1
|
Otsuka M, Kodama Y, Kuraoka A, Ishikawa Y, Nakamura M, Nakano T, Kado H, Umemoto S, Ishikita A, Sakamoto I, Ide T, Tsutsui H, Sagawa K. Hemodynamic Characteristics After Fontan Procedure in Patients with Down's Syndrome. Pediatr Cardiol 2022; 43:360-365. [PMID: 34498105 DOI: 10.1007/s00246-021-02727-6] [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: 07/09/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
Patients with Down's syndrome (DS) are generally regarded as not being good candidates for the Fontan procedure. However, detailed hemodynamic changes over time are not fully clarified. A retrospective chart review of all patients with DS who underwent the Fontan procedure and 5 times that number of Fontan patients without DS performed in Fukuoka Children's Hospital and Kyushu University Hospital. Seven Fontan patients with DS were identified, and 35 Fontan patients without DS were recruited. During the mean observational periods of 14.7 years and 15.0 years (DS and non-DS, respectively) after the Fontan procedure, only one DS patient died. Central venous pressure (CVP) and transpulmonary pressure gradient significantly increased, and arterial oxygen saturation significantly decreased over time in DS patients after the Fontan procedure compared with those without DS. CVP in DS patients after the Fontan procedure increased over time compared with non-DS patients. Better management including the efficacy of Pulmonary arterial hypertension-specific therapy should be clarified in further studies.
Collapse
Affiliation(s)
- Masakazu Otsuka
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
| | - Yoshihiko Kodama
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan. .,Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, 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
| | - Toshihide Nakano
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
| | - Hideaki Kado
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
| | - Shintaro Umemoto
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ayako Ishikita
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan
| |
Collapse
|
2
|
Alizadeh Sani Z, Ghasemi A, Mohammadzadeh S, Khajali Z, Behjati M, Alizadehsani R, Khosravi A, Nahavandi S, Islam SMS. Non diagnosed PAPVC induce large reverse venovenous shunt after modified Fontan surgery: A case report of a rare anomaly and embolization therapy. J Cardiovasc Thorac Res 2021; 13:364-366. [PMID: 35047141 PMCID: PMC8749363 DOI: 10.34172/jcvtr.2021.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/09/2022] Open
Abstract
Fontan operation is a reliable palliative surgery for patients with single ventricle physiology. Still, the development of complication is common; one of these complications that need to interventional approach is veno-venous collaterals between systemic and pulmonary veins. A 16-yearoldgirl with a history of modified Fontan operation at 9 years ago was referred with progressive cyanosis and dyspnea on exertion. In contrast trans-thoracic echocardiography (TTE), no fenestration was seen in Fontan circulation. Cardiac magnetic resonance revealed partial anomalous pulmonary vein connection (PAPVC) from left upper pulmonary vein to vertical vein and then into the in nominate vein and SVC with the reverse flow from superior vena cava (SVC) to left upper pulmonary vein(LUPV). This anomalous vein became severe engorged and tortuous. Possibly, LUPV and the verticalvein was dilated gradually as a result of increased pressure in the Fontan circuit. Finally, she underwent successful coil embolization in the midpart of the vertical vein. The oxygen saturation increased from80% to 93%.
Collapse
Affiliation(s)
- Zahra Alizadeh Sani
- MRI Department, Shaheed Rajaei Cardiovascular & Medical Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolrahim Ghasemi
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zahra Khajali
- Shaheed Rajaei Cardiovascular & Medical Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Behjati
- Shaheed Rajaei Cardiovascular & Medical Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC 3216, Australia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC 3216, Australia
| | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC 3216, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
- Cardiovascular Division, The George Institute for Global Health, Australia
- Sydney Medical School, University of Sydney, Australia
| |
Collapse
|
3
|
Alibrahim IJ, Mohammed MHA, Kabbani MS, Jijeh AMZ, Tamimi OR, Alghamdi AA, Alhabshan F. Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome. Ann Pediatr Cardiol 2020; 14:10-17. [PMID: 33679056 PMCID: PMC7918011 DOI: 10.4103/apc.apc_144_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/05/2019] [Accepted: 08/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Pulmonary arteriovenous malformations (PAVMs) are the major cause of progressive cyanosis in patients palliated with bidirectional cavopulmonary connection (BCPC). The aim of our study is to analyze the occurrence of PAVMs in patients after Kawashima procedure, to study the effect of total cavopulmonary connection (TCPC) on PAVMs, to evaluate the effect of axillary arteriovenous fistula (AAVF) creation on PAVMs, and to study the risk factors for PAVMs. Methods: In this retrospective cohort study, all patients with left isomerism and azygous continuation of an interrupted inferior vena cava who underwent Kawashima procedure from July 2001 to December 2017 were included. Results: Twenty.six patients after Kawashima procedure were included in our study. PAVMs were diagnosed in 12 patients (46%). Five of these 12 patients underwent TCPC with complete resolution of hypoxemia. Three patients underwent AAVF creation, 2 had complete resolution, while 1 had partial resolution of hypoxemia. Fourteen patients (54%) did not develop PAVMs. Nakata index below 267 mm2/m2and McGoon ratio below 1.9 predicted the development of PAVMs with high sensitivity and specificity. Conclusions: PAVMs represent a serious complication in patients who undergo Kawashima procedure. Small size of pulmonary arteries is an important risk factor for the development of PAVMs. Resolution of hypoxemia after TCPC completion supports the hepatic factor hypothesis. Early TCPC completion in these patients may help to avoid the development of PAVMs by restoring the hepatic factor. Resolution of hypoxemia after AAVF creation may support the lack of pulsatile flow hypothesis.
Collapse
Affiliation(s)
- Ibrahim J Alibrahim
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed H A Mohammed
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohamad S Kabbani
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulraouf M Z Jijeh
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Omar R Tamimi
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah A Alghamdi
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahad Alhabshan
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Elective left pulmonary artery embolisation for pulmonary arteriovenous malformations secondary to cavopulmonary anastomoses not responsive to heart transplantation: a case report. Cardiol Young 2019; 29:1404-1406. [PMID: 31514756 DOI: 10.1017/s1047951119002130] [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] [Indexed: 11/05/2022]
Abstract
A 10-year-old female with heterotaxy-asplenia and complex CHD developed pulmonary arteriovenous malformations with associated cyanosis after Fontan completion. She underwent orthotopic heart transplantation, but her pulmonary arteriovenous malformations persisted with progressive worsening cyanosis. Elective transcatheter left pulmonary artery embolisation was performed 2 years post-transplant, which successfully normalised her oxygen saturation without a significant increase in pulmonary artery pressure.
Collapse
|
5
|
Asai H, Tachibana T, Shingu Y, Kato H, Wakasa S, Matsui Y. Modified total cavopulmonary shunt as a staged Fontan operation. Asian Cardiovasc Thorac Ann 2017; 26:701-703. [PMID: 28132535 DOI: 10.1177/0218492317692466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The left superior vena cava became occluded in an infant with hypoplastic left heart syndrome. After a bidirectional Glenn procedure, he presented with severe oxygen desaturation and right ventricular dysfunction; the left superior vena cava drained into the inferior vena cava through collateral veins. As salvage therapy, we created a modified total cavopulmonary shunt using only autologous tissue in which the right hepatic vein and inferior vena cava drained into the pulmonary artery via a lateral tunnel in the right atrium. Immediately after surgery, his oxygen saturation increased and right ventricular function improved.
Collapse
Affiliation(s)
- Hidetsugu Asai
- 1 Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Tsuyoshi Tachibana
- 1 Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Yasushige Shingu
- 1 Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroki Kato
- 2 Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan
| | - Satoru Wakasa
- 1 Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshiro Matsui
- 1 Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
6
|
Yamada K, Shinmoto H, Kawamura Y, Wakamatsu H, Kawauchi T, Soga S, Ogata S, Kaji T. Transarterial embolization for pediatric hepatocellular carcinoma with cardiac cirrhosis. Pediatr Int 2015; 57:766-70. [PMID: 26013052 DOI: 10.1111/ped.12619] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/27/2014] [Accepted: 12/11/2014] [Indexed: 12/28/2022]
Abstract
We describe the case of a 15-year-old boy with a history of Fontan operation and multiple intrahepatic tumors. Computed tomography showed multiple hepatic nodules with arterial enhancement. Because hepatocellular carcinoma (HCC) was not detected on biopsies and tumor markers were normal, progress was monitored on imaging. One hepatic tumor increased greatly in size during follow up. At 15 years of age, tumor markers rose rapidly, and he had upper abdominal swelling. Therefore, transarterial embolization (TAE) was performed for the largest tumor, suspected to be a HCC due to cardiac cirrhosis. This tumor had not increased at follow up 4 months later. The patient died from hepatic failure at the age of 17 years, and HCC was diagnosed at autopsy. Although pediatric HCC is rare, its incidence is likely to increase. TAE, with or without anticancer agents, is a therapeutic option for unresectable pediatric HCC, as it is for adult HCC.
Collapse
Affiliation(s)
- Kentaro Yamada
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yoichi Kawamura
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hajime Wakamatsu
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshio Kawauchi
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Shigeyoshi Soga
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Sho Ogata
- Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Tatsumi Kaji
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|
7
|
Jabbar AA, Franklin WJ, Simpson L, Civitello AB, Delgado RM, Frazier OH. Improved systemic saturation after ventricular assist device implantation in a patient with decompensated dextro-transposition of the great arteries after the Fontan procedure. Tex Heart Inst J 2015; 42:40-3. [PMID: 25873797 DOI: 10.14503/thij-13-3374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report the successful implantation of a HeartMate II left ventricular assist device after a failed Fontan procedure in a patient with dextro-transposition of the great arteries. The patient had developed significant intrapulmonary arteriovenous shunting. Despite the theoretical risk of worsening intrapulmonary shunting due to the decrease in systemic vascular resistance after device implantation, our patient did well. He was discharged from the hospital in stable condition and had better oxygen saturation than before the device was implanted. To our knowledge, ours is the 2nd report of the use of a ventricular assist device after the failure of a Fontan procedure, and the first report concerning the effect of ventricular assist device implantation on intrapulmonary shunting.
