201
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Denniss DL, Sholler GF, Costa DSJ, Winlaw DS, Kasparian NA. Need for Routine Screening of Health-Related Quality of Life in Families of Young Children with Complex Congenital Heart Disease. J Pediatr 2019; 205:21-28.e2. [PMID: 30366775 DOI: 10.1016/j.jpeds.2018.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess health-related quality of life (HRQOL) in families of young children with complex congenital heart disease (CHD), and identify the demographic, clinical, and psychosocial factors that place these children and their mothers at greater risk of vulnerability. STUDY DESIGN This cross-sectional study took place from June 2015 to October 2016 at The Sydney Children's Hospitals Network Cardiac Service, Australia. Mothers of a child aged 1-5 years with either single ventricle CHD or CHD requiring neonatal biventricular repair were invited to participate. Eighty-seven mothers completed a suite of validated measures, including the Pediatric Quality of Life Inventory, which assessed the outcomes of child and maternal HRQOL. RESULTS Sixty percent of children with single ventricle CHD and 25% of children with biventricular repair had total Pediatric Quality of Life Inventory scores within the at-risk range. Lower child HRQOL was strongly associated with single ventricle CHD (β = -0.38; P < .001), physical comorbidity (β = -0.32; P = .001), feeding difficulties (β = -0.26; P = .008), and greater maternal psychological stress (β = -0.18; P = .045), accounting for 52% of the variance in child HRQOL. Lower maternal HRQOL was strongly associated with poorer family functioning (β = 0.61; P < .001), greater maternal psychological stress (β = -0.23; P = .004), child physical comorbidity (β = -0.17; P = .01), and a 'difficult' child temperament (β = -0.14; P = .01), accounting for 73% of the variance in maternal HRQOL. CONCLUSIONS Lower HRQOL is common in young children with complex CHD, particularly single ventricle CHD. Several predictors of HRQOL are potentially modifiable, offering possible pathways for prevention and early intervention. Routine screening is a necessary first step toward developing models of care to improve HRQOL in this population.
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Affiliation(s)
- Dominique L Denniss
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia
| | - Gary F Sholler
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, North Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - David S Winlaw
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Nadine A Kasparian
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia.
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202
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Wilson TG, d'Udekem Y, Winlaw DS, Cordina RL, Ayer J, Gentles TL, Weintraub RG, Grigg LE, Cheung M, Cain TM, Rao P, Verrall C, Plessis KD, Rice K, Iyengar AJ. Creatinine-based estimation of glomerular filtration rate in patients with a Fontan circulation. CONGENIT HEART DIS 2019; 14:454-463. [PMID: 30664330 DOI: 10.1111/chd.12746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/17/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with a Fontan circulation are at risk of renal dysfunction. We analyzed cross-sectional data in pediatric and adult Fontan patients in order to assess the accuracy of commonly used serum creatinine-based methods in estimating glomerular filtration rate (GFR). METHODS A total of 124 Fontan patients (58 children, 66 adults) were enrolled across three study centers. Measurement of GFR (mGFR) using in vivo 99m Tc-DTPA clearance was performed. Various serum creatinine-based equations were used to calculate estimated GFR (eGFR). RESULTS Mean mGFR was 108 ± 28 mL/min/1.73 m2 in children and 92 ± 20 mL/min/1.73 m2 in adults. Fourteen children (25%) and 28 adults (45%) had an mGFR <90 mL/min/1.73 m2 . There was no significant correlation between mGFR and eGFR (Schwartz) in children (r = 0.22, P = .1), which substantially overestimated mGFR (bias 50.8, 95%CI: 41.1-60.5 mL/min/1.73 m2 , P < .0001). The Bedside Schwartz equation also performed poorly in the children (r = 0.08, P = .5; bias 5.9, 95%CI: -2.9-14.6 mL/min/1.73 m2 , P < .0001). There was a strong correlation between mGFR and both eGFR (CKD-EPI) and eGFR (MDRD) in adults (r = 0.67, P < .0001 in both cases), however, both methods overestimated mGFR (eGFR(CKD-EPI):bias 23.8, 95%CI: 20-27.6 mL/min/1.73 m2 , P < .0001; eGFR (MDRD):bias 16.1, 95%CI: 11.8-20.4 mL/min/1.73 m2 , P < .0001). None of the children with an mGFR <90 mL/min/1.73 m2 had an eGFR (Schwartz) <90 mL/min/1.73 m2 . Sensitivity and specificity of eGFR (CKD-EPI) and eGFR (MDRD) for mGFR <90 mL/min/1.73 m2 in adults were 25% and 92% and 39% and 100%, respectively. CONCLUSIONS This study identifies the unreliability of using creatinine-based equations to estimate GFR in children with a Fontan circulation. The accuracy of formulas incorporating cystatin C should be further investigated and may aid noninvasive surveillance of renal function in this population.
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Affiliation(s)
- Thomas G Wilson
- Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David S Winlaw
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Cordina
- Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julian Ayer
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas L Gentles
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Robert G Weintraub
- Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Leeanne E Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Cheung
- Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Timothy M Cain
- Medical Imaging Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Padma Rao
- Medical Imaging Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Charlotte Verrall
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karin Du Plessis
- Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Kathryn Rice
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Ajay J Iyengar
- Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
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203
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Granegger M, Valencia A, Quandt D, Dave H, Kretschmar O, Hübler M, Schweiger M. Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review. World J Pediatr Congenit Heart Surg 2019; 10:81-89. [DOI: 10.1177/2150135118802788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Long-term survival of patients with a single ventricle palliated with a Fontan procedure is still limited. No curative treatment options are available. To investigate the pathophysiology and potential treatment options, such as mechanical circulatory support (MCS), appropriate large animal models are required. The aim of this review was to analyze all full-text manuscripts presenting approaches for an extracardiac total cavopulmonary connection (TCPC) animal model to identify the feasibility and limitations in the acute and chronic setting. Methods: A literature search was performed for full-text publications presenting large animal models with extracardiac TCPCs on Pubmed and Embase. Out of 454 reviewed papers, 23 manuscripts fulfilled the inclusion criteria. Surgical procedures were categorized and hemodynamic changes at the transition from the biventricular to the univentricular condition analyzed. Results: Surgical procedures varied especially regarding coronary venous flow handling and anatomic shape of the TCPC. In most studies (n = 14), the main pulmonary artery was clamped and the coronary venous flow redirected by additional surgical interventions. Only in five reports, the caval veins were connected to the right pulmonary artery to create a true TCPC shape, whereas in all others (n = 18), the veins were connected to the main pulmonary artery. An elevated pulmonary vascular resistance was identified as a limiting hemodynamic factor for TCPC completion in healthy animals. Conclusions: A variety of acute TCPC animal models were successfully established with and without MCS, reflecting the most important hemodynamic features of a Fontan circulation; however, chronic animal models were not reported.
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Affiliation(s)
- Marcus Granegger
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Anna Valencia
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Daniel Quandt
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Michael Hübler
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Martin Schweiger
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
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204
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205
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Impact of Non-cardiac Comorbidities in Adults with Congenital Heart Disease: Management of Multisystem Complications. INTENSIVE CARE OF THE ADULT WITH CONGENITAL HEART DISEASE 2019. [PMCID: PMC7123096 DOI: 10.1007/978-3-319-94171-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence and impact of non-cardiac comorbidities in adult patients with congenital heart disease increase over time, and these complications are often specifically a consequence of the long-term altered cardiovascular physiology or sequelae of previous therapies. For the ACHD patient admitted to the intensive care unit (ICU) for either surgical or medical treatment, an assessment of the burden of multisystem disease, as well as an understanding of the underlying cardiovascular pathophysiology, is essential for optimal management of these complex patients. This chapter takes an organ-system-based approach to reviewing common comorbidities in the ACHD patient, focusing on conditions that are directly related to ACHD status and may significantly impact ICU care.
