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https://www.readbyqxmd.com/read/29860487/atrial-flow-regulator-for-failing-fontan-circulation-an-initial-european-experience
#1
Lucia Manuri, Rita Emanuela Calaciura, Andrea De Zorzi, Lilia Oreto, Massimiliano Raponi, Anja Lehner, Nikolaus Haas, Salvatore Agati
Transcatheter creation or enlargement of an atrial septal defect has been used to promote adequate blood flow and mixing in some forms of congenital heart defects or as a relief valve in right or left atrial hypertension, resulting in better cardiac output and/or systemic saturation. We report a case of a 4-year-old male affected by complex congenital heart disease who was admitted for management of severe cyanosis following a staged pericardial fenestrated Fontan procedure. Transoesophageal echocardiogram showed a wide fenestration of 9 mm in size with a severely dilated pericardial Fontan system...
May 30, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29794380/successful-treatment-of-protein-losing-enteropathy-and-plastic-bronchitis-by-biphasic-cuirass-ventilation-in-a-patient-with-failing-fontan-circulation
#2
Seigo Okada, Jun Muneuchi, Yusaku Nagatomo, Kaori Nonaka, Chiaki Iida, Hiromitsu Shirouzu, Ryohei Matsuoka, Mamie Watanabe, Kunitaka Joo
We present a 16-year-old male patient with hypoplastic left heart syndrome who developed protein-losing enteropathy (PLE) and plastic bronchitis (PB) after a Fontan operation. He received medical therapies, including albumin infusion, unfractionated heparin, and high-dose anti-aldosterone therapy but could not obtain clinical relief. Biphasic cuirass ventilation (BCV) led to expectoration of bronchial casts and prompt resolution of PB. Notably, clinical symptoms related to PLE were dramatically improved after starting BCV...
May 23, 2018: International Heart Journal
https://www.readbyqxmd.com/read/29778332/cause-versus-effect-tricuspid-valve-replacement-in-the-management-of-a-failing-fontan-circulation
#3
EDITORIAL
S Adil Husain
No abstract text is available yet for this article.
April 18, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29752919/first-use-of-heartmate-3-tm-in-a-failing-fontan-circulation
#4
Angela Lorts, Chet Villa, Kyle W Riggs, John Broderick, David Ls Morales
The failing Fontan circulation can be challenging to support with ventricular assist devices (VAD) mostly due to the variety of causes of failure, some of which cannot be addressed by VAD therapy alone. A new VAD, the HeartMate 3TM , was recently approved for use in adults in the United States and is now widely available with excellent survival in two-ventricle patients. We report the first successful implantation of the HeartMate 3 in a 22-year-old male with a failing Fontan circulation and the possible benefits it may have in supporting this ever-growing population of young adults with single ventricles...
May 9, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29746313/avalonelite-double-lumen-cannula-for-total-cavopulmonary-assist-in-failing-fontan-sheep-model-with-valved-extracardiac-conduit
#5
Cheng Zhou, Dongfang Wang, Francesca Condemi, Guangfeng Zhao, Stephen Topaz, Cherry Ballard-Croft, Joseph B Zwischenberger
The AvalonElite double lumen cannula (DLC) provides total cavopulmonary assist (CPA) in failing Fontan sheep, but recirculation limits reliability. To improve CPA performance, a two-valve extracardiac conduit (ECC) was used to bracket infusion blood toward pulmonary artery (PA). A total cavopulmonary connection with failing Fontan circulation adult sheep model was created with valved ECC (n = 6). The valved ECC was connected to superior/inferior venae cavae (SVC/IVC) and right PA. The AvalonElite DLC was inserted from right jugular vein with infusion opening between the ECC valves...
May 8, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29709356/tricuspid-valve-replacement-in-failing-fontan-circulation-with-severe-ventricular-dysfunction-the-road-not-taken
#6
Stephanie L Perrier, Michael Z L Zhu, Robert G Weintraub, Igor E Konstantinov
No abstract text is available yet for this article.
April 3, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29673634/the-right-tool-for-the-right-job-bridging-a-failing-fontan-to-transplant
#7
Kyle W Riggs, Angela Lorts, Chet R Villa, James Tweddell, Roosevelt Bryant, David Ls Morales
Mechanical circulatory support and heart transplantation are both becoming increasingly common in Fontan patients as this growing cohort of patients is reaching young adulthood. Though device placement may present challenges, the new focus is on selecting the correct cannulation sites and devices at the correct time in order to successfully bridge these challenging patients to heart transplant. Herein, we report the use of multiple mechanical circulatory support strategies tailored to the clinical setting which culminated in 130 days of support prior to cardiac transplantation in a young adult with a failing Fontan circulation...
April 16, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29666009/in-vitro-validation-of-a-self-driving-aortic-turbine-venous-assist-device-for-fontan-patients
#8
Kerem Pekkan, Ibrahim Basar Aka, Ece Tutsak, Erhan Ermek, Haldun Balim, Ismail Lazoglu, Riza Turkoz
BACKGROUND: Palliative repair of single ventricle defects involve a series of open-heart surgeries where a single-ventricle (Fontan) circulation is established. As the patient ages, this paradoxical circulation gradually fails, because of its high venous pressure levels. Reversal of the Fontan paradox requires an extra subpulmonic energy that can be provided through mechanical assist devices. The objective of this study was to evaluate the hemodynamic performance of a totally implantable integrated aortic-turbine venous-assist (iATVA) system, which does not need an external drive power and maintains low venous pressure chronically, for the Fontan circulation...