Collapse
|
8
|
Kavarana MN, Jones JA, Stroud RE, Bradley SM, Ikonomidis JS, Mukherjee R. Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications. Expert Rev Cardiovasc Ther 2014; 12:703-13. [PMID: 24758411 DOI: 10.1586/14779072.2014.912132] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Children with functional single ventricle heart disease are commonly palliated down a staged clinical pathway toward a Fontan completion procedure (total cavopulmonary connection). The Fontan physiology is fraught with long-term complications associated with lower body systemic venous hypertension, eventually resulting in significant morbidity and mortality. The bidirectional Glenn shunt or superior cavopulmonary connection (SCPC) is commonly the transitional stage in single ventricle surgical management and provides excellent palliation. Some studies have demonstrated lower morbidity and mortality with the SCPC when compared with the Fontan. Unfortunately the durability of the SCPC is significantly limited by the development of pulmonary arteriovenous malformations (PAVMs) which have been commonly attributed to the absence of hepatic venous blood flow and the lack of pulsatile flow to the affected lungs. Abnormal angiogenesis has been suggested as a final common pathway to PAVM development. Understanding these fundamental mechanisms through the investigation of angiogenic pathways associated with the pathogenesis of PAVMs would help to develop medical therapies that could prevent or reverse this complication following SCPC. Such therapies could improve the longevity of the SCPC, potentially eliminate or significantly postpone the Fontan completion with its associated complications, and improve long-term survival in children with single ventricle disease.
Collapse
Affiliation(s)
- Minoo N Kavarana
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | | | | | | | | | | |
Collapse
|
9
|
Hemodynamics and arteriovenous malformations in cavopulmonary anastomosis: The case for residual antegrade pulsatile flow. J Thorac Cardiovasc Surg 2013; 146:1359-65. [DOI: 10.1016/j.jtcvs.2013.02.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/22/2013] [Accepted: 02/13/2013] [Indexed: 11/18/2022]
|
10
|
Abstract
Severe cyanosis due to pulmonary arteriovenous fistulas occurs often after a bidirectional superior cavopulmonary anastomosis (Glenn operation) and also in some congenital anomalies in which hepatic venous blood bypasses the lungs in the first passage. Relocation of hepatic flow into the lungs usually causes these fistulas to disappear. Similar pulmonary arteriovenous fistulas are observed in hereditary haemorrhagic telangiectasia, and in liver disease (hepatopulmonary syndrome). There is no convincing identification yet of a responsible hepatic factor that produces these lesions. Candidates for such a factor are reviewed, and the possibility of angiotensin or bradykinin contributing to the fistulas is discussed.
Collapse
|
11
|
Meek ME, Meek JC, Beheshti MV. Management of pulmonary arteriovenous malformations. Semin Intervent Radiol 2012; 28:24-31. [PMID: 22379273 DOI: 10.1055/s-0031-1273937] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pulmonary arteriovenous malformations are rare lesions with significant clinical complications. These lesions are commonly seen in patients with hereditary hemorrhagic telangiectasia (formerly Osler-Weber-Rendu syndrome). Interventional radiologists are a key part of the treatment team in this complex disease, and a thorough understanding of the disease process is critical to providing good patient care. In this article, the authors review the disease course and its association with hereditary hemorrhagic telangiectasia, discusses the clinical evaluation and treatment of these complex patients, and outlines complications and follow-up.
Collapse
Affiliation(s)
- Mary E Meek
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | |
Collapse
|
12
|
Chin AJ, Whitehead KK, Watrous RL. Insights After 40 Years of the Fontan Operation. World J Pediatr Congenit Heart Surg 2010; 1:328-43. [DOI: 10.1177/2150135110379623] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fontan’s visionary operation and its modifications over the ensuing decades have re-established nonturbulent flow and substantially reduced cyanosis for patients with severe hypoplasia of one ventricle. However, a long list of largely unexpected sequelae has emerged over the last 40 years. Although it is not difficult to understand how care providers could become discouraged, a number of myths have arisen, which we will attempt to dispel with real-world counterexamples as well as with lessons learned from other disciplines: evolutionary, developmental, and computational biology. We argue that distinctive biochemical abnormalities pointing to dysfunction in multiple organs, including the largest organ system in the body, the endothelium, occur long before grossly observable changes in cardiac imaging can be recognized. With a rational redesign of both our surveillance scheme and our wellness strategies, we hope that Fontan survivors and their families, as well as physicians, nurses, and therapists, will see why Fontan’s principle remains just as vibrant today as it was in 1971.
Collapse
Affiliation(s)
- Alvin J. Chin
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin K. Whitehead
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raymond L. Watrous
- Department of Electrical and Systems Engineering, University of Pennsylvania School of Engineering and Applied Science, Philadelphia, Pennsylvania
| |
Collapse
|