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206
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Weber RW, Stiasny B, Ruecker B, Fasnacht M, Cavigelli-Brunner A, Valsangiacomo Buechel ER. Prenatal Diagnosis of Single Ventricle Physiology Impacts on Cardiac Morbidity and Mortality. Pediatr Cardiol 2019; 40:61-70. [PMID: 30121866 DOI: 10.1007/s00246-018-1961-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Abstract
We sought to evaluate the impact of prenatal diagnosis on morbidity and mortality in single ventricle (SV) lesions. All consecutive patients with pre- or postnatally diagnosed SV physiology admitted to our centre between January 2001 and June 2013 were reviewed. Primary endpoints included survival until 30 days after bidirectional cavopulmonary connection (BCPC) without transplant or BCPC takedown. Prenatal diagnosis was performed in 160 of 259 cases (62%). After excluding all cases with termination of pregnancy, intrauterine demise or treated with comfort care, a total of 180 neonates were admitted to our centre for treatment, including 87 with a prenatal and 93 with a postnatal diagnosis. Both groups showed similar distribution regarding diagnosis, dominant ventricle and risk factors such as restrictive foramen or some form of atrial isomerism. A larger proportion of postnatally diagnosed children presented at admission with elevated lactate > 10 mmol/l (p = 0.02), a higher dose of prostaglandin (p = 0.0013) and need for mechanical ventilation (p < 0.0001). Critical lesions such as hypoplastic left heart syndrome were an important determinant for morbidity and mortality. Thirty-days survival after BCPC was better in patients with prenatal diagnosis (p = 0.025). Prenatal diagnosis is associated with higher survival in neonates with SV physiology.
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Affiliation(s)
- Roland W Weber
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Children's Research Centre, Zurich, Switzerland.
| | - Brian Stiasny
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
| | - Beate Ruecker
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
| | | | - Anna Cavigelli-Brunner
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
| | - Emanuela R Valsangiacomo Buechel
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
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207
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Conway J, Tunuguntla H. Impact of disease process on post-transplant outcomes: Protein-losing enteropathy in Fontan patients. J Heart Lung Transplant 2018; 38:3-4. [PMID: 30558740 DOI: 10.1016/j.healun.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
| | - Hari Tunuguntla
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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208
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Kumar KR, Hornik CP. Commentary: Singling out single ventricles after Fontan. J Thorac Cardiovasc Surg 2018; 157:2016-2017. [PMID: 30553591 DOI: 10.1016/j.jtcvs.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Karan R Kumar
- Department of Pediatrics and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
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209
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Alsaied T, Sleeper LA, Masci M, Ghelani SJ, Azcue N, Geva T, Powell AJ, Rathod RH. Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity. J Cardiovasc Magn Reson 2018; 20:85. [PMID: 30558626 PMCID: PMC6296022 DOI: 10.1186/s12968-018-0505-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/09/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Maldistribution of pulmonary artery blood flow (MPBF) is a potential complication in patients who have undergone single ventricle palliation culminating in the Fontan procedure. Cardiovascular magnetic resonance (CMR) is the best modality that can evaluate MPBF in this population. The purpose of this study is to identify the prevalence and associations of MPBF and to determine the impact of MPBF on exercise capacity after the Fontan operation. METHODS This retrospective single-center study included all patients after Fontan operation who had maximal cardiopulmonary exercise test (CPET) and CMR with flow measurements of the branch pulmonary arteries. MPBF was defined as > 20% difference in branch pulmonary artery flow. Exercise capacity was measured as percent of predicted oxygen consumption at peak exercise (% predicted VO2). Linear and logistic regression models were used to determine univariate and multivariable predictors of exercise capacity and correlates of MPBF, respectively. RESULTS A total of 147 patients who had CMR between 1999 and 2017 were included (median age at CMR 21.8 years [interquartile range (IQR) 16.5-30.6]) and the median time between CMR and CPET was 2.8 months [IQR 0-13.8]. Fifty-three patients (36%) had MPBF (95% CI 29-45%). The mean % predicted VO2 was 63 ± 16%. Patients with MPBF had lower mean % predicted VO2 compared to patients without MPBF (60 ± 14% versus 65 ± 16%, p = 0.04). On multivariable analysis, a lower % predicted VO2 was independently associated with longer time since Fontan, higher ventricular mass-to-volume ratio, and MPBF. On multivariable analysis, only compression of the branch pulmonary arteries by the ascending aorta or aortic root was associated with MPBF (OR 6.5, 95% CI 5.6-7.4, p < 0.001). CONCLUSION In patients after the Fontan operation, MPBF is common and is independently associated with lower exercise capacity. MPBF was most likely to be caused by pulmonary artery compression by the aortic root or the ascending aorta. This study identifies MPBF as an important risk factor and as a potential target for therapeutic interventions in this fragile patient population.
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Affiliation(s)
- Tarek Alsaied
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Marco Masci
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Nina Azcue
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Rahul H. Rathod
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
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210
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Iyengar AJ, d'Udekem Y. Are we ready for cosmetic surgery on aortic arches after Norwood? J Thorac Cardiovasc Surg 2018; 157:696-698. [PMID: 30501945 DOI: 10.1016/j.jtcvs.2018.10.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Ajay J Iyengar
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
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211
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Impact of Nesiritide Infusion on Early Postoperative Recovery After Total Cavopulmonary Connection Surgery. Pediatr Cardiol 2018; 39:1598-1603. [PMID: 29998377 DOI: 10.1007/s00246-018-1935-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of the study is to compare the effects of nesiritide on the discharge time and pleural effusion in children with total cavopulmonary connection (TCPC), and to provide a more reasonable clinical method for these children. METHODS Forty-four who children underwent cavopulmonary connection between January 2016 and 2017 were retrospectively collected, and 5 children were excluded from analysis due to postoperative thrombosis or second Fontan surgery due to high pulmonary hypertension. Thirteen children received nesiritide (3-11 days) plus conventional treatment as the nesiritide group, continuous infusion of nesiritide with the dose of 0.01 ug kg-1 min-1. Twenty-six children with the conventional treatment as the conventional treatment group. The length of stay in hospital and the retention time of chest drainage tube were compared between two groups. RESULTS There were no significant differences in the time of cardiopulmonary bypass, postoperative ventilation time, ICU time, and vasoactive inotropic drug scores in the two groups. There were no hospital deaths in two groups. The median hospital stay was 20 days in the nesiritide group (11-56 days, means 25 days), and the median length of hospital stay was 28 days in the routine treatment group (9-95 days, means 34 days). There is no statistically significant difference between two groups with regard to the length of stay in hospital (P = 0.281). Regarding the thoracic drainage duration, the median was 17 days (9-55 days, means 22 days) in the nesiritide group and 23 days in the conventional treatment group (7-91 days, means 31 days) (P = 0.294). All the patients had no severe complications such as excessive fluid load, intractable hypotension, and liver or kidney injury. CONCLUSION Nesiritide is safe in children who underwent cavopulmonary connection surgery. Compared with the conventional treatment group, postoperative nesiritide is not associated with improved early clinical outcomes after TCPC surgery.
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212
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Augmentation of the pulmonary arteries at or prior to the Fontan procedure is not associated with worse long-term outcomes: a propensity-matched analysis from the Australia-New Zealand Fontan Registry†. Eur J Cardiothorac Surg 2018; 55:829-836. [DOI: 10.1093/ejcts/ezy376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/02/2018] [Accepted: 10/10/2018] [Indexed: 11/14/2022] Open
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213
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Bouchardy J, Meyer P, Yerly P, Blanche C, Hullin R, Giostra E, Hanquinet S, Rubbia-Brandt L, Sekarski N, Prêtre R, Beghetti M. Regression of Advanced Liver Fibrosis After Heart Transplantation in a Patient With Prior Fontan Surgery for Complex Congenital Heart Disease. Circ Heart Fail 2018; 11:e003754. [DOI: 10.1161/circheartfailure.117.003754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith Bouchardy
- Division of Cardiology, Lausanne University Hospital, Switzerland. (J.B., P.Y., R.H.)
- Division of Cardiology, Geneva University Hospital, Switzerland (J.B., P.M., C.B.)
| | - Philippe Meyer
- Division of Cardiology, Geneva University Hospital, Switzerland (J.B., P.M., C.B.)
| | - Patrick Yerly
- Division of Cardiology, Lausanne University Hospital, Switzerland. (J.B., P.Y., R.H.)
| | | | - Roger Hullin
- Division of Cardiology, Lausanne University Hospital, Switzerland. (J.B., P.Y., R.H.)
| | - Emiliano Giostra
- Division of Gastro-Enterology and Hepatology, Geneva University Hospital, Switzerland (E.G.)
| | | | - Laura Rubbia-Brandt
- Radio-pediatric Unit, Division of Radiology, Geneva University Hospital, Switzerland (S.H.)
