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Gutiérrez-Gil JA, Torres-Canchala LA, Castro-Viáfara LD, Uribe-Mora M, Vélez-Moreno JF, Mejía-Quiñones V, Mosquera-Álvarez W. 20 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital. Cardiol Young 2023; 33:1378-1382. [PMID: 36205146 DOI: 10.1017/s1047951122002475] [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] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Without participating in a contractile chamber, the Fontan procedure seeks to create a separation of oxygenated and deoxygenated blood in patients with univentricular heart, reducing the risks of long-term hypoxemia and improving their survival. This study describes the clinical outcomes of children undergoing the Fontan procedure between 2000 and 2020 in a tertiary referral hospital care centre in southwestern Colombia. MATERIALS AND METHODS A retrospective observational descriptive study. The 81 patients who underwent the Fontan procedure were included. Categorical variables were presented with percentages and continuous variables with measures of central tendency according to the distribution of the data evaluated through the Shapiro-Wilk test. Sociodemographic, clinical, surgical variables, complications, and mortality were described. RESULTS Between 2000 and 2020, 81 patients underwent the Fontan procedure: 43 (53.1%) males and a median age of 5.3 years (interquartile range 4.3-6.6). The most common diagnosis was tricuspid atresia (49.4%). The median mean pulmonary arterial pressure was 12 mmHg (interquartile range 10-15), the Nakata index 272 mm2/m2 (interquartile range 204-327), and the McGoon index (interquartile range 1.86-2.3). Seventy-two (88.9%) patients underwent extracardiac Fontan and 44 (54.3%) patients underwent fenestration. The median hospitalisation days were 19 days. The main complication was coagulopathy (19.8%), mortality in the first month between 2000 and 2010 was 8.6%, and after 2010 was 1.2%. CONCLUSION The Fontan procedure is a palliative surgery for children with complex heart disease. According to anatomical and physiological variables, the proper choice of patients determines the short- and long-term results.
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Affiliation(s)
| | | | | | | | - Juan F Vélez-Moreno
- Departamento de Cardiología Pediátrica, Fundación Valle del Lili, Cali, Colombia
| | - Valentina Mejía-Quiñones
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
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Guruchandrasekar SH, Dakin H, Kadochi M, Bhatia A, Bardales L, Johnston M, Piggott KD. Pre-Fontan Cardiac Catheterization Data as a Predictor of Prolonged Hospital Stay and Post-Discharge Adverse Outcomes Following the Fontan Procedure: A Single-Center Study. Pediatr Cardiol 2020; 41:1697-1703. [PMID: 32734530 DOI: 10.1007/s00246-020-02430-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Abstract
Despite improved outcomes following modifications to the Fontan technique, significant morbidity and mortality persist. We sought to determine if abnormal pre-Fontan catheterization hemodynamic data will predict postoperative prolonged hospital stay (PHLOS) and adverse post-discharge outcomes. This is a retrospective study of patients who underwent the Fontan procedure at Children's Hospital of New Orleans from 2008 to 2018. PHLOS was defined as ≥ 14 and ≥ 21 days to discharge post Fontan. We defined post-discharge adverse outcomes as thromboembolic phenomena requiring anticoagulation therapy, protein-losing enteropathy, plastic bronchitis, transplantation, persistent chylous effusion requiring fenestration creation, or death. Statistical analysis was performed using student t test, Chi-square test, and multivariable logistic regression analysis using IBM SPSS version 22. Ninety-seven patients underwent extracardiac Fontan. Forty-one patients (42.3%) experienced hospitalization ≥ 14 days, 31 patients (32%) experienced hospitalization ≥ 21 days, and 14 patients (14.4%) experienced adverse post-discharge outcome. Elevated end-diastolic pressure (EDP) ≥ 10 mmHg (p = 0.005, OR 4.2, CI 1.5-11.4) was independently associated with ≥ 14 days of hospitalization, while a CI < 4 L/minute/meters2 combined with one abnormal catheterization variable was associated with PHLOS and post-discharge adverse outcomes (p = 0.03, OR 2.8, CI 1.1-7.3 and p = 0.043, OR 6.42, OR 1.1-38.9, respectively). The absence of fenestration was also associated with post-discharge adverse outcomes (p = 0.007, OR 5.8, CI1.6-20.7). Elevated EDP may be associated with PHLOS, while CI < 4 L/minute/meters2 combined with abnormal catheterization hemodynamics may be associated with PHLOS and adverse post-discharge outcomes, while absence of fenestration may be associated with post-discharge adverse events.
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Affiliation(s)
- Sanchitha H Guruchandrasekar
- Department of Pediatric Cardiology, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA
| | - Hannah Dakin
- Department of Pediatric Cardiology, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA
| | - Musunkumuki Kadochi
- Department of Pediatric Cardiology, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA
| | - Ajay Bhatia
- Division of Pediatric Cardiac Intensive Care, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA
| | - Lynn Bardales
- Department of Pediatric Cardiology, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA
| | - Marla Johnston
- Department of Pediatric Cardiology, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA
| | - Kurt D Piggott
- Division of Pediatric Cardiac Intensive Care, Children's Hospital, Louisiana State University Health Sciences, 200 Henry Clay Avenue, New Orleans, Louisiana, 70118, USA.
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Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation. Cardiol Young 2019; 29:1066-1071. [PMID: 31331409 DOI: 10.1017/s1047951119001513] [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: 11/06/2022]
Abstract
INTRODUCTION Some authors advocate the use of a dedicated formula to predict the Fontan pressure starting from pre-Fontan catheterisation data. This paper aims at testing the predictive value of the mentioned formula through a retrospective clinical study. METHODS AND RESULTS Pre-Fontan catheterisation data and Fontan pressure measured at the completion were retrospectively collected. Pre-Fontan data were used to calculate the predicted pressure in the Fontan system. The predicted values were compared to the Fontan pressure measured at the Fontan completion and with the needs for fenestration. One hundred twenty-four Fontan patients were retrospectively enrolled (At Fontan: median age 30.73 [24.70-37.20] months, median weight 12.00 [10.98-14.15] kg). Fontan conduit was fenestrated in 78 patients. A poor correlation (r2 = 0.05128) between the measured and predicted data for non-fenestrated patients was observed. In the case of Fontan-predicted pressure <17.59 mmHg, the formula identified a good short-term clinical outcome with a sensitivity of 92%. CONCLUSION The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. As the pressure into the Fontan system is determined by multiple factors, the tested formula could be an additional data in a multi-parametric approach.
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Al-Dairy A, Dehaki MG, Omrani G, Sadeghpour A, Jalali AH, Afjehi RS, Mahdavi M, Salesi M. The Outcomes of Superior Cavopulmonary Connection Operation: a Single Center Experience. Braz J Cardiovasc Surg 2017; 32:503-507. [PMID: 29267614 PMCID: PMC5731310 DOI: 10.21470/1678-9741-2017-0025] [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: 02/03/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction The superior cavopulmonary connection operation is one of the stages of the
palliative surgical management for patients with functionally single
ventricle. After surviving this stage, the patients are potential candidates
for the final palliative procedure: the Fontan operation. Objectives This study aimed to analyze the outcomes of superior cavopulmonary connection
operations in our center and to identify factors affecting the survival and
the progression to Fontan stage. Methods The outcomes of 161 patients were retrospectively analyzed after undergoing
superior cavopulmonary connection operation in our center between 2005 and
2015. Results The early mortality rate was 2.5%. Five (3.1%) patients underwent takedown of
the superior cavopulmonary connection. The rate of exclusion from the Fontan
stage was 8.3%. Statistical analysis revealed that elevated mean pulmonary
artery pressure preoperatively and the prior palliation with pulmonary
artery banding were risk factors for both early mortality and takedown;
however, the age, the morphology of the single ventricle and the type of
operation were not considered risk factors. Conclusion The superior cavopulmonary connection operation can be performed with low
rate mortality and morbidity; however, the elevated mean pulmonary artery
pressure preoperatively and the prior pulmonary artery banding are
associated with poor outcomes.
