1. Absence of Pulmonary Artery Growth After Fontan Operation and Its Possible Impact on Late Outcome 
Stanislav Ovroutski, MD, Peter Ewert, MD, PhD, Vladimir Alexi-Meskishvili, MD, PhD, Katinka Hölscher, Oliver Miera, MD, Björn Peters, MD, Roland Hetzer, MD, PhD, Felix Berger, MD, PhD 
The Annals of Thoracic Surgery 
Volume 87, Issue 3, Pages (March 2009)
DOI: /j.athoracsur
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(A) Angiogram of the cavopulmonary anastomosis and pulmonary arteries before Fontan operation. The vessel diameter and the body surface area (BSA) are shown. Stenosis of the central part of left pulmonary artery (LPA) is visible. The peripheral pulmonary vessels are well developed. The pulmonary artery index (Nakata index; [π × (RPA2 + LPA2)/4]/BSA mm2/m2) is 158 mm2m2; the total lower lobe index ([π × (RLLA2 + LLLA2)/4]/BSA mm2/m2) is 145 mm2/m2. (B) The same patient 9 years after Fontan operation with additional enlargement of the central left pulmonary artery. Heart catheterization was performed because of the first episode of protein-losing enteropathy. No local stenosis of the pulmonary arteries with very low pulmonary indices (pulmonary artery [Nakata] index = 81 mm2/m2; total lower lobe index = 89 mm2/m2) were found. (LLLA = left lower lobe artery; RLLA = right lower lobe artery; RPA = right pulmonary artery.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Changes in Nakata index (pulmonary artery index [PAI]) and lower lobe index (LLI) of the pulmonary arteries during follow-up. Box-plot diagram demonstrates a significant decrease in the pulmonary artery index as well as the lower lobe index according to the stable somatic development of the children and nondevelopment of the pulmonary arteries.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Scatter-diagram shows significant decrease in the pulmonary artery index (PAI; Nakata index) of the central pulmonary arteries according to the duration of the follow-up. The lowest pulmonary artery index is to be noted in the patients with longest follow-up.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Correlation between low pulmonary artery index (PAI) and Fontan outcome. Block diagram shows significant differences in the long-term postoperative outcome between patients with low pulmonary artery index (<150 mm2/m2) and those with pulmonary artery index greater than 150 mm2/m2. In patients with pulmonary artery index less than 150 mm2/m2 at the end of the follow-up, unfavorable outcome was observed more frequently than in those with pulmonary artery index greater than 150 mm2/m2.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Changes in the pulmonary artery pressure (PAP) during the follow up. Black triangles indicate patients with low pulmonary artery index (PAI < 150 mm2/m2). (OP = operation.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions