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Chowdhury SM, Atz AM, Graham EM, Bandisode VM, Rhodes JF, Nutting AC, Taylor C, Savage A, Hassid M, Kavarana M, Menick D. Low Ventricular Stiffness Is Associated With Suboptimal Outcomes in Patients With a Single Right Ventricle After the Fontan Operation: A Novel Phenotype. J Am Heart Assoc 2024; 13:e035601. [PMID: 39189484 DOI: 10.1161/jaha.124.035601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Despite a rigorous screening process, including cardiac catheterization, a subset of patients with a single right ventricle (SRV) demonstrates suboptimal short-term outcomes after the Fontan operation. The goal of this study was to perform a comprehensive assessment of diastolic function in pre-Fontan patients with an SRV using invasive reference-standard measures and determine their associations with post-Fontan outcomes. METHODS AND RESULTS Children aged 2 to 6 years with SRV physiology undergoing pre-Fontan heart catheterization were recruited prospectively. Patients were divided into those who had an optimal or suboptimal outcome. A suboptimal outcome was defined as length of stay ≥14 days or heart transplant/cardiac death in first year after Fontan. Patients underwent pressure-volume loop analysis using reference-standard methods. The measure of ventricular stiffness, β, was obtained via preload reduction. Cardiac magnetic resonance imaging for extracellular volume and serum draws for matrix metalloproteinase activity were performed. Of 19 patients with an SRV, 9 (47%) had a suboptimal outcome. Mean age was 4.2±0.7 years. Patients with suboptimal outcomes had lower ventricular stiffness (0.021 [0.009-0.049] versus 0.090 [0.031-0.118] mL-1; P=0.02), lower extracellular volume (25% [28%-32%] versus 31% [28%-33%]; P=0.02), and lower matrix metalloproteinase-2 (90 [79-104] versus 108 [79-128] ng/mL; P=0.01) compared with patients with optimal outcomes. The only invasive measure that had an association with suboptimal outcome was β (P=0.038). CONCLUSIONS Patients with an SRV with suboptimal outcome after the Fontan operation had lower ventricular stiffness and evidence of maladaptive extracellular matrix metabolism compared with patients with optimal outcome. This appears to be a novel phenotype that may have important clinical implications and requires further study.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Andrew M Atz
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Eric M Graham
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - John F Rhodes
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Arni C Nutting
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Carolyn Taylor
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Andrew Savage
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Marc Hassid
- Department of Anesthesia Medical University of South Carolina Charleston SC USA
| | - Minoo Kavarana
- Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Donald Menick
- Department of Medicine, Division of Cardiology Medical University of South Carolina Charleston SC USA
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Demir IH, Celebi A, Ozdemir DM, Yilmaz EH, Bulut MO, Surucu M, Korun O, Aydemir NA, Yucel IK. Utility of Balloon Occlusion Testing in Determining Fontan Suitability Among Patients with Elevated Pulmonary Artery Pressure and Additional Antegrade Pulmonary Blood Flow. Pediatr Cardiol 2024; 45:632-639. [PMID: 38182891 DOI: 10.1007/s00246-023-03380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
In individuals with a single ventricle undergoing evaluation before Fontan surgery, the presence of excessive pulmonary blood flow can contribute to increased pulmonary artery pressure, notably in those who had a Glenn procedure with antegrade pulmonary flow. 28 patients who had previously undergone Glenn anastomosis with antegrade pulmonary blood flow (APBF) and with elevated mean pulmonary artery (mPAP) pressure > 15 mmHg in diagnostic catheter angiography were included in the study. After addressing other anatomical factors that could affect pulmonary artery pressure, APBF was occluded with semi-compliant, Wedge or sizing balloons to measure pulmonary artery pressure accurately. 23 patients (82% of the cohort) advanced to Fontan completion. In this group, median mPAP dropped from 20.5 (IQR 19-22) mmHg to 13 (IQR 12-14) mmHg post-test (p < 0.001). Median PVR post-test was 1.8 (IQR 1.5-2.1) WU m2. SpO2 levels decreased from a median of 88% (IQR 86%-93%) pre-test to 80% (IQR 75%-84%) post-test (p < 0.001). In five patients, elevated mPAP post-test occlusion on diagnostic catheter angiography led to non-completion of Fontan circulation. In this group, median pre- and post-test mPAP were 23 mmHg (IQR 21.5-23.5) and 19 mmHg (IQR 18.5-20), respectively (p = 0.038). Median post-test PVR was 3.8 (IQR 3.6-4.5) WU m2. SpO2 levels decreased from a median of 79% (IQR 76%-81%) pre-test to 77% (IQR 73.5%-80%) post-test (p = 0.039). Our study presents a specialized approach for patients initially deemed unsuitable for Fontan due to elevated pulmonary artery pressures. We were able to successfully complete the Fontan procedure in the majority of these high-risk cases after temporary balloon occlusion test.
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Affiliation(s)
- Ibrahim Halil Demir
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey
| | - Dursun Muhammed Ozdemir
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey
| | - Emine Hekim Yilmaz
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey
| | - Mustafa Orhan Bulut
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey
| | - Murat Surucu
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiovascular Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ilker Kemal Yucel
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey.
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Eilers LF, Britt JJ, Weigand J, Penny DJ, Gowda ST, Qureshi AM, Stapleton GE, Khan A, Webb MK, Bansal M. Pre-Fontan Assessment Utilizing Combined Cardiac Catheterization and Cardiac MRI: Comparison to the Pre-Fontan Catheterization. Pediatr Cardiol 2023:10.1007/s00246-023-03178-x. [PMID: 37210685 DOI: 10.1007/s00246-023-03178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
Single ventricle patients eligible for Fontan completion undergo pre-Fontan catheterization for hemodynamic and anatomic assessment prior to surgery. Cardiac magnetic resonance imaging may be used to evaluate pre-Fontan anatomy, physiology, and collateral burden. We describe our center's outcomes in patients undergoing pre-Fontan catheterization combined with cardiac magnetic resonance imaging. A retrospective review of patients undergoing pre-Fontan catheterization from 10/2018 to 04/2022 at Texas Children's Hospital was performed. Patients were divided into 2 groups: combined cardiac magnetic resonance imaging and catheterization (combined group) and those who underwent catheterization only (catheterization only group). There were 37 patients in the combined group and 40 in the catheterization only group. Both groups were similar in age and weight. Patients undergoing combined procedures received less contrast, and experienced less in-lab time, fluoroscopy time and catheterization procedure time. Median radiation exposure was lower in the combined procedure group but was not statistically significant. Intubation and total anesthesia times were higher in the combined procedure group. Patients undergoing a combined procedure were less likely to have collateral occlusion performed than in the catheterization only group. Bypass time, intensive care unit length of stay, and chest tube duration were similar in both groups at the time of Fontan completion. Combined pre-Fontan assessment decreases catheterization procedure and fluoroscopy time associated with cardiac catheterization at the expense of longer anesthetic times, and results in similar Fontan outcomes compared to when cardiac catheterization alone is utilized.
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Affiliation(s)
- Lindsay F Eilers
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Jolie J Britt
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Justin Weigand
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Daniel J Penny
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Srinath T Gowda
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Gary E Stapleton
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Asra Khan
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Melissa K Webb
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA
| | - Manish Bansal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX, 77030, USA.
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Impact of pulmonary artery flow distribution on Fontan hemodynamics and flow energetics. Pediatr Radiol 2023; 53:900-909. [PMID: 36879047 PMCID: PMC10156799 DOI: 10.1007/s00247-023-05591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND With improved life expectancy following Fontan palliation, there is an increasing population of patients with a total cavopulmonary connection. However, there is a poor understanding of which patients will experience Fontan failure and when. 4D flow MRI has identified several metrics of clinical interest, but longitudinal studies investigating hemodynamics in Fontan patients are lacking. OBJECTIVE We aimed to investigate the relationship between flow distribution to the pulmonary arteries and regional hemodynamic metrics in a unique cohort with follow-up 4D flow MRI. MATERIALS AND METHODS Patients with > 6 months of 4D flow MRI follow-up were included. Flow distribution from the caval veins to pulmonary arteries was measured in addition to regional measures of peak velocity, viscous energy loss (ELmean and ELtot), and kinetic energy. RESULTS Ten patients with total cavopulmonary connection (17.7 ± 8.8 years at baseline, follow-up: 4.4 ± 2.6 years) were included. Five subjects had unequal flow distribution from the IVC to the pulmonary arteries at baseline. Over time, these subjects tended to have larger increases in peak velocity (39.2% vs 6.6%), ELmean (11.6% vs -38.3%), ELtot (9.5% vs -36.2%), and kinetic energy (96.1% vs 36.3%) in the IVC. However, these differences were statistically insignificant. We found that changes in ELmean and ELtot were significantly associated with changes in peak velocity in the caval veins (R2 > 0.5, P < 0.001). CONCLUSION Unequal flow distribution from the IVC may drive increasing peak velocities and viscous energy losses, which have been associated with worse clinical outcomes. Changes in peak velocity may serve as a surrogate measure for changes in viscous energy loss.
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Azhar A, Eid R, Elakaby A, Abdelsalam M, Al-Ata J, Alkhushi N, Bahaidarah S, Zaher Z, Maghrabi K, Noaman N, Abdelmohsen G. Outcomes of bidirectional Glenn surgery done without prior cardiac catheterization. Egypt Heart J 2022; 74:57. [PMID: 35925522 PMCID: PMC9352820 DOI: 10.1186/s43044-022-00296-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac catheterization is usually done routinely in patients with univentricular hearts before palliative Bidirectional Glenn (BDG) surgery. The objective of this study was to compare the outcomes of patients with physiological univentricular hearts and restrictive pulmonary flow that did not undergo routine cardiac catheterization before BDG with the patients that did have cardiac catheterization done. We retrospectively reviewed the data of all patients with single ventricle physiology and restrictive pulmonary blood flow who underwent BDG surgery from January 2016 till December 2020. Patients were divided into two groups: the catheterization and the non-catheterization groups. Results Out of 93 patients, 25 (27%) underwent BDG surgery without prior cardiac catheterization. The median age of patients was ten months, interquartile range (IQR) was 5–18 months. Tricuspid atresia represented 36% of the non-catheterization group, while unbalanced atrioventricular septal defect and hypoplastic left heart syndrome represented 19% and 17.6% of the catheterization group. No patients in the catheterization group were excluded from further BDG surgery based on the catheterization data. Moreover, no significant differences were found between the patients' groups regarding the length of hospital stay, length of intensive care unit stay, postoperative oxygen saturation, or survival (P = 0.266, P = 0.763, P = 0.543, P = 0456). Conclusions Although pre-BDG cardiac catheterization is the routine and standard practice, in certain situations, some patients with single ventricle physiology and restrictive pulmonary blood flow may go directly to BDG without cardiac catheterization if noninvasive imaging is satisfactory on a case-by-case basis and according to center experience. Pre-BDG catheterization could be reserved for patients with limited echocardiographic studies, high-risk patients, or those indicated for catheter intervention before BDG surgery.
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Jobran AW, Hijjeh N, Haymouni N, Sbeitan I, Abdelraziq S, Rizik R, Darsalim A, Abutaqa M, Shrateh ON. Successful stenting of an obstructed Glenn anastomosis in a 20-month-old child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
A Fontan circulation requires a series of three-staged operations aimed to palliate patients with single-ventricle CHD. Currently, the most frequent technique is the extracardiac total cavopulmonary connection, an external conduit connecting the IVC and right pulmonary artery, bypassing the right side of the heart. Fontan candidates must meet strict criteria; they are assessed utilising both cardiac catheterisation and cardiac magnetic resonance. Postoperatively, treatment protocols prioritise antibiotic prophylaxis, diuretics, angiotensin-converting enzyme inhibitors, anticoagulation, and oxygen therapy with fluid restriction and a low-fat diet. These measures aim to reduce length of stay in the ICU and hospital by preventing acute complications such as infection, venous thromboembolism, low cardiac output, pleural effusion, and acute kidney injury. Late complications of a Fontan procedure include circulation failure, protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease. The definitive management is cardiac transplantation, with promising innovations in selective embolisation of lymphatic vessels and Fontan-specific ventricular assist devices. Further research assessing current protocols in the perioperative management of Fontan patients would be beneficial for standardising current practice and improving outcomes.
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8
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Aortopulmonary Collaterals in Single Ventricle Physiology: Variation in Understanding Occlusion Practice Among Interventional Cardiologists. Pediatr Cardiol 2020; 41:1608-1616. [PMID: 32720087 DOI: 10.1007/s00246-020-02418-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Although aortopulmonary collaterals (APCs) frequently develop in patients with single ventricle palliation, there is a lack of understanding of pathophysiology, natural history, and outcomes with no universal guidelines for management and interventional practice. We conducted a study to assess the views held by interventional congenital cardiologists regarding the hemodynamic impact of APCs in patients with single ventricle palliation, and their embolization practice. An electronic survey using the Pediatric Interventional Cardiology Symposium (PICS) mailing list was conducted between February and March 2019 with one reminder sent 2 weeks after initial invitation for participation. Of the 142 interventional cardiologist respondents, 95 (66.9%) reside in North America and 47 (33.1%) worldwide. We elected to exclude the data from interventionalists outside North America in this analysis as it was not representative of worldwide practice. Hypoxemia was considered to be the most common trigger for development of APCs by 56 (58.9%) respondents. After completion of total cavopulmonary connection, 30 (31.6%) respondents reported the APC burden stays the same while 31 (32.6%) feel it decreases. In evaluating the burden of APC flow, only 4 (4.2%) reported measuring oxygen saturation at different pulmonary artery segments, 21 (22.1%) perform segmental aortic angiograms, and 18 (19%) perform selective bilateral subclavian artery angiograms. A majority of respondents, 71 (74.7%), occlude the feeder vessel at different locations, while 10 (10.5%) occlude only the origin of the vessel. Our study demonstrates significant variation in the understanding of the cause and prognosis of APCs in patients with single ventricle palliation. Furthermore, there is variation in the approach for diagnosis and management among interventional cardiologists. Further studies are required to improve understanding of APCs and develop universal management guidelines.
