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Marschall A, Alvarez-Fuente M, Garrido-Lestache E, Tellez L, Sanchez I, Toledano M, Molina I, Rivero N, Garcia-Ormazabal I, Tamariz R, Del Cerro MJ. Percutaneous interventions in Fontan circulation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In light of increased survival of patients with Fontan circulation, percutaneous interventions in these patients have become growingly significant in the recent years. Percutaneous treatments in patients with univentricular physiology can optimize the short term hemodynamics in these patients. However, information on long term outcomes is scarce.
Purpose
To present the cumulative work experience in percutaneous interventions of a tertiary center in the past 12 years in patients that have undergone total cavopulmonary deviation (TCD) and to investigate long term outcomes.
Methods
In this retrospective study, all patients with TCD that underwent follow-up in our specialized department of congenital heart disease in the past 12 years, were eligible for chart-review. Cardiac catheterization was performed by experienced interventional cardiologists, specialized in structural interventions in congenital heart disease. All catheterizations were performed under general anesthesia and mechanical ventilation. All patients underwent Fontan pressure measurements and cardiac output estimation with Fick method.
Results
A total of 80 patients, with a mean follow-up time of 24 (±7.1) years, were included in the study. Details on baseline characteristics are depicted in Table 1. Fifty-two (65%) patients underwent percutaneous intervention during follow-up, and 33% (n=17) of these patients required multiple interventions. Angioplasty with stent implantation of the Fontan conduit or the pulmonary arteries was the most common intervention (30 (58%) and 8 (15%) patients, respectively), followed by embolization of collaterals (11 (21%) patients). Patients with right systemic ventricle physiology needed more interventions and had a shorter time-to-first-intervention period. (Figure 1) Pacemaker implantation was required in a total of 15 patients, being significantly more frequent in patients with atriopulmonary connection than in patients with lateral tunnel or extracardiac conduit (11 (36%) vs 4 (11%), p<0.01). Overall long-term outcome (with regards to mortality) was good (4 (0.5%) patients). Patients that required percutaneous structural interventions showed a tendency towards a higher mortality than those not in need of intervention (4 (8%) vs 0 (0%), respectively, p=0.14).
Conclusions
During long-term follow-up of patients with Fontan circulation, almost two thirds of the patients required percutaneous intervention. Patients with right systemic ventricle physiology were in greater need of intervention. Patients that required intervention had a tendency towards a worse clinical outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Marschall
- Gomez Ulla Central Defense Hospital, Department of Cardiology , Madrid , Spain
| | - M Alvarez-Fuente
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - E Garrido-Lestache
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - L Tellez
- Ramon and Cajal University Hospital, Hepatic Hemodynamics & Vascular Liver Diseases Unit , Madrid , Spain
| | - I Sanchez
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - M Toledano
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - I Molina
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - N Rivero
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - I Garcia-Ormazabal
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - R Tamariz
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
| | - M J Del Cerro
- Ramon and Cajal University Hospital, Paediatric and Adult Congenital Heart Disease , Madrid , Spain
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Camarero C, Tamariz R, García Trujillo JA, Villagrá F, Escobar H, Suárez L, Cazzaniga M, León F. [Protein-losing enteropathy after Fontan's operation]. An Pediatr (Barc) 2001; 54:39-42. [PMID: 12737793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- C Camarero
- Hospital Ramón y Cajal. Madrid. Universidad de Alcalá de Henares. Madrid
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Pérez-Caballero C, Maldonado MS, Tamariz R, de Oteyza JP, Muñoz A. Unsuccessful allogeneic and autologous transplants after prolonged interferon-alpha treatment in a pediatric patient with chronic myeloid leukemia. Haematologica 2000; 85:105-6. [PMID: 10629605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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