Postural Cerebral Hypoperfusion Related to Brain Atrophy After a Modified Fontan Operation

Abstract

A brain CT in a 7-year-old girl who had a modified Fontan procedure 5 years earlier revealed cortical atrophy, especially in the frontal areas. Upright brain SPECT was performed because she had frequent episodes of headache and vomiting when standing that were relieved when she was recumbent. Brain SPECT revealed postural cerebral hypoperfusion in the frontal areas and basal ganglia. The postural cerebral hypoperfusion may be related to the Fontan operation, with associated neuron damage and brain atrophy because the frontal areas might be highly susceptible to a reduction in blood flow. The patient may have experienced the postural cerebral hypoperfusion repeatedly during the 5 years since the operation. Upright imaging using Tc-99m HMPAO brain SPECT can be applied to pediatric patients to detect postural cerebral hypoperfusion after undergoing cardiac surgery that may affect cerebral blood flow.