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Percutaneous salvage interventions in the Glenn circuit: a case series. Egypt Heart J 2020; 72:76. [PMID: 33128706 PMCID: PMC7603438 DOI: 10.1186/s43044-020-00113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background In majority of children bidirectional Glenn shunt is a safe and efficacious procedure with minimal post-operative issues. Rarely, there may be dysfunction in the Glenn pathway due loss of anatomical integrity or derangements in normal physiological or hemodynamic milieu. We report 4 cases in the last 3 years (2016-2019) where complications in the Glenn circuit led to serious consequences requiring transcatheter interventions. Case presentation Two of our patients presented with frank features of superior vena cava syndrome. One of them had right Glenn anastomotic site narrowing leading to severe obstruction along with significant left pulmonary artery origin stenosis. The other child had excessive antegrade flow impeding normal Glenn flow leading to superior vena cava syndrome. The next child in our series was initially lost to follow-up after bidirectional Glenn surgery. Later on, this child was noted to have discontinuous left pulmonary artery with perfusion only to the right lung from the Glenn. The remaining child described in this series had developed a large tortuous venous collateral post Glenn shunt leading to severe cyanosis. All the above children needed prompt percutaneous interventions to revert back to their basal state. On follow-up, the benefit was sustained in all. Conclusions Percutaneous intervention procedures often provide a successful bailout option in various complicated situations post Glenn surgery with reasonable efficacy and safety.
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Mohammad Nijres B, Taqatqa AS, Mubayed L, Jutzy GJ, Abdulla RI, Diab KA, Nguyen HH, Muller BA, Sosnowski CR, Murphy JJ, Vettukattil J, Kaley VR, Marckini DN, Samuel BP, Abdelhady K, Awad S. Determination of the Frequency of Right and Left Internal Mammary Artery Embolization in Single Ventricle Patients: A Two-Center Study. Pediatr Cardiol 2018; 39:1657-1662. [PMID: 30105467 DOI: 10.1007/s00246-018-1946-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/03/2018] [Indexed: 11/26/2022]
Abstract
Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to evaluate the frequency and implications of internal mammary artery (IMA) embolization in the single ventricle (SV) population. A retrospective chart review was performed of SV patients who underwent cardiac catheterization before and after Fontan procedure between February 2007 and 2017. Data were collected from two tertiary care centers in the Midwest. Of the 304 SV patients, 62 (20.4%) underwent embolization of one or more IMAs, whereas 242 (79.6%) did not. The rate of embolization of IMA was 40.5% in one center and 14.5% in the second center. Among patients who received IMA embolization, left internal mammary artery (LIMA) embolization was seen in 6 (9.7%) patients. Majority of patients underwent either right internal mammary artery (RIMA) embolization (n = 25; 40.3%) or RIMA and LIMA embolization (n = 27; 43.5%). IMA embolization in SV patients is common. Embolizing IMAs early in life will likely eliminate a valuable graft option for coronary artery bypass grafting should it be required in the future care of these patients. Multi-center, prospective, nation-wide studies are warranted to examine coronary artery disease in the SV population and true frequency of IMA embolization. Delineation of which IMAs were embolized is a necessary in surgical and cardiac intervention national data, such as Society of Thoracic Surgeons (STS) database. All measures should be taken to preserve IMAs patency, if deemed feasible and safe.
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Affiliation(s)
- Bassel Mohammad Nijres
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA.
| | - Anas S Taqatqa
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Lamya Mubayed
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Gregory J Jutzy
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Ra-Id Abdulla
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Karim A Diab
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Hoang H Nguyen
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Brieann A Muller
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Cyndi R Sosnowski
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Joshua J Murphy
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Joseph Vettukattil
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Vishal R Kaley
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Darcy N Marckini
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Bennett P Samuel
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Khaled Abdelhady
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60612, USA
| | - Sawsan Awad
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
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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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