- Division of Pathology, Geneva University Hospital, Switzerland (L.R.-B.)
| | - Nicole Sekarski
- Pediatric Cardiology Unit, Lausanne University Hospital, Switzerland. (N.S.)
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Lausanne University Hospital, Switzerland. (N.S., R.P., M.B.)
- Division of Pathology, Geneva University Hospital, Switzerland (L.R.-B.)
- Centre Universitaire Romand de Cardiologie et hirurgie Cardiaque Pédiatrique, Geneva University Hospital, Switzerland (N.S., R.P., M.B.)
| | - René Prêtre
- Division of Cardiac Surgery, Lausanne University Hospital, Switzerland. (R.P.)
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Lausanne University Hospital, Switzerland. (N.S., R.P., M.B.)
- Centre Universitaire Romand de Cardiologie et hirurgie Cardiaque Pédiatrique, Geneva University Hospital, Switzerland (N.S., R.P., M.B.)
| | - Maurice Beghetti
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Lausanne University Hospital, Switzerland. (N.S., R.P., M.B.)
- Division of Cardiology, Geneva University Hospital, Switzerland (J.B., P.M., C.B.)
- Division of Pathology, Geneva University Hospital, Switzerland (L.R.-B.)
- Paediatric Cardiology Unit, Department of Child and Adolescent, Geneva University Hospital, Switzerland (M.B.)
- Centre Universitaire Romand de Cardiologie et hirurgie Cardiaque Pédiatrique, Geneva University Hospital, Switzerland (N.S., R.P., M.B.)
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214
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Zaki NC, Kelleman MS, James Parks W, Slesnick TC, McConnell ME, Oster ME. The utility of cardiac magnetic resonance imaging in post-Fontan surveillance. CONGENIT HEART DIS 2018; 14:140-146. [PMID: 30378262 DOI: 10.1111/chd.12692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/17/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Gated cardiac MRI offers the most detailed and accurate noninvasive method of assessing cardiac anatomy, particularly in patients with complex congenital heart disease. The proposed benefits of using cMRI as a routine screening tool in the Fontan population include early recognition of asymptomatic, postoperative anatomic and physiologic changes. In 2011, we therefore instituted at our center a recommended practice of cMRI screening in patients with Fontan physiology at 3 and 8 years post-Fontan operation. The purpose of this study was to determine the impact of this standardized practice of cMRI screening on the clinical management of a Fontan population. DESIGN We retrospectively reviewed charts from our institutional Fontan database to determine which patients were eligible for cMRI under the current guidelines and who underwent imaging from November 2002 to June 2015. We reviewed the frequency of cMRI and number of changes in management based on the results. Statistical significance was determined using a chi-square test. RESULTS There were 141 cMRIs performed on 121 patients who met inclusion criteria. The odds of a change in management were significantly greater after clinically indicated cMRI compared to screening cMRI (OR = 3.79, 95% CI: 1.48-9.66, P = .004). There were near significant odds of change in management if the cMRI occurred <8 years after Fontan regardless of whether it was for screening or clinically indicated purposes (OR = 2.43, 95% CI: 0.97-6.08, P = .052). The most frequent change in management was referral for catheterization with pulmonary artery angioplasty. CONCLUSIONS There is an important role for cMRI in routine surveillance of post-Fontan patients. Screening cMRI performed less than 8 years after Fontan palliation offers increased utility compared to studies performed later. The optimal timing of such imaging after Fontan palliation remains unclear.
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Affiliation(s)
- Neil C Zaki
- Emory University School of Medicine, Atlanta, Georgia.,Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - W James Parks
- Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Timothy C Slesnick
- Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael E McConnell
- Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew E Oster
- Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
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215
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du Plessis K, Peters R, King I, Robertson K, Mackley J, Maree R, Stanley T, Pickford L, Rose B, Orchard M, Stewart H, d'Udekem Y. "How long will I continue to be normal?" Adults with a Fontan circulation's greatest concerns. Int J Cardiol 2018; 260:54-59. [PMID: 29622455 DOI: 10.1016/j.ijcard.2018.01.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known about adults living with a Fontan circulation's concerns outside the scope of their clinical outcomes. We examined adults with a Fontan circulations' greatest concerns, as well as their concerns around anti-coagulation, pregnancy and finances. METHODS Adults with a Fontan circulation in the Australian and New Zealand Fontan Registry were invited to complete an anonymous online survey, of which 57 participated. A qualitative method approach using thematic analyses was used. RESULTS The greatest concerns for adults living with a Fontan circulation were fear of death/uncertainty around life expectancy which for many individuals colored their concerns around physical health, pregnancy and having children, quality of life and finances. Improving information about outcomes to patients with a Fontan circulation might alleviate uncertainties about their future. CONCLUSIONS Fear of death is the primary concern of adults with a Fontan circulation. It may require improved communication and targeted psychological interventions. Physical exercise incorporated as part of their lifestyle should be encouraged to alleviate physical concerns and also improve psychological well-being.
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Affiliation(s)
- Karin du Plessis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rebecca Peters
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Ingrid King
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Kirsty Robertson
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Jonathan Mackley
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Rachel Maree
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Tracy Stanley
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Louise Pickford
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Brian Rose
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Matthew Orchard
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Helen Stewart
- Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Australian and New Zealand Fontan Advisory Committee, Australia and New Zealand; Cardiac Surgery Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
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216
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Rösner A, Khalapyan T, Pedrosa J, Dalen H, McElhinney DB, Friedberg MK, Lui GK. Ventricular mechanics in adolescent and adult patients with a Fontan circulation: Relation to geometry and wall stress. Echocardiography 2018; 35:2035-2046. [DOI: 10.1111/echo.14169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Assami Rösner
- Department of Cardiology; Division of Cardiothoracic and Respiratory Medicine; University Hospital of North Norway; Tromsø Norway
| | - Tigran Khalapyan
- Department of Cardiothoracic Surgery; Stanford University School of Medicine; Stanford California
| | - João Pedrosa
- Department of Cardiovascular Sciences; K.U. Leuven; Leuven Belgium
| | - Håvard Dalen
- Department of Medicine; Levanger Hospital; Nord-Trøndelag Hospital Trust; Levanger Norway
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Doff B. McElhinney
- Division of Pediatric Cardiology; Department of Pediatrics; Stanford University School of Medicine; Stanford California
| | - Mark K. Friedberg
- Division of Pediatric Cardiology; Hospital for Sick Children; Toronto Ontario Canada
| | - George K. Lui
- Division of Pediatric Cardiology; Department of Pediatrics; Stanford University School of Medicine; Stanford California
- Division of Cardiovascular Medicine; Department of Medicine; Stanford University School of Medicine; Stanford California
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217
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Erikssen G, Aboulhosn J, Lin J, Liestøl K, Estensen ME, Gjesdal O, Skulstad H, Døhlen G, Lindberg HL. Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology. Open Heart 2018; 5:e000902. [PMID: 30364544 PMCID: PMC6196969 DOI: 10.1136/openhrt-2018-000902] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Patients with univentricular hearts (UVH) have high mortality despite modern treatment, and better methods to identify patients at highest risk are needed. We wanted to improve risk stratification in patients with UVH by focusing on the prognostic significance of single right versus single left ventricular morphology (SRV vs SLV). Methods All 395 patients with UVH operated at our centre were prospectively included from 1972 to 2016 (195 SRV, 166 SLV, 34 mixed or indeterminate ventricular morphology). Diagnoses, UVH morphology, types of all operations and time and causes of death or heart transplantation (HTX) were recorded. The primary endpoint was death or HTX. Results Among the 111 non-Fontan patients, 88 died (SRV 62 vs SLV 20; p<0.0001), 32 due to heart failure (SRV 23 vs SLV 5; p=0.0012). Twenty-five years of cumulative SRV versus SLV survival among the 284 Fontan patients (41 deaths/HTX) was 66.9% vs 87.9% (p=0.0027), partly explained by more deaths/HTX due to heart failure among patients with SRV (p=0.0006). Survival in patients with SRV with and without hypoplastic left heart syndrome (HLHS) was similar. SRV versus SLV was a strong predictor of death/HTX in multivariable proportional hazards analyses (RR 3.3, 95% CI 1.6 to 6.6). Conclusion SRV versus SLV is a strong short-term and long-term predictor of survival among patients with UVH, mainly explained by higher rates of death/HTX due to heart failure in the SRV group. Our findings apply to patients with SRV both with and without HLHS.
