter angiography for significant pre-Fontan anatomical findings.
Why the study?
Although conventional catheter angiography is the reference standard for hemodynamic evaluation before Fontan completion, cardiac computed tomography angiography has emerged as a tool for anatomical assessment, warranting evaluation of their complementary roles.
Does cardiac CTA provide comparable anatomical and hemodynamic information to CCA before Fontan completion in pediatric patients with single-ventricle physiology?
Observational (n=32)
No
Does cardiac CTA provide comparable anatomical and hemodynamic information to CCA before Fontan completion in pediatric patients with single-ventricle physiology?
Cardiac CTA provides comprehensive anatomical assessment complementary to conventional catheter angiography before Fontan completion, though CCA remains necessary for hemodynamic evaluation.
Answers are grounded in this paper and cite their sources.
May support CTA for pre-Fontan anatomy in single-ventricle patients; leaves open whether it can reduce CCA use.
Background: In congenital heart disease patients with single-ventricle physiology, accurate anatomical and hemodynamic evaluation prior to the Fontan completion procedure is critical for surgical planning and long-term outcomes. Although conventional catheter angiography (CCA) remains the reference standard for hemodynamic evaluation, cardiac computed tomography angiography (CTA) has emerged as an increasingly valuable tool for anatomical assessment in the preoperative evaluation of Fontan candidates. Objective: To compare the anatomical and hemodynamic information provided by CTA and CCA before Fontan completion and to evaluate their complementary roles in the preoperative assessment of pediatric patients with single-ventricle physiology. Methods: This single-center, retrospective study included 32 patients with single-ventricular physiology who underwent staged palliation and Fontan completion. All patients underwent TTE and CCA. Twenty-three patients also underwent cardiac CTA with three-dimensional reconstruction. Anatomical and hemodynamic findings obtained from CTA and CCA were compared, with particular focus on extracardiac anatomy, collateral vessels, and findings relevant to surgical planning. Results: Cardiac CTA showed concordant detection of clinically significant anatomical findings identified by CCA, while providing a more comprehensive assessment of extracardiac anatomy. While CCA remained superior for hemodynamic assessment, CTA provided more comprehensive evaluation of extracardiac anatomy. In this cohort, catheterization findings did not alter the planned surgical strategy (0%, 95% CI 0–10.9%). Conclusions: CTA may provide valuable anatomical information for preoperative assessment and surgical planning; however, larger prospective multicenter studies are required before less invasive pre-Fontan evaluation strategies can be considered.
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Çevlik et al. (2026) conducted an observational in Single-ventricle physiology (n=32). Cardiac computed tomography angiography (CTA) vs. Conventional catheter angiography (CCA) was evaluated on Agreement for clinically significant anatomical findings (κ = 1.00, p=<0.001). Cardiac CTA showed perfect agreement with conventional catheter angiography in detecting clinically significant anatomical findings (κ = 1.00, p < 0.001) before Fontan completion.
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