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Affiliation(s)
- Alwaleed Al-Dairy
- Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Gholampour Dehaki
- Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Omrani
- Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sadeghpour
- Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Sadat Afjehi
- Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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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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Talwar S, Das A, Khadgawat R, Sahu MK, Choudhary SK, Airan B. A prospective study of risk factors associated with persistent pleural effusion after total cavopulmonary connection with special reference to serum cortisol level. Indian J Thorac Cardiovasc Surg 2017; 34:345-354. [PMID: 33060892 DOI: 10.1007/s12055-017-0617-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives The Fontan operation is usually followed by significant pleural effusion. We aimed to study the factors associated with persistent pleural effusion with special reference to serum cortisol levels. Patients and methods Thirty-eight patients undergoing the Fontan operation between September 2015 and November 2016 were prospectively studied. Parameters studied included age, weight, symptoms, atrio- ventricular valve regurgitation/stenosis/atresia, ventricular function, pulmonary artery pressures, oxygen saturation, aorto-pulmonary, and veno-venous collaterals, type of Fontan, duration of cardiopulmonary bypass, need for inotropes, duration of mechanical ventilation, conduit size, presence or absence of fenestration, and serum cortisol levels. The latter were measured before and after the Fontan operation and the co-relation between pleural effusion and change in serum cortisol levels was studied. Results Mean age at operation was 13.1 ± 5.6 years (median 13 years). Mean duration and amount of pleural drainage was 15.76 ± 13.2 days (median 11.5 days) and 9.15 ± 4.6 mL/kg/day (median 9 mL/kg/day) respectively. Statistically significant risk factors for prolonged pleural effusion were higher pulmonary artery (PA) pressures (r = 0.328, p = 0.003, odds ratio 1.30), higher inotropic score (r = 0.4, p = 0.01), lower rise in serum cortisol (p = 0.03),elevated superior caval venous pressure (CVP) at 6 h (r = 0.44, p = 0.005) and 12 h (r = 0.4, p = 0.01) and higher duration of mechanical ventilation (r = 0.45, p = 0.005). Conclusions PA pressures > 15 mmHg, higher inotropic score, higher CVP and lower rise in serum cortisol levels following the Fontan operation were associated with persistent pleural effusion.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Anupam Das
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Manoj Kumar Sahu
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Shiv Kumar Choudhary
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Balram Airan
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, 110029 India
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Park PW, Atz AM, Taylor CL, Chowdhury SM. Speckle-Tracking Echocardiography Improves Pre-operative Risk Stratification Before the Total Cavopulmonary Connection. J Am Soc Echocardiogr 2017; 30:478-484. [PMID: 28274715 PMCID: PMC5420476 DOI: 10.1016/j.echo.2017.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Single-ventricle patients with elevated pulmonary vascular resistance (PVR) or end-diastolic pressure (EDP) are excluded from undergoing total cavopulmonary connection (TCPC). However, a subset of patients deemed to be at acceptable risk experience prolonged length of stay (LOS) after TCPC. Routine assessment of ventricular function has been inadequate in identifying these high-risk patients. Speckle-tracking echocardiography (STE) is a novel method for assessment of myocardial deformation that may be useful in single-ventricle patients. The aim of this study was to perform a contemporary preoperative risk assessment for prolonged LOS to determine whether STE improves risk stratification before TCPC. METHODS Our single institution's perioperative data were retrospectively collected. The primary outcome was postoperative LOS >14 days. Longitudinal and circumferential STE deformation measures were analyzed on echocardiograms obtained during preoperative catheterization. Patient-specific, echocardiographic, and catheterization data were included in multivariable logistic regression. Receiver operating characteristic area under the curves (AUC) were analyzed. RESULTS From 2007 to 2014, 135 patients who underwent TCPC were included in the analysis. The median LOS was 11 (IQR 9-14) days. The PVR (P < .01) and circumferential strain rate (CSR) (P < .01) were the only variables independently associated with LOS >14 days. For every 0.1 s-1 CSR increased, there was a 20% increased odds of prolonged LOS. The AUC for CSR was 0.70. The AUC for PVR and EDP combined was 0.68. The AUC for PVR, EDP, and CSR combined was 0.73. CONCLUSION Preoperative CSR is independently associated with LOS >14 days and improves preoperative risk stratification in patients undergoing TCPC.