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Affiliation(s)
- Gunnar Erikssen
- ACHD Unit, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Plaza, Los Angeles, California, USA
| | - Jeannette Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Plaza, Los Angeles, California, USA
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Mette E Estensen
- ACHD Unit, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ola Gjesdal
- ACHD Unit, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Helge Skulstad
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
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218
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Marathe SP, Zannino D, Shi WY, du Plessis K, Kehr J, Perumal G, Sun J, Gentles TL, Ayer J, Sholler GF, Verrall CE, Alphonso N, Andrews D, d'Udekem Y, Winlaw DS. Two Ventricles Are Not Better Than One in the Fontan Circulation: Equivalent Late Outcomes. Ann Thorac Surg 2018; 107:852-859. [PMID: 30300642 DOI: 10.1016/j.athoracsur.2018.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND A subset of patients who underwent Fontan operations has two adequate-sized ventricles, but an anatomic biventricular circulation cannot be achieved because of complex morphology or for technical reasons. This study sought to determine whether these patients with two-ventricle Fontan circulation had superior outcomes compared with those with a single ventricle. METHODS A binational Fontan Registry of patients (n = 1,377) was analyzed to identify those patients with two adequate ventricles. This cohort was compared with patients with single-ventricle Fontan circulation. The primary end point was a composite end point called "Fontan failure" encompassing death, heart transplantation, Fontan takedown or conversion, protein-losing enteropathy, plastic bronchitis, or New York Heart Association functional class III or IV. RESULTS A total of 79 Fontan patients with two adequate ventricles (2V) were compared with 1,291 single ventricle (1V) Fontan patients. Median follow-up for the entire cohort was 11.5 years (interquartile range, 5.1 to 18.8 years). There was no difference in unadjusted 15-year freedom from Fontan failure (2V: 81% [95% confidence interval (CI), 69% to 94%] vs 1V: 86% [95% CI, 83% to 88%], p = 0.4). Propensity-score matching for potential confounding factors yielded 75 two-ventricle Fontan patients matched with 604 single-ventricle Fontan patients, in which 15-year freedom from Fontan failure was also not different (2V: 79% [95% CI, 67% to 94%] vs 1V: 87% [95% CI, 84% to 91%], p = 0.3). CONCLUSIONS The two-ventricle Fontan circulation does not have better outcomes compared with the single-ventricle Fontan circulation. Late outcomes may depend more on other characteristics of the Fontan circulation. This finding is relevant when the Fontan procedure is being considered as an alternative to anatomic repair in patients with complex two-ventricle morphologies.
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Affiliation(s)
- Supreet P Marathe
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, Australia
| | - William Y Shi
- Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia
| | - Karin du Plessis
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Jascha Kehr
- Starship Green Lane Pediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Gopinath Perumal
- Queensland Pediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Jessica Sun
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thomas L Gentles
- Starship Green Lane Pediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Julian Ayer
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; School of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; School of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Charlotte E Verrall
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Nelson Alphonso
- Queensland Pediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - David Andrews
- Department of Cardiothoracic Surgery, Princess Margaret Hospital, Perth, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - David S Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; School of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.
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219
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Kodama Y, Koga K, Kuraoka A, Ishikawa Y, Nakamura M, Sagawa K, Ishikawa S. Efficacy of Sports Club Activities on Exercise Tolerance Among Japanese Middle and High School Children and Adolescents After Fontan Procedure. Pediatr Cardiol 2018; 39:1339-1345. [PMID: 29785512 DOI: 10.1007/s00246-018-1900-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Abstract
The exercise tolerance of Fontan patients is poorer than that of healthy people. Some previous studies reported that exercise tolerance can be improved in this population by cardiac rehabilitation. This study aimed to determine the factors associated with peak oxygen uptake (VO2) and to subsequently clarify the correlation between participation in sports club activities and variables related to exercise tolerance. Cardiopulmonary exercise tests were performed by 115 Fontan patients aged between 6 and 20 years. The patients completed questionnaires on their daily physical activities including participation in extracurricular sports clubs in middle (junior high school) and high school. Peak VO2 had a significant negative correlation with age and a positive correlation with hemoglobin, stroke volume, and resting tidal volume in the entire study group. Additionally, the sports club participants who were middle and high school students had significantly higher peak VO2 and resting tidal volume. Exercise habits including participation in sports club activities may promote exercise tolerance by improving respiratory function in Fontan adolescents.
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Affiliation(s)
- Yoshihiko Kodama
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Kyoko Koga
- Department of Clinical Laboratory, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Ayako Kuraoka
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Makoto Nakamura
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Shiro Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
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220
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Moore BM, Anderson R, Nisbet AM, Kalla M, du Plessis K, d’Udekem Y, Bullock A, Cordina RL, Grigg L, Celermajer DS, Kalman J, McGuire MA. Ablation of Atrial Arrhythmias After the Atriopulmonary Fontan Procedure. JACC Clin Electrophysiol 2018; 4:1338-1346. [DOI: 10.1016/j.jacep.2018.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/17/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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221
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Abstract
The Fontan procedure is the final procedure in staged palliation for patients with functional single-ventricle physiology. The goal of the procedure is to separate systemic and pulmonary blood flow by directing systemic venous return through the Fontan connection to the pulmonary arteries and the lungs without ventricular contribution. Following the procedure, pulmonary blood flow is completely passive and dependent on pressure gradients, resulting in complex postoperative cardiopulmonary interactions. Understanding the physiology is essential to effectively manage these patients. Critical care nurses caring for patients after a Fontan procedure must understand preoperative data, risk factors, and unique postoperative physiology so they can anticipate specific postoperative problems, recognize trends in clinical status, and develop an appropriate plan of care. This paper reviews the first 2 stages of single-ventricle palliation, relevant modifications to the Fontan procedure, important preoperative cardiac catheterization data, common postoperative problems, and outcomes after the Fontan procedure.
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Affiliation(s)
- Melissa Beaudet Jones
- Melissa Beaudet Jones is a nurse practitioner and ventricular assist device coordinator in the cardiac intensive care unit at Children's National Health System in Washington, DC.
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222
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Foeller ME, Foeller TM, Druzin M. Maternal Congenital Heart Disease in Pregnancy. Obstet Gynecol Clin North Am 2018; 45:267-280. [PMID: 29747730 DOI: 10.1016/j.ogc.2018.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital heart disease comprises most maternal cardiac diseases in pregnancy and is an important cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Pregnancy is often considered a high-risk state for individuals with structural heart disease as a consequence of a limited ability to adapt to the major hemodynamic changes associated with pregnancy. Preconception counseling and evaluation are of utmost importance, as pregnancy is contraindicated in certain cardiac conditions. Pregnancy can be safely accomplished in most individuals with careful risk assessment before conception and multidisciplinary care throughout pregnancy and the postpartum period.
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Affiliation(s)
- Megan E Foeller
- Obstetrics and Gynecology, Stanford University, Stanford Hospital, 300 Pasteur Drive, Room G302, 5317, Stanford, CA 94305-5317, USA.
| | - Timothy M Foeller
- Internal Medicine, Stanford Health Care-ValleyCare, 5555 West Positas Boulevard, 1 West Hospitalist Room 1, Pleasanton, CA 94588, USA
| | - Maurice Druzin
- Obstetrics and Gynecology, Stanford University, Stanford Hospital, 300 Pasteur Drive, Room G302, 5317, Stanford, CA 94305-5317, USA
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223
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Kay WA, Moe T, Suter B, Tennancour A, Chan A, Krasuski RA, Zaidi AN. Long Term Consequences of the Fontan Procedure and How to Manage Them. Prog Cardiovasc Dis 2018; 61:365-376. [PMID: 30236751 DOI: 10.1016/j.pcad.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
In 1971, Fontan and Baudet described a surgical technique for successful palliation of patients with tricuspid atresia. Subsequently, this technique has been applied to treat most forms of functional single ventricles and has become the current standard of care for long-term palliation of all patients with single ventricle congenital heart disease. Since 1971, the Fontan procedure has undergone several variations. These patients require lifelong management including a thorough knowledge of their anatomic substrate, hemodynamic status, management of rhythm and ventricular function along with multi organ evaluation. As these patients enter middle age, there is increasing awareness regarding the long-term complications and mortality. This review highlights the long-term outcomes of the Fontan procedure and management of late sequelae.
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Affiliation(s)
- W Aaron Kay
- Indiana University School of Medicine, Krannert Institute of Cardiology, IN.
| | - Tabitha Moe
- University of Arizona School of Medicine, Phoenix, AZ.
| | - Blair Suter
- Indiana University School of Medicine, Departments of Medicine and Pediatrics, IN.
| | - Andrea Tennancour
- Indiana University School of Medicine, Krannert Institute of Cardiology, IN.
| | - Alice Chan
- Children's Hospital at Montefiore, Montefiore Medical Center, Albert Einstein College of Medicine, NY.
| | | | - Ali N Zaidi
- Children's Hospital at Montefiore, Montefiore Medical Center, Albert Einstein College of Medicine, NY.
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224
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Ohuchi H, Inai K, Nakamura M, Park IS, Watanabe M, Hiroshi O, Kim KS, Sakazaki H, Waki K, Yamagishi H, Yamamura K, Kuraishi K, Miura M, Nakai M, Nishimura K, Niwa K. Mode of death and predictors of mortality in adult Fontan survivors: A Japanese multicenter observational study. Int J Cardiol 2018; 276:74-80. [PMID: 30201381 DOI: 10.1016/j.ijcard.2018.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/28/2018] [Accepted: 09/03/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mortality rates may be high in adult Fontan patients; however, the clinical determinants remain unclear. PURPOSE We conducted a prospective multicenter study of adult Fontan survivors to determine the 5-year mortality rate and clarify the determinants. METHOD AND RESULTS We followed 600 adult Fontan survivors from 40 Japanese institutions (307 men, 28 ± 7 years old, follow-up: 18 ± 6 years). The New York Heart Association (NYHA) functional class I and II was 51% and 42%, respectively. During the follow-up period of 4.1 ± 1.6 years, 33 patients died, and the 5-year survival rate was 93.5%. The mode of death was heart failure in 11 patients (34%), arrhythmia or sudden death in 8 (24%), cancer in 5 (15%), perioperative problems and hemostatic problems in 4 each (12% for each), and infection in 1 (3%). Left isomerism, prior hospitalization, protein losing enteropathy (PLE), pulmonary arteriovenous fistulae, NYHA functional class, impaired hemodynamics, hyponatremia, hepatorenal dysfunction, and use of diuretics were associated with a high mortality rate (p < 0.05-0.0001). Further, PLE (hazard ratio [HR]: 14.4), left isomerism (HR: 3.5), and NYHA (HR: 2.4) independently predicted a high 5-year high mortality (p < 0.05 for all). The incidence of cancer-related mortality increased markedly with age >40 years. CONCLUSIONS Majority of the Japanese adult Fontan survivors had good functional status, with an acceptable 5-year survival rate. However, the significant prevalence of non-cardiac mortality highlights Fontan pathophysiology as a multi-organ disease that requires a multidisciplinary management strategy to improve the long-term outcome.
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Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Kei Inai
- Pediatric Cardiology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Makoto Nakamura
- Cardiology, Fukuoka Children's Hospital, Fukuoka, Fukuoka, Japan
| | - In-Sam Park
- Pediatric Cardiology, Sakakibara Heart Institution, Fuchu, Tokyo, Japan
| | - Mamie Watanabe
- Pediatric Cardiology, Kyushu Hospital (JCHO), Kitakyushu, Fukuoka, Japan
| | - Ono Hiroshi
- Cardiology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Ki-Sung Kim
- Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Hisanori Sakazaki
- Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Kenji Waki
- Pediatric Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiroyuki Yamagishi
- Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenichiro Yamamura
- Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Kenji Kuraishi
- Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Masaru Miura
- Cardiology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Michikazu Nakai
- Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Center, Japan
| | - Kunihiro Nishimura
- Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Center, Japan
| | - Koichiro Niwa
- Cardiology, St Luke's International Hospital, Chuo-ku, Tokyo, Japan
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225
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Oliver KJ, Cheung M, Hallett K, Manton DJ. Caries experience of children with cardiac conditions attending the Royal Children's Hospital of Melbourne. Aust Dent J 2018; 63:429-440. [PMID: 30125372 DOI: 10.1111/adj.12647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Poor oral health in children with cardiac conditions can have negative effects on quality of life and increased risk of infective endocarditis. The aim of this study was to investigate the caries experience in children with cardiac conditions attending the Royal Children's Hospital, Melbourne. METHODS Medical and dental records of 428 children aged <12 years were examined. Cardiac and other medical diagnoses, decayed, missing and filled surfaces/teeth were recorded and analysed. Children referred for reasons other than caries management (NRCM) was analysed separately to address confounding of referral reason on caries experience. RESULTS Mean age of overall study population was 4.9 (SD 2.4) years, caries prevalence 52.1%, mean dmft 3.65 (SD 4.8), mean dmfs 6.19 (SD 11.3), enamel defects prevalence 29.2%. Mean age of NRCM group was 4.6 (SD 2.4) years, caries prevalence 37.5%, mean dmft 2.37 (SD 4.2), mean dmfs 4.22 (SD 9.4), enamel defects prevalence 23.0%. Untreated carious lesions accounted for 89.9% of caries experience. Caries experience was associated with low socio-economic status, absence of comorbidity and enamel defect presence. CONCLUSIONS High disease levels were observed. Age, socio-economic status and enamel defects were associated with caries experience, not severity of cardiac diagnoses. Early referral for dental care and improved access should be facilitated.
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Affiliation(s)
- K J Oliver
- Dentistry Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Heart Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mmh Cheung
- Heart Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Cardiology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - K Hallett
- Dentistry Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - D J Manton
- Dentistry Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
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226
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Gerardin JF, Earing MG. Preoperative Evaluation of Adult Congenital Heart Disease Patients for Non-cardiac Surgery. Curr Cardiol Rep 2018; 20:76. [DOI: 10.1007/s11886-018-1016-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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227
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Ask not what your Fontan can do for you, ask what you can do for your Fontan! J Thorac Cardiovasc Surg 2018; 156:249-251. [DOI: 10.1016/j.jtcvs.2017.11.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/26/2017] [Accepted: 11/09/2017] [Indexed: 11/18/2022]
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228
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van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. State of the art of the Fontan strategy for treatment of univentricular heart disease. F1000Res 2018; 7. [PMID: 30002816 PMCID: PMC6024235 DOI: 10.12688/f1000research.13792.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival. However, the resulting Fontan physiology is associated with high morbidity. In this review, we discuss the state of the art of the Fontan strategy by assessing survival and risk factors for mortality. Complications of the Fontan circulation, such as cardiac arrhythmia, thromboembolism, and protein-losing enteropathy, are discussed. Common surgical and catheter-based interventions following Fontan completion are outlined. We describe functional status measurements such as quality of life and developmental outcomes in the contemporary Fontan patient. The current role of drug therapy in the Fontan patient is explored. Furthermore, we assess the current use and outcomes of mechanical circulatory support in the Fontan circulation and novel surgical innovations. Despite large improvements in outcomes for contemporary Fontan patients, a large burden of disease exists in this patient population. Continued efforts to improve outcomes are warranted. Several remaining challenges in the Fontan field are outlined.
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Affiliation(s)
- Jelle P G van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Ad J C C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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229
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du Plessis K, Peters R, King I, Robertson K, Mackley J, Maree R, Stanley T, Pickford L, Rose B, Orchard M, Stewart H, d'Udekem Y. "Will she live a long happy life?" Parents' concerns for their children with Fontan circulation. IJC HEART & VASCULATURE 2018; 18:65-70. [PMID: 29876506 PMCID: PMC5988481 DOI: 10.1016/j.ijcha.2018.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/28/2018] [Indexed: 11/29/2022]
Abstract
Background Families of children at the worst end of the congenital heart disease endure a significant burden which is often not clearly delineated in the clinical literature. We examined the greatest concerns of parents whose children have a Fontan circulation. Methods Parents (N = 107) of children in the Australian and New Zealand Fontan Registry completed online surveys with open-ended and closed questions. A qualitative method approach incorporating thematic analyses was used. Results The greatest concerns for parents of a child with a Fontan circulation were centered on fear of death for their child and psychosocial well-being, followed by lesser themes around anti-coagulation use, pregnancy and financial burdens. Conclusions Fear of death and the psychological well-being of their children were the main parental concerns. It highlights the need to clearly communicate information on outcomes to families, and the need for family-focused psychological interventions to improve the psychosocial functioning of both parents and young people. Fontan parents' greatest concern for their child is fear of death and well-being. Clear communication around outcomes could help alleviate these fears. It highlights the need for psychological support for parents and young people.
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Affiliation(s)
- Karin du Plessis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rebecca Peters
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Fontan Advisory Committee
| | - Ingrid King
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Fontan Advisory Committee
| | | | | | - Rachel Maree
- Australian and New Zealand Fontan Advisory Committee
| | - Tracy Stanley
- Australian and New Zealand Fontan Advisory Committee
| | | | - Brian Rose
- Australian and New Zealand Fontan Advisory Committee
| | | | - Helen Stewart
- Australian and New Zealand Fontan Advisory Committee
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Fontan Advisory Committee.,Cardiac Surgery Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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230
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Abdulla RI. A Shift in Focus. Pediatr Cardiol 2018; 39:857-858. [PMID: 29637253 DOI: 10.1007/s00246-018-1856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Ra-Id Abdulla
- Rush University, 1630 W Harrison Street, Chicago, IL, 60607, USA.
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231
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Rijnberg FM, Hazekamp MG, Wentzel JJ, de Koning PJ, Westenberg JJ, Jongbloed MR, Blom NA, Roest AA. Energetics of Blood Flow in Cardiovascular Disease. Circulation 2018; 137:2393-2407. [DOI: 10.1161/circulationaha.117.033359] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Jolanda J. Wentzel
- Leiden University Medical Center, The Netherlands. Department of Biomechanical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands (J.J.W.)
| | | | | | | | - Nico A. Blom
- Department of Pediatric Cardiology (N.A.B., A.A.W.R.)
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232
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Downing TE, Allen KY, Goldberg DJ, Rogers LS, Ravishankar C, Rychik J, Fuller S, Montenegro LM, Steven JM, Gillespie MJ, Rome JJ, Spray TL, Nicolson SC, Gaynor JW, Glatz AC. Surgical and Catheter-Based Reinterventions Are Common in Long-Term Survivors of the Fontan Operation. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004924. [PMID: 28851719 DOI: 10.1161/circinterventions.116.004924] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 07/24/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the Fontan operation. METHODS AND RESULTS All 773 patients who underwent Fontan at our institution between 1992 and 2009 were retrospectively reviewed. Current information regarding post-Fontan intervention was available for 70%. By 20 years after Fontan, 65% of patients had experienced either surgical or transcatheter intervention. The median time to first reintervention was 9.8 years. Freedom from reoperation was 69% at 15 years and 63% at 20 years. The most common operations were pacemaker placement and Fontan revision. Risk factors for pacemaker placement included systemic left ventricle (hazard ratio [HR], 2.2; P=0.006) and lateral tunnel Fontan (HR, 4.3; P=0.001). Freedom from interventional catheterization was 53% at 15 years and 50% at 20 years. The most common procedures performed were fenestration closure and pulmonary artery intervention. Catheter intervention for anatomic indications was associated with Fontan after 2002 (HR, 2.1; P=0.007), Norwood operation (HR, 2.3; P=0.001), and longer cardiopulmonary bypass time (HR, 1.1 per 10 minutes; P=0.001). Catheter intervention for physiological indications was associated with prolonged post-Fontan pleural drainage (HR, 4.0; P<0.001) and hypoplastic left heart syndrome (HR, 2.0; P=0.01). CONCLUSIONS In this study of Fontan survivors, two thirds of patients required surgical or catheter-based reintervention by 20 years. Families should be counseled that the Fontan is typically not the final stage of single-ventricle palliation.
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Affiliation(s)
- Tacy E Downing
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.).
| | - Kiona Y Allen
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - David J Goldberg
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Lindsay S Rogers
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Chitra Ravishankar
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Jack Rychik
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Stephanie Fuller
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Lisa M Montenegro
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - James M Steven
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Matthew J Gillespie
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Jonathan J Rome
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Thomas L Spray
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Susan C Nicolson
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - J William Gaynor
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.)
| | - Andrew C Glatz
- From the Division of Pediatric Cardiology (T.E.D., D.J.G., C.R., J.R., M.J.G., J.J.R., A.C.G.), Department of Surgery (S.F., T.L.S., J.W.G.), and Department of Anesthesiology and Critical Care (L.M.M., J.M.S., S.C.N.), The Perelman School of Medicine at the University of Pennsylvania, and Cardiac Center at The Children's Hospital of Philadelphia; Division of Cardiology, University of Texas, Houston (L.S.R.); and Division of Critical Care, Lurie Children's Hospital, Chicago, IL (K.Y.A.).
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233
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Holbein CE, Fogleman ND, Hommel K, Apers S, Rassart J, Moons P, Luyckx K, Sluman MA, Enomoto J, Johansson B, Yang HL, Dellborg M, Subramanyan R, Jackson JL, Budts W, Kovacs AH, Morrison S, Tomlin M, Gosney K, Soufi A, Eriksen K, Thomet C, Berghammer M, Alday L, Callus E, Fernandes SM, Caruana M, Menahem S, Cook SC, Rempel GR, White K, Khairy P, Kutty S, Veldtman G. A multinational observational investigation of illness perceptions and quality of life among patients with a Fontan circulation. CONGENIT HEART DIS 2018; 13:392-400. [PMID: 29457362 PMCID: PMC5993574 DOI: 10.1111/chd.12583] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE First, to compare QOL and illness perceptions between patients with a Fontan circulation and patients with anatomically simple defects (ie, atrial septal defects [ASD] or ventricular septal defects [VSD]). Second, to explore illness perceptions as a mediator of the association between congenital heart disease (CHD) diagnosis and QOL. DESIGN Cross-sectional observational study. SETTING Twenty-four cardiology centers from 15 countries across five continents. PATIENTS Four hundred thirty-five adult patients with congenital heart disease (177 Fontan and 258 ASD/VSD) ages 18-83 years. OUTCOME MEASURES QOL and illness perceptions were assessed by the Satisfaction With Life Scale and the Brief Illness Perceptions Questionnaire, respectively. RESULTS Patients with a Fontan circulation reported lower QOL (Wald Z = -3.59, p = <.001) and more negative perceptions of their CHD (Wald Z = -7.66, p < .001) compared with patients with ASD/VSD. After controlling for demographics, anxiety, depressive symptoms, and New York Heart Association functional class, path analyses revealed a significant mediation model, αβ = 0.15, p = .002, 95% CI = 0.06-0.25, such that CHD diagnosis was indirectly related to QOL through illness perceptions. CONCLUSIONS The Fontan sample's more negative perceptions of CHD were likely a reflection of life with a more complex defect. Illness perceptions appear to account for unique differences in QOL between groups of varying CHD complexity. Psychosocial screening and interventions may be important treatment components for patients with CHD, particularly those with Fontan circulations.
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Affiliation(s)
| | - Nicholas D. Fogleman
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- University of Louisville, Louisville, USA
| | - Kevin Hommel
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | | | | | - Philip Moons
- KU Leuven, Leuven, Belgium
- University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | - Mikael Dellborg
- University of Gothenburg, Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Werner Budts
- KU Leuven, Leuven, Belgium
- University Hospitals Leuven and Department of Cardiovascular Sciences, Leuven, Belgium
| | | | - Stacey Morrison
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Martha Tomlin
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Kathy Gosney
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | | | | | - Corina Thomet
- KU Leuven, Leuven, Belgium
- University Hospital Bern, University of Bern, Bern, Switzerland
| | - Malin Berghammer
- University of Gothenburg, Gothenburg, Sweden
- University West, Trollhättan, Sweden
| | | | | | | | | | | | | | | | - Kamila White
- Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, USA
| | | | - Shelby Kutty
- Children's Hospital & Medical Center, Omaha, USA
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Garcia Ropero A, Baskar S, Roos Hesselink JW, Girnius A, Zentner D, Swan L, Ladouceur M, Brown N, Veldtman GR. Pregnancy in Women With a Fontan Circulation. Circ Cardiovasc Qual Outcomes 2018; 11:e004575. [DOI: 10.1161/circoutcomes.117.004575] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/20/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Alvaro Garcia Ropero
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain (A.G.R.)
| | - Shankar Baskar
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (S.B. G.R.V., N.B.)
| | - Jolien W. Roos Hesselink
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.W.R.H., N.B., G.R.V.)
| | - Andrea Girnius
- Department of Anesthesiology, University of Cincinnati, OH (A.G.)
