Fontan Pathway Growth: A Quantitative Evaluation of Lateral Tunnel and Extracardiac Cavopulmonary Connections Using Serial Cardiac Magnetic Resonance

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Fontan Pathway Growth: A Quantitative Evaluation of Lateral Tunnel and Extracardiac Cavopulmonary Connections Using Serial Cardiac Magnetic Resonance Maria Restrepo, BS, Lucia Mirabella, PhD, Elaine Tang, BEng, Christopher M. Haggerty, PhD, Reza H. Khiabani, PhD, Francis Fynn- Thompson, MD, Anne Marie Valente, MD, Doff B. McElhinney, MD, Mark A. Fogel, MD, Ajit P. Yoganathan, PhD The Annals of Thoracic Surgery Volume 97, Issue 3, Pages 916-922 (March 2014) DOI: 10.1016/j.athoracsur.2013.11.015 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Relationship between patient age (years) and the body surface area (BSA) (m2) for all the patients included in the study. (B) Relationship between the changes of age and BSA normalized to the variable value at the initial time point. Linear regression equations are indicated; p values indicate the regression significance. (T1 = initial scan.) The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Absolute and (B) normalized mean vessel diameters for the superior vena cava (SVC), left pulmonary artery (LPA), and right pulmonary artery (RPA) in the cohort, lateral tunnel (LT), and extracardiac (EC) subgroups. T1 (first scan) is shown in the open columns and T2 (second scan) in the solid ones. (∗ = p value <0.05.) The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Absolute and (B) normalized minimum, mean, and maximum Fontan pathway diameters for lateral tunnel (LT) and extracardiac (EC) subgroups. T1 [first scan] is shown in the open columns and T2 [second scan] in the solid ones. (∗ = p value <0.05.) The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Relationship between absolute mean Fontan pathway (FP) diameters (mm) and body surface area (BSA) (m2) in (A) lateral tunnel (LT) and (B) extracardiac (EC) patients. (Dashed red line = decreasing absolute diameter; solid black line = increasing absolute diameter.) The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Absolute and (B) normalized cross-sectional vessel areas for the Fontan pathway (FP) at the pulmonary artery (PA) bifurcation and the descending aorta (dAo). T1 (first scan) is shown in the open columns and T2 (second scan) in the solid ones. (∗ = p value <0.05.) The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A)Absolute and normalized mean flows for the cohort, and (B) the lateral tunnel (LT) and extracardiac (EC) groups. T1 (first scan) is shown in the open columns and T2 (second scan) in the solid ones. (Ao = aorta; LPA = left pulmonary artery; RPA = right pulmonary artery; SVC = superior vena cava; ∗ = p value <0.05.) The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Distance (in mm) between the geometry at the initial time point (color coded) and the latter time (translucent gray). (A) Top row shows extracardiac patients (EC1 through EC4); (B) bottom row shows lateral tunnel patients (LT1 to LT4). Patient’s age and body surface area (BSA) for each time point of the study are indicated. The Annals of Thoracic Surgery 2014 97, 916-922DOI: (10.1016/j.athoracsur.2013.11.015) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions