{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T05:19:40Z","timestamp":1793337580288,"version":"4.5.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,4,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients with functional single ventricle (SV) are at risk for adverse outcomes after staged palliation from the superior cavopulmonary connection (SCPC) to the Fontan. Current pre\u2010Fontan assessment by cardiac magnetic resonance and cardiac catheterization includes measuring atrioventricular valve regurgitation, aortopulmonary collateral burden, and pressures. Four\u2010dimensional flow can quantify complex flows representing hemodynamic inefficiency. This study determined the clinical significance of kinetic energy (KE) and viscous energy loss in patients before the Fontan procedure using 4\u2010dimensional flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      This was a retrospective analysis of patients before the Fontan procedure who underwent ferumoxytol\u2010enhanced cardiac magnetic resonance and same\u2010day catheterization. Four\u2010dimensional flow data sets were analyzed using ITFlow (CardioFlowDesign) to measure KE\/viscous energy loss in the atrium, SV, and SCPC. A composite outcome was defined by rejected Fontan candidacy, prolonged hospitalization, lymphatic dysfunction, or heart failure. The relationship between these outcomes and KE\/viscous energy loss was assessed by bivariable and multivariable logistic regression analyses as appropriate. Sixty\u2010five patients (3.9\u00b11.5\u2009years, 0.64\u00b10.1 m\n                      <jats:sup>2<\/jats:sup>\n                      ) were included. Fifty (77%) proceeded to Fontan operation with median hospitalization time of 8.5 (interquartile range, 7\u201312.7) days. Twenty\u2010six (40%) experienced a composite outcome, including 9 with rejected candidacy. Lower SCPC flow was associated with an outcome (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.042). Meanwhile, higher SV KE and lower SCPC KE were independently associated with composite outcome (odds ratio, 3.63 [95% CI, 1.32\u201313.2];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.0263; odds ratio, 0.906 [95% CI, 0.814\u20130.980];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.0377). Higher SV KE and lower SCPC KE corresponded to significant atrioventricular valve regurgitation, higher aortopulmonary collateral burden, and higher cathetherization pressures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Four\u2010dimensional flow analysis provides insight into SV hemodynamics and is associated with short\u2010term outcomes. Future work will analyze the longitudinal implications for patients undergoing the Fontan procedure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.037949","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T08:14:55Z","timestamp":1743668095000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Discordances in Kinetic Energy Between the Superior Cavopulmonary Connection and Single Ventricle Are Associated With\u00a0Suboptimal Fontan Outcomes: A Pre\u2010Fontan 4\u2010Dimensional Flow Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5897-6132","authenticated-orcid":false,"given":"Jacqueline","family":"Contento","sequence":"first","affiliation":[{"name":"Children\u2019s National Hospital","place":["Washington, 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