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia (D.Z.)
| | - Lorna Swan
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (L.S.)
| | - Magalie Ladouceur
- Department of Adult Congenital Heart Disease, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris Descartes University, Sorbonne Paris Cité, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.)
| | - Nicole Brown
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (S.B. G.R.V., N.B.)
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.W.R.H., N.B., G.R.V.)
| | - Gruschen R. Veldtman
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (S.B. G.R.V., N.B.)
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.W.R.H., N.B., G.R.V.)
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Attard C, Huang J, Monagle P, Ignjatovic V. Pathophysiology of thrombosis and anticoagulation post Fontan surgery. Thromb Res 2018; 172:204-213. [PMID: 29685556 DOI: 10.1016/j.thromres.2018.04.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 01/19/2023]
Abstract
The Fontan procedure has transformed the lives of children born with single-ventricle physiology, previously deemed inoperable. Worldwide, there are an increasing number of children with Fontan circulation, with the potential for survival into adulthood. Due to the abnormal circulation, Fontan patients have an increased risk of thromboembolic (TE) events, with up to 25% of events leading to death. Despite the importance of preventing TE events in this patient population, there is currently no clinical consensus on the optimal monitoring, thromboprophylaxis therapies, and treatment of these events. This paper reviews the available literature regarding anticoagulation in the pediatric and adult Fontan population, including the mechanisms for thrombosis and current antithrombotic therapies.
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Affiliation(s)
- Chantal Attard
- Murdoch Children's Research Institute, Haematology Research Group, Parkville, Victoria, Australia; Royal Children's Hospital, Department of Clinical Haematology, Parkville, Victoria, Australia; The University of Melbourne, Department of Paediatrics, Parkville, Victoria, Australia.
| | - Joanna Huang
- Murdoch Children's Research Institute, Haematology Research Group, Parkville, Victoria, Australia; Royal Children's Hospital, Department of Clinical Haematology, Parkville, Victoria, Australia; Monash University, School of Clinical Sciences, Clayton, Victoria, Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Haematology Research Group, Parkville, Victoria, Australia; Royal Children's Hospital, Department of Clinical Haematology, Parkville, Victoria, Australia; The University of Melbourne, Department of Paediatrics, Parkville, Victoria, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Haematology Research Group, Parkville, Victoria, Australia; Royal Children's Hospital, Department of Clinical Haematology, Parkville, Victoria, Australia
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236
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Inefficient Ventriculoarterial Coupling in Fontan Patients: A Cardiac Magnetic Resonance Study. Pediatr Cardiol 2018; 39:763-773. [PMID: 29404642 DOI: 10.1007/s00246-018-1819-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/19/2018] [Indexed: 11/27/2022]
Abstract
The ventriculoarterial coupling (VAC) ratio, the ratio of arterial elastance (Ea) to ventricular end-systolic elastance (Ees), reflects cardiovascular efficiency. Little is known about this ratio in patients who have undergone the Fontan procedure. Our aim was to assess the VAC ratio in a cohort of Fontan patients using a cardiac magnetic resonance (CMR) method, and to examine its relation to outcomes. We retrospectively assessed VAC from CMR data on 195 Fontan patients (age 19.6 ± 10.7 years) and 42 controls (age 15.2 ± 2.2 years). The VAC ratio was calculated as Ea/Ees (Ea = mean arterial blood pressure (MBP)/ventricular stroke volume; Ees = MBP/end-systolic volume). Compared with controls, Fontan patients had lower body surface area-adjusted median Ees (1.54 vs. 2.4, p < 0.001) and Ea (1.35 vs. 1.48, p = 0.01), and a higher median VAC ratio (0.88 vs. 0.62, p < 0.001). After a median follow-up of 4 years (range 1-10), 20 patients reached a composite endpoint of death or heart transplant listing. On multivariable modeling, being in the lowest tertile of the VAC ratio was independently associated with the composite endpoint (odds ratio 11.39, p = 0.02), and inclusion of the VAC ratio in the model improved prediction compared to traditional risk factors. In patients without ventricular dilation, the VAC ratio was the only factor predictive of the composite endpoint (p = 0.02). In conclusion, we found evidence for inefficient ventriculoarterial coupling in Fontan patients. The VAC ratio improved prediction of outcomes and was especially useful in patients without ventricular dilation. Further investigation into the clinical significance of ventriculoarterial coupling in this patient population is warranted.
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Lee D, Levin A, Kiess M, Sexsmith G, Chakrabarti S, Barlow A, Human D, Grewal J. Chronic kidney damage in the adult Fontan population. Int J Cardiol 2018; 257:62-66. [DOI: 10.1016/j.ijcard.2017.11.118] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 11/30/2017] [Indexed: 12/21/2022]
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Schwartz I, McCracken CE, Petit CJ, Sachdeva R. Late outcomes after the Fontan procedure in patients with single ventricle: a meta-analysis. Heart 2018. [PMID: 29535229 DOI: 10.1136/heartjnl-2017-312807] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE More patients with Fontan physiology are reaching adulthood. The purpose of this meta-analysis was to evaluate the late outcomes of patients palliated with Fontan procedure and to assess the risk factors for mortality. METHODS PubMed, Embase and Web of Science were queried to retrieve observational studies of survival in patients following the Fontan procedure with ≥5 years of follow-up. A random-effects model was used to determine pooled survival estimates at 5, 10 and 15 years. Meta-regression was used to assess potential moderators for death. RESULTS Nineteen articles with a total of 5859 patients were included. The weighted mean follow-up time was 8.94±2.64 years with overall 8.3% deaths and 1.5% transplants. Pooled survival estimates at 5, 10 and 15 years were 90.7%, 87.2% and 87.5%, respectively; and 88.4%, 85.7% and 84.1%, respectively, for studies that included all three time intervals (n=4). Earliest surgical year included in the study, proportion of atriopulmonary connections versus extracardiac conduit or lateral tunnel, and older age at Fontan were associated with higher rates of death, but ventricular morphology was not. Protein-losing enteropathy, reoperation and pacemaker insertion were reported in 2.1%, 5.6% and 6.8% patients, respectively. CONCLUSIONS Survival following the Fontan procedure has improved with time and is influenced by Fontan type and age at the time of Fontan. At a mean follow-up of 8.9 years, there was no significant association between survival and ventricular morphology, not taking into account the mortality prior to Fontan.
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Affiliation(s)
- Ilana Schwartz
- School of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher J Petit
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
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Di Maria MV, Menon SC. Role of comprehensive care in Fontan survivors: A multidisciplinary team approach. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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241
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Steiner JM, Kovacs AH. Adults with congenital heart disease – Facing morbidities and uncertain early mortality. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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242
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Cordina R, du Plessis K, Tran D, d'Udekem Y. Super-Fontan: Is it possible? J Thorac Cardiovasc Surg 2018; 155:1192-1194. [DOI: 10.1016/j.jtcvs.2017.10.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
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243
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Wilson WM, Valente AM, Hickey EJ, Clift P, Burchill L, Emmanuel Y, Gibson P, Greutmann M, Grewal J, Grigg LE, Gurvitz M, Hickey K, Khairy P, Mayer JE, Teo E, Vonder Muhll I, Roche SL, Silversides CK, Wald RM. Outcomes of Patients With Hypoplastic Left Heart Syndrome Reaching Adulthood After Fontan Palliation. Circulation 2018; 137:978-981. [DOI: 10.1161/circulationaha.117.031282] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William M. Wilson
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada (W.M.W., E.J.H., S.L.R., C.K.S., R.M.W.)
- Adult Congenital Heart Disease Program, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (W.M.W., L.E.G., E.T.)
| | - Anne M. Valente
- Children’s Hospital Boston, Harvard Medical School, MA (A.M.V., M.G., K.H., J.E.M.)
| | - Edward J. Hickey
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada (W.M.W., E.J.H., S.L.R., C.K.S., R.M.W.)
| | - Paul Clift
- Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.C., Y.E.)
| | - Luke Burchill
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health Science University, Portland (L.B.)
| | - Yaso Emmanuel
- Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.C., Y.E.)
| | - Patrick Gibson
- Northern Alberta Adult Congenital Heart Program, University of Alberta, Edmonton, Canada (P.G., I.V.M.)
| | - Matthias Greutmann
- Children’s Hospital Boston, Harvard Medical School, MA (A.M.V., M.G., K.H., J.E.M.)
| | - Jasmine Grewal
- Pacific Adult Congenital Heart Clinic, Division of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (J.G.)
| | - Leeanne E. Grigg
- Adult Congenital Heart Disease Program, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (W.M.W., L.E.G., E.T.)
| | - Michelle Gurvitz
- University Heart Centre, University Hospital Zurich, Switzerland (M.G.)
| | - Kelsey Hickey
- Children’s Hospital Boston, Harvard Medical School, MA (A.M.V., M.G., K.H., J.E.M.)
| | - Paul Khairy
- Montréal Heart Institute Adult Congenital Center, Université de Montréal, Quebec, Canada (P.K.)
| | - John E. Mayer
- Children’s Hospital Boston, Harvard Medical School, MA (A.M.V., M.G., K.H., J.E.M.)
| | - Eliza Teo
- Adult Congenital Heart Disease Program, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia (W.M.W., L.E.G., E.T.)
| | - Isabelle Vonder Muhll
- Northern Alberta Adult Congenital Heart Program, University of Alberta, Edmonton, Canada (P.G., I.V.M.)
| | - S. Lucy Roche
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada (W.M.W., E.J.H., S.L.R., C.K.S., R.M.W.)
| | - Candice K. Silversides
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada (W.M.W., E.J.H., S.L.R., C.K.S., R.M.W.)
| | - Rachel M. Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada (W.M.W., E.J.H., S.L.R., C.K.S., R.M.W.)
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Rösner A, Khalapyan T, Dalen H, McElhinney DB, Friedberg MK, Lui GK. Classic-Pattern Dyssynchrony in Adolescents and Adults With a Fontan Circulation. J Am Soc Echocardiogr 2018; 31:211-219. [DOI: 10.1016/j.echo.2017.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/25/2022]
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245
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Zentner D, Cheshire C, Grigg L. Extracardiac Conduit Fontan – Outcome Data in Early Adulthood. Heart Lung Circ 2018; 27:254-259. [DOI: 10.1016/j.hlc.2017.03.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
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Rogers L, Pagel C, Sullivan ID, Mustafa M, Tsang V, Utley M, Bull C, Franklin RC, Brown KL. Interventional treatments and risk factors in patients born with hypoplastic left heart syndrome in England and Wales from 2000 to 2015. Heart 2018; 104:1500-1507. [DOI: 10.1136/heartjnl-2017-312448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/25/2023] Open
Abstract
ObjectiveTo describe the long-term outcomes, treatment pathways and risk factors for patients diagnosed with hypoplastic left heart syndrome (HLHS) in England and Wales.MethodsThe UK’s national audit database captures every procedure undertaken for congenital heart disease and updated life status for resident patients in England and Wales. Patients with HLHS born between 2000 and 2015 were identified using codes from the International Paediatric and Congenital Cardiac Code.ResultsThere were 976 patients with HLHS. Of these, 9.6% had a prepathway intervention, 89.5% underwent a traditional pathway of staged palliation and 6.4% of infants underwent a hybrid pathway. Patients undergoing prepathway procedures or the hybrid pathway were more complex, exhibiting higher rates of prematurity and acquired comorbidity. Prepathway intervention was associated with the highest in-hospital mortality (34.0%).44.6% of patients had an off-pathway procedure after their primary procedure, most frequently stenting or dilation of residual or recoarctation and most commonly occurring between stage 1 and stage 2.The survival rate at 1 year and 5 years was 60.7% (95% CI 57.5 to 63.7) and 56.3% (95% CI 53.0 to 59.5), respectively. Patients with an antenatal diagnosis (multivariable HR (MHR) 1.63 (95% CI 1.12 to 2.38)), low weight (<2.5 kg) (MHR 1.49 (95% CI 1.05 to 2.11)) or the presence of an acquired comorbidity (MHR 2.04 (95% CI 1.30 to 3.19)) were less likely to survive.ConclusionTreatment pathways among patients with HLHS are complex and variable. It is essential that the long-term outcomes of conditions like HLHS that require serial interventions are studied to provide a fuller picture and to inform quality assurance and improvement.
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Kverneland LS, Kramer P, Ovroutski S. Five decades of the Fontan operation: A systematic review of international reports on outcomes after univentricular palliation. CONGENIT HEART DIS 2018; 13:181-193. [DOI: 10.1111/chd.12570] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/08/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Laura S. Kverneland
- Department of Internal Medicine; Herlev Hospital; Copenhagen Denmark
- Department of Congenital Heart Disease/Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease/Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
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Bacon MK, Gray SB, Schwartz SM, Cooper DS. Extracorporeal Membrane Oxygenation (ECMO) Support in Special Patient Populations-The Bidirectional Glenn and Fontan Circulations. Front Pediatr 2018; 6:299. [PMID: 30386759 PMCID: PMC6199392 DOI: 10.3389/fped.2018.00299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/25/2018] [Indexed: 01/27/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a support modality used within the pediatric cardiac ICU population as a bridge to recovery or decision in the setting of acute myocardial decompensation, support for combined cardiopulmonary failure or in the setting of refractory cardiopulmonary arrest. Patients with univentricular physiology are at particular risk for decompensation requiring ECMO support. This review will focus upon current evidence and techniques for ECMO support of single ventricle patients who have undergone a stage II bidirectional Glenn procedure or the stage III Fontan procedure.
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Affiliation(s)
- Matthew K Bacon
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Seth B Gray
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Steven M Schwartz
- Departments of Critical Care Medicine and Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Poh CL, d'Udekem Y. Life After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and Predictors of Late Death. Heart Lung Circ 2017; 27:552-559. [PMID: 29402692 DOI: 10.1016/j.hlc.2017.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/18/2017] [Indexed: 12/29/2022]
Abstract
AIM We now know that 20-40% of patients with a single ventricle will develop heart failure after the second decade post-Fontan surgery. However, we remain unable to risk-stratify the cohort to identify patients at highest risk of late failure and death. We conducted a systematic review of all reported late outcomes for patients with a Fontan circulation to identify predictors of late death. METHODS We searched MEDLINE, Embase and PubMed with subject terms ("single ventricle", "Hypoplastic left heart syndrome", "congenital heart defects" or "Fontan procedure") AND ("heart failure", "post-operative complications", "death", "cause of death", "transplantation" or "follow-up studies") for relevant studies between January 1990 and December 2015. Variables identified as significant predictors of late death on multivariate analysis were collated for meta-analysis. Survival data was extrapolated from Kaplan-Meier survival curves to generate a distribution-free summary survival curve. RESULTS Thirty-four relevant publications were identified, with a total of 7536 patients included in the analysis. Mean follow-up duration was 114 months (range 24-269 months). There were 688 (11%) late deaths. Predominant causes of death were late Fontan failure (34%), sudden death (19%) and perioperative death (16%). Estimated mean survival at 5, 10 and 20 years post Fontan surgery were 95% (95%CI 93-96), 91% (95%CI 89-93) and 82% (95%CI 77-85). Significant predictors of late death include prolonged pleural effusions post Fontan surgery (HR1.18, 95%CI 1.09-1.29, p<0.001), protein losing enteropathy (HR2.19, 95%CI 1.69-2.84, p<0.001), increased ventricular end diastolic volume (HR1.03 per 10ml/BSA increase, 95%CI 1.02-1.05, p<0.001) and having a permanent pacemaker (HR12.63, 95%CI 6.17-25.86, p<0.001). CONCLUSIONS Over 80% of patients who survive Fontan surgery will be alive at 20 years. Developing late sequelae including protein losing enteropathy, ventricular dysfunction or requiring a pacemaker predict a higher risk of late death.
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Affiliation(s)
- C L Poh
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia; Heart Research, Murdoch Childrens Research Institute, Melbourne, Vic, Australia
| | - Y d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia; Heart Research, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.
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Daniels CJ, Bradley EA, Landzberg MJ, Aboulhosn J, Beekman RH, Book W, Gurvitz M, John A, John B, Marelli A, Marino BS, Minich LL, Poterucha JJ, Rand EB, Veldtman GR. Fontan-Associated Liver Disease. J Am Coll Cardiol 2017; 70:3173-3194. [DOI: 10.1016/j.jacc.2017.10.045] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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