Fig. 6.

Cardiovascular complications of Fontan palliation in a boy with hypoplastic left heart syndrome. a–d CT angiography at 4 years old. Coronal (a) and sagittal (b) early postoperative images after Fontan completion show residual pleural effusions, stenosis of the left pulmonary artery (arrow in a) and narrowing of the aortic arch anastomosis (arrow in b). Angiography with balloonplasty of the left pulmonary artery shows a stent (c) and the aortic arch anastomosis (d). e–g Five years later at 9 years of age, the boy presented with echocardiographic findings of a subaortic stenosis confirmed on CT angiography in axial (e), coronal (f) and volume-rendered reconstruction (g) images, revealing the subaortic stenosis (arrows) caused by muscular hypertrophy. h, i Additional functional information from cardiac MRI. Cine 2-D steady-state free precession four-chamber (h) and short-axis (i) views show volumetric measurements. j–m Contrast-enhanced MR angiography in coronal (j) and volume-rendered (k) images. Note the thin native aorta (thick arrows) and the subaortic stenosis (thin arrow in k). Through-plane velocity-encoded phase-contrast measurement at the subaortic level (l) reveals a moderate increased velocity and a small regurgitation (m). n, o Consecutive MR exam of the liver. Axial contrast-enhanced T1-W gradient echo sequence (n) and T2-weighted sequence (o) reveal a slightly enlarged liver with peripheral enhancement pattern and perisinusoidal sparing, consistent with liver congestion