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Affiliation(s)
- Patsy W Park
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew M Atz
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
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Abstract
Although mortality is low after the modified Fontan procedure, there is a significant percentage of patients with prolonged postoperative recovery. The objective of this study is to evaluate the usefulness of postoperative administration of oral sildenafil and inhaled nitric oxide on early postoperative outcome. A prospective interventional and comparison study with a historical cohort was conducted. Between January, 2010 and March, 2013, 16 patients received oral sildenafil during immediate modified Fontan postoperative period. Inhaled nitric oxide was also administered if the patient was kept intubated 12 hours after surgery. Early postoperative outcome was compared with a historical cohort of 32 patients on whom the modified Fontan procedure was performed between March, 2000 and December, 2009. Postoperative administration of sildenafil and nitric oxide had no influence on early postoperative outcome after the modified Fontan procedure in terms of duration of pleural effusions, mechanical ventilation time, length of stay in the ICU, and length of hospital stay.
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Percutaneous interventions in Fontan circulation. IJC HEART & VASCULATURE 2015; 8:138-146. [PMID: 28785693 PMCID: PMC5497275 DOI: 10.1016/j.ijcha.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/10/2015] [Accepted: 06/21/2015] [Indexed: 11/25/2022]
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Subirana MT, Barón-Esquivias G, Manito N, Oliver JM, Ripoll T, Lambert JL, Zunzunegui JL, Bover R, García-Pinilla JM. 2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant. ACTA ACUST UNITED AC 2014; 67:211-7. [PMID: 24774396 DOI: 10.1016/j.rec.2013.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/02/2013] [Indexed: 11/25/2022]
Abstract
This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices.
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Affiliation(s)
- M Teresa Subirana
- Unidad de Cardiopatías Congénitas del Adolescente y Adulto Vall d'Hebron-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Nicolás Manito
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Universitario de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - José M Oliver
- Unidad de Cardiopatías Congénitas del Adulto, Hospital La Paz, Madrid, Spain
| | - Tomás Ripoll
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Jose Luis Lambert
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco del Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José L Zunzunegui
- Unidad de Cardiología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ramon Bover
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Clínico Universitario San Carlos Madrid, Spain
| | - José Manuel García-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Santisteban M, Pan M, Romero M, Casares J, Gómez E, Suárez de Lezo J. Fenestration closure after Fontan surgery. Contributions of percutaneous interventionism. ACTA ACUST UNITED AC 2014; 66:909-11. [PMID: 24774002 DOI: 10.1016/j.rec.2013.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/17/2013] [Indexed: 11/20/2022]
Affiliation(s)
- Marta Santisteban
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Miguel Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jaime Casares
- Servicio de Cirugía Cardiovascular, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Gómez
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain
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Subirana MT, Barón-Esquivias G, Manito N, Oliver JM, Ripoll T, Lambert JL, Zunzunegui JL, Bover R, García-Pinilla JM. Actualización 2013 en cardiopatías congénitas, cardiología clínica e insuficiencia cardiaca y trasplante. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ibrahim L. Mid-term outcome of Egyptian children post univentricular repair (experience of single center). EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2014. [DOI: 10.1016/j.epag.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Santisteban M, Pan M, Romero M, Casares J, Gómez E, Suárez de Lezo J. Cierre de fenestración tras la cirugía de Fontan. Aportaciones del intervencionismo percutáneo. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Naranjo-Ugalde AM, Rivera-Ladino KM, Consuegra-Chuarey MT, Marcano-Sanz LE, Palenzuela Lopez H. Uso de sildenafilo antes de la derivación cavopulmonar total. Rev Esp Cardiol 2013; 66:71. [DOI: 10.1016/j.recesp.2012.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
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