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Piccinelli E, Grutter G, Pilati M, Rebonato M, Scalera ST, Adorisio R, Amodeo A, Ingrasciotta G, Mencarelli E, Galletti L, Butera G. Use of the CardioMEMS Device in Children and Patients with Congenital Heart Disease: A Literature Review. J Clin Med 2024; 13:4234. [PMID: 39064274 PMCID: PMC11277830 DOI: 10.3390/jcm13144234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
The CardioMEMS HF System (Abbott, Abbott Park, IL) is the first FDA- and CE-Mark-approved device for monitoring patients with heart failure, significantly reducing hospitalizations and improving the quality of life for NYHA class III non-congenital adult patients. This device, implanted percutaneously, allows the direct monitoring of pulmonary arterial pressure with the wireless transfer of pressure data to the clinician, who can adjust the therapy remotely. Limited experience exists regarding its use in patients with congenital heart disease (CHD). CardioMEMS device implantation is feasible and safe in selected adults and children with CHD. The potential of the device to reduce heart failure hospitalizations in this population is enormous, but further multi-center studies are needed to demonstrate its efficacy.
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Affiliation(s)
- Enrico Piccinelli
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Torino, Italy
| | - Giorgia Grutter
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
| | - Mara Pilati
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
| | - Micol Rebonato
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
| | | | - Rachele Adorisio
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
| | - Antonio Amodeo
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
| | | | - Erica Mencarelli
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
| | - Lorenzo Galletti
- Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (G.I.)
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Yang Y, Chu TC, Suthar D, Beshish AG, Oster ME, Alonso A, Huang Y, Modanwal G, Kochilas LK, Knight JH. Association of patient-level characteristics with long-term outcomes after Fontan palliation: Rationale, design, and baseline characteristics of the Pediatric Cardiac Care Consortium Fontan cohort study. Am Heart J 2024; 273:111-120. [PMID: 38677504 PMCID: PMC11162923 DOI: 10.1016/j.ahj.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The Fontan operation is used to palliate single ventricle congenital heart defects (CHD) but poses significant morbidity and mortality risks. We present the design, planned analyses, and rationale for a long-term Fontan cohort study aiming to examine the association of patient characteristics at the time of Fontan with post-Fontan morbidity and mortality. METHODS AND RESULTS We used the Pediatric Cardiac Care Consortium (PCCC), a US-based, multicenter registry of pediatric cardiac surgeries to identify patients who underwent the Fontan procedure for single ventricle CHD between 1 and 21 years of age. The primary outcomes are in-hospital Fontan failure (death or takedown) and post-discharge mortality through 2022. A total of 1461 (males 62.1%) patients met eligibility criteria and were included in the analytical cohort. The median age at Fontan evaluation was 3.1 years (IQR: 2.4-4.3). While 95 patients experienced in-hospital Fontan failure (78 deaths and 17 Fontan takedown), 1366 (93.5%) survived to discharge with Fontan physiology and formed the long-term analysis cohort. Over a median follow-up of 21.2 years (IQR: 18.4-24.5) 184 post-discharge deaths occurred. Thirty-year post Fontan survival was 75.0% (95% CI: 72.3%-77.8%) for all Fontan types with higher rates for current techniques such as lateral tunnel and extracardiac conduit 77.1% (95% CI: 73.5-80.8). CONCLUSION The PCCC Fontan study aims to identify predictors for post-Fontan morbidity and mortality, enabling risk- stratification and informing surveillance practices. Additionally, the study may guide therapeutic interventions aiming to optimize hemodynamics and enhance Fontan longevity for individual patients.
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Affiliation(s)
- Yanxu Yang
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tzu-Chun Chu
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA
| | - Divya Suthar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta Cardiology, Atlanta, GA
| | - Asaad G Beshish
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta Cardiology, Atlanta, GA
| | - Matthew E Oster
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta Cardiology, Atlanta, GA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yijian Huang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA
| | - Gourav Modanwal
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, and Emory University School of Medicine, Atlanta, GA
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta Cardiology, Atlanta, GA.
| | - Jessica H Knight
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA
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Kelly B, Mohanakumar S, Ford B, Smith CL, Pinto E, Biko DM, Hjortdal VE, Dori Y. Sequential MRI Evaluation of Lymphatic Abnormalities over the Course of Fontan Completion. Radiol Cardiothorac Imaging 2024; 6:e230315. [PMID: 38814187 PMCID: PMC11211943 DOI: 10.1148/ryct.230315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/11/2024] [Accepted: 03/11/2024] [Indexed: 05/31/2024]
Abstract
Purpose To evaluate lymphatic abnormalities before and after Fontan completion using noncontrast lymphatic imaging and relate findings with postoperative outcomes. Materials and Methods This study is a retrospective review of noncontrast T2-weighted lymphatic imaging performed at The Children's Hospital of Philadelphia from June 2012 to February 2023 in patients with single ventricle physiology. All individuals with imaging at both pre-Fontan and Fontan stages were eligible. Lymphatic abnormalities were classified into four types based on severity and location of lymphatic vessels. Classifications were compared between images and related to clinical outcomes such as postoperative drainage and hospitalization, lymphatic complications, heart transplant, and death. Results Forty-three patients (median age, 10 years [IQR, 8-11]; 20 [47%] boys, 23 [53%] girls) were included in the study. Lymphatic abnormalities progressed in 19 individuals after Fontan completion (distribution of lymphatic classifications: type 1, 23; type 2, 11; type 3, 6; type 4, 3 vs type 1, 10; type 2, 18; type 3, 10; type 4, 5; P = .04). Compared with individuals showing no progression of lymphatic abnormalities, those progressing to a high-grade lymphatic classification had longer postoperative drainage (median time, 9 days [IQR, 6-14] vs 17 days [IQR, 10-23]; P = .04) and hospitalization (median time, 13 days [IQR, 9-25] vs 26 days [IQR, 18-30]; P = .03) after Fontan completion and were more likely to develop chylothorax (12% [three of 24] vs 75% [six of eight]; P < .01) and/or protein-losing enteropathy (0% [0 of 24] vs 38% [three of eight]; P < .01) during a median follow-up of 8 years (IQR, 5-9). Progression to any type was not associated with an increased risk of adverse events. Conclusion The study demonstrated that lymphatic structural abnormalities may progress in select individuals with single ventricle physiology after Fontan completion, and progression of abnormalities to a high-grade classification was associated with worse postoperative outcomes. Keywords: Congenital Heart Disease, Glenn, Fontan, Lymphatic Imaging, Cardiovascular MRI Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Benjamin Kelly
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - Sheyanth Mohanakumar
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - Brooke Ford
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - Christopher L. Smith
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - Erin Pinto
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - David M. Biko
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - Vibeke E. Hjortdal
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
| | - Yoav Dori
- From the Departments of Cardiothoracic Surgery (B.K.) and Radiology
(S.M.), Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus
N, Denmark; Division of Cardiology (B.K., B.F., C.L.S., E.P., Y.D.) and
Department of Radiology (D.M.B.), Children's Hospital of Philadelphia,
Philadelphia, Pa; and Department of Cardiothoracic Surgery, Copenhagen
University Hospital–Rigshospitalet, Copenhagen, Denmark (V.E.H.)
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Hirose K, Ikai A, Ito H, Ishidou M, Toritsuka D, Nakamura Y, Watanabe S, Nakatani E, Sakamoto K. The effect of the conduit size on middle-term outcomes in patients with extracardiac total cavopulmonary connection. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae013. [PMID: 38374222 PMCID: PMC10884530 DOI: 10.1093/icvts/ivae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/05/2023] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The 18- and 16-mm conduits in extracardiac total cavopulmonary connection (eTCPC) were reported to be optimal based on energy loss and flow stagnation at the relatively early phase. However, because the artificial conduit lacks growth potential, we have recently encountered some cases in which the conduit needs to be changed several years after eTCPC. These cases prompted us to reconsider the surgical strategy for eTCPC. METHODS We reviewed our 20-year single-centre experience with eTCPC patients (n = 256) to compare the 18-mm conduit (n = 195) and 16-mm conduit (n = 61) in terms of mortality and morbidity. RESULTS The 16-mm conduit was used significantly more frequently in patients whose main chamber was right ventricle (P < 0.001). There was also a significant difference in preoperative inferior vena cava pressure (P = 0.008). There was a significant difference in the actuarial rate of freedom from late-occurring complications, including mortality, between the 2 groups (P = 0.003). There was a significant difference in the actuarial rate of reoperation-free survival (P = 0.042); however, there was no significant difference in resurgical intervention for the conduit (P = 0.333). In multivariate analysis, preoperative inferior vena cava pressure was an independent predictor for late-occurring complications (hazard ratio 1.19; P = 0.026). Conduit size (18 or 16 mm) itself was not an independent predictive factor for late-occurring complications (P = 0.690). CONCLUSIONS The mid-term clinical outcomes in patients who underwent eTCPC were excellent with low mortality. Preoperative inferior vena cava pressure was the only predictive risk factor for postoperative morbidity, and the 16 mm conduit was not predictive thereof.
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Affiliation(s)
- Keiichi Hirose
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akio Ikai
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Motonari Ishidou
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Daisuke Toritsuka
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yuji Nakamura
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Seito Watanabe
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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Marshall WH, Rajpal S, Mah ML, Armstrong AK, Salavitabar A, Hickey J, Metzger R, Sisk T, Daniels CJ. Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation. J Am Heart Assoc 2023; 12:e031836. [PMID: 38063189 PMCID: PMC10863767 DOI: 10.1161/jaha.123.031836] [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: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Data on the use of implanted hemodynamic monitoring (IHM) in patients with Fontan circulation are limited. This study reports our experience using the CardioMEMS HF system in adults with Fontan circulation. METHODS AND RESULTS This single-center, retrospective study evaluated heart failure hospitalizations, procedural complications, and device-related complications in patients with Fontan circulation referred for IHM placement (2015-2022). The association of pulmonary artery pressure (by most recent catheterization and median IHM pressure within 30 days of placement) with both death and follow-up Model for End-Stage Liver Disease Excluding International Normalized Ratio score were evaluated. Of 18 patients referred for IHM placement, 17 were successful (median age, 30 [range 21-48] years, 6 women). Procedural complications (access site hematomas, pulmonary artery staining) occurred in 3 patients, without device-related procedural complications. In follow-up (median, 35 [range, 6-83] months), 1 patient developed a pulmonary embolism (possibly device-related). Heart failure hospitalizations/year were similar before and after IHM (median, 1 [interquartile range, 0-1.0] versus 0.6 [0-2.3]; P=0.268), though only 46% of heart failure hospitalizations had associated IHM transmissions. IHM pressures were associated with Model for End-Stage Liver Disease Excluding International Normalized Ratio scores (R2=0.588, P<0.001), though catheterization pressures were not (R2=0.140, P=0.139). The long-term mortality rate was 53% in this cohort. On unadjusted survival analysis, IHM pressures ≥18 mm Hg were associated with mortality (log rank P=0.041), which was not reproduced with catheterization pressures (log rank P=0.764). CONCLUSIONS In patients with Fontan circulation, IHM did not reduce heart failure hospitalizations, though patient adherence to transmission was low. Device-related complications were low. IHM pressures may better represent real-life conditions compared with catheterization given associations with mortality and Model for End-Stage Liver Disease Excluding International Normalized Ratio score.
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Affiliation(s)
- William H. Marshall
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Saurabh Rajpal
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - May Ling Mah
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | | | | | - Jenne Hickey
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Rachel Metzger
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Tracey Sisk
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Curt J. Daniels
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
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Venna A, Deshpande S, Downing T, John A, d'Udekem Y. Are dynamic measurements of central venous pressure in Fontan circulation during exercise or volume loading superior to resting measurements? Cardiol Young 2023:1-12. [PMID: 37981897 DOI: 10.1017/s1047951123003797] [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: 11/21/2023]
Abstract
BACKGROUND The main objective measure to assess the health of the Fontan circulation is the pressure measurement of the superior vena cava or pulmonary arteries. We reviewed the literature for benefits of measuring resting pressure in the Fontan circuit and explored whether dynamic measurement by volume loading or exercise has the potential to refine this diagnostic tool. METHODS PubMed was searched for articles showing a relationship between resting post-operative central venous pressure or pulmonary artery pressure and Fontan failure. Relationships between post-operative central venous pressure or pulmonary artery pressure and volume loading changes, such as during exercise or volume loading during cardiac catheterization, were also queried. RESULTS A total of 44 articles mentioned relationships between resting central venous pressure or pulmonary artery pressure and Fontan failure. Only 26 included an analysis between the variables and only seven of those articles found pressure to be predictive of Fontan failure. Ten articles examined the relationship between exercise or volume loading and outcomes and demonstrated a large individual variation of pressures under these dynamic conditions. CONCLUSIONS Based on current literature, there is not a lot of strong evidence to show that elevated resting central venous pressure or pulmonary artery pressure is predictive of Fontan failure. Some individuals experience dramatic increases in central venous pressure or pulmonary artery pressure under increased loading conditions with exercise or bolus fluid infusion, while others experience increases closer to that of a healthy control population. Further studies are needed to examine whether more dynamic and continuous monitoring of systemic venous pressures might better predict outcomes in patients with Fontan circulation.
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Affiliation(s)
- Alyssia Venna
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
| | | | - Tacy Downing
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Anitha John
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Yves d'Udekem
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
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Téllez L, Payancé A, Tjwa E, Del Cerro MJ, Idorn L, Ovroutski S, De Bruyne R, Verkade HJ, De Rita F, de Lange C, Angelini A, Paradis V, Rautou PE, García-Pagán JC. EASL-ERN position paper on liver involvement in patients with Fontan-type circulation. J Hepatol 2023; 79:1270-1301. [PMID: 37863545 DOI: 10.1016/j.jhep.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 10/22/2023]
Abstract
Fontan-type surgery is the final step in the sequential palliative surgical treatment of infants born with a univentricular heart. The resulting long-term haemodynamic changes promote liver damage, leading to Fontan-associated liver disease (FALD), in virtually all patients with Fontan circulation. Owing to the lack of a uniform definition of FALD and the competitive risk of other complications developed by Fontan patients, the impact of FALD on the prognosis of these patients is currently debatable. However, based on the increasing number of adult Fontan patients and recent research interest, the European Association for The Study of the Liver and the European Reference Network on Rare Liver Diseases thought a position paper timely. The aims of the current paper are: (1) to provide a clear definition and description of FALD, including clinical, analytical, radiological, haemodynamic, and histological features; (2) to facilitate guidance for staging the liver disease; and (3) to provide evidence- and experience-based recommendations for the management of different clinical scenarios.
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Affiliation(s)
- Luis Téllez
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), University of Alcalá, Madrid, Spain
| | - Audrey Payancé
- DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France; Université Denis Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Eric Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - María Jesús Del Cerro
- Pediatric Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Lars Idorn
- Department of Pediatrics, Section of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Ruth De Bruyne
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Belgium
| | - Henkjan J Verkade
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, The Netherlands
| | - Fabrizio De Rita
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Charlotte de Lange
- Department of Pediatric Radiology, Queen Silvia Childrens' Hospital, Sahlgrenska University Hospital, Behandlingsvagen 7, 41650 Göteborg, Sweden
| | - Annalisa Angelini
- Pathology of Cardiac Transplantation and Regenerative Medicine Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Valérie Paradis
- Centre de recherche sur l'inflammation, INSERM1149, Université Paris Cité, Paris, France; Pathology Department, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Pierre Emmanuel Rautou
- AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Clichy, France; Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France
| | - Juan Carlos García-Pagán
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departament de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain; CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Spain.
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Bhat DP, Graziano JN, Garn BJ, Franklin WJ. Safety and utility of CardioMEMS device for remote pulmonary artery monitoring in paediatric Fontan patients: a case series. Eur Heart J Case Rep 2023; 7:ytad422. [PMID: 37705945 PMCID: PMC10497180 DOI: 10.1093/ehjcr/ytad422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
Background Patients with single ventricle congenital heart disease who undergo total cavo-pulmonary anastomosis (Fontan surgery) suffer from elevated pulmonary artery pressure (PAP), which leads to multiple adverse sequelae. Traditionally, the Fontan pressures are assessed via invasive haemodynamic catheterization that exposes these medically fragile patients to the risks of vascular injury and anaesthesia. While the CardioMEM remote PAP monitor has been extensively used in adults with heart failure, the safety of this device has not been established in children. Case summary We report safety and utility of this device in eight paediatric Fontan patients. Our patients ranged from 9 to 18 years of age. There were no reported complications related to the implantation of the CardioMEMS device in our population. Discussion This is the first case series of safety of CardioMEMS device in paediatric Fontan Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation patients. Our experience indicates that the device may be safely utilized for the management of Fontan-related complications in this vulnerable population.
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Affiliation(s)
- Deepti P Bhat
- The Fontan Clinic, Division of Cardiology, Phoenix Children's Hospital and University of Arizona, 1919, E Thomas Road, Phoenix, AZ 85016, USA
| | - Joseph N Graziano
- The Fontan Clinic, Division of Cardiology, Phoenix Children's Hospital and University of Arizona, 1919, E Thomas Road, Phoenix, AZ 85016, USA
| | - Byron J Garn
- The Fontan Clinic, Division of Cardiology, Phoenix Children's Hospital and University of Arizona, 1919, E Thomas Road, Phoenix, AZ 85016, USA
| | - Wayne J Franklin
- The Fontan Clinic, Division of Cardiology, Phoenix Children's Hospital and University of Arizona, 1919, E Thomas Road, Phoenix, AZ 85016, USA
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Crea F. Ischaemic heart disease: from the celebration of Heberden's description of angina pectoris to novel therapeutic targets for angiogenesis and myocardial fibrosis. Eur Heart J 2023; 44:1669-1673. [PMID: 37179122 DOI: 10.1093/eurheartj/ehad278] [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: 05/15/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Crea F. The challenge of risk stratification in aortic aneurysms, congenital heart disease, and coronary bypass surgery. Eur Heart J 2022; 43:2343-2346. [PMID: 35772806 DOI: 10.1093/eurheartj/ehac334] [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: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Affiliation(s)
- Jack Rychik
- Corresponding author. Cardiac Center, the Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Tel: +1 215 5902192, Fax: +1 267 426 5082,
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