March 11, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29521133/cavopulmonary-mechanical-circulatory-support-in-fontan-patients-and-the-need-for-physiologic-control-a-computational-study-with-a-closed-loop-exercise-model
#9
Marcus Granegger, Martin Schweiger, Marianne Schmid Daners, Mirko Meboldt, Michael Hübler
PURPOSE: Rotary blood pumps are a promising treatment approach for patients with a total cavopulmonary connection and a failing cardiovascular system. The aim of this study was to investigate the hemodynamic effects of cavopulmonary support using a numerical model with closed-loop baroreflex and exercise mechanisms. METHODS: A numerical model of the univentricular cardiovascular system was developed, mimicking the hemodynamics during rest and exercise. Rotary blood pumps with different hydraulic pump characteristics (flat vs steep pressure-flow relationships) were investigated in the cavopulmonary position...
May 2018: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29492392/overview-of-adult-congenital-heart-transplants
#10
Roosevelt Bryant, David Morales
Transplantation for adult patients with congenital heart disease (ACHD) is a growing clinical endeavor in the transplant community. Understanding the results and defining potential high-risk patient subsets will allow optimization of patient outcomes. This review summarizes the scope of ACHD transplantation, the mechanisms of late ventricular dysfunction, the ACHD population at risk of developing heart failure, the indications and potential contraindications for transplant, surgical considerations, and post-transplant outcomes...
January 2018: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29441279/externally-applied-compression-therapy-for-fontan-patients
#11
Joseph Hernandez, Steven G Chopski, Sam Lee, William B Moskowitz, Amy L Throckmorton
Background: Limited therapeutic options are available for Fontan patients with dysfunctional or failing single ventricle physiology. This study describes the evaluation of an alternative, non-invasive, at-home therapeutic compression treatment for Fontan patients. Our hypothesis is that routinely administered, externally applied compression treatments to the lower extremities will augment systemic venous return, improve ventricular preload, and thus enhance cardiac output in Fontan patients...
January 2018: Translational Pediatrics
https://www.readbyqxmd.com/read/29433731/relation-of-increased-epicardial-fat-after-fontan-palliation-to-cardiac-output-and-systemic-ventricular-ejection-fraction
#12
Adam M Lubert, Jimmy C Lu, Albert P Rocchini, Mark D Norris, Sunkyung Yu, Prachi P Agarwal, Maryam Ghadimi Mahani, Adam L Dorfman
Epicardial fat produces multiple proinflammatory cytokines and is associated with adverse cardiovascular events. Inflammation and resultant endothelial dysfunction may play a role in progressive myocardial dysfunction among adults with single ventricle physiology after Fontan palliation, but the potential impact of increased epicardial fat volume (EFV) has not been studied. This study sought to determine if there is greater EFV in Fontan patients compared with a group of repaired tetralogy of Fallot (rTOF) patients...
April 1, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29313804/endolymphatic-balloon-occluded-retrograde-abdominal-lymphangiography-boral-and-embolization-borale-for-the-diagnosis-and-treatment-of-chylous-ascites-technique-and-experience-in-three-patients
#13
Ravi N Srinivasa, Joseph J Gemmete, Matthew L Osher, Jeffrey Forris Beecham Chick
PURPOSE: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. MATERIALS AND METHODS: Two (66%) men and one (33%) woman with mean age of 52 years (range: range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29310555/mechanical-circulatory-support-for-the-failing-fontan-conversion-to-assisted-single-ventricle-circulation-preliminary-observations
#14
Syed M Peer, Kristopher B Deatrick, Thomas J Johnson, Jonathan W Haft, Francis D Pagani, Richard G Ohye, Edward L Bove, Alvaro Rojas-Peña, Ming-Sing Si
BACKGROUND: Mechanical circulatory support (MCS) of a failing Fontan circulation remains challenging. We hypothesized that MCS can be provided by converting the Fontan circulation into a mechanically assisted single ventricle parallel circulation (MASVC). METHODS: A porcine model of functionally univentricular circulation was created under cardiopulmonary bypass (CPB) by performing an atrial septectomy, tricuspid valvectomy, and interrupting antegrade pulmonary blood flow...
January 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29217440/endolymphatic-balloon-occluded-retrograde-abdominal-lymphangiography-boral-and-embolization-borale-for-the-diagnosis-and-treatment-of-chylous-ascites-approach-technical-success-and-clinical-outcomes
#15
Ravi N Srinivasa, Joseph J Gemmete, Matthew L Osher, Anthony N Hage, Jeffrey Forris Beecham Chick
BACKGROUND: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. METHODS: Two (66%) men and 1 (33%) woman with mean age of 52 years (range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with chylous ascites (n = 3) and with renal cell carcinoma after left nephrectomy and lymph node dissection (n = 1), metastatic Merkel cell carcinoma after left nephrectomy and adrenalectomy (n = 1), and heart transplantation after failed Fontan procedure (n = 1)...
May 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29177420/endothelin-1-may-play-an-important-role-in-the-fontan-circulation
#16
Masaya Aoki, Keiichi Hirono, Tomonori Higuma, Yoko Suzuki, Kazuhiko Nakayama, Fukiko Ichida, Hideki Origasa, Naoki Nishida, Johji Imura, Noriaki Emoto, Naoki Yoshimura
OBJECTIVES: Our goal was to evaluate whether endothlin-1 (ET-1) plays an important role in the Fontan circulation. METHODS: Thirteen patients with single-ventricle physiology (Glenn circulation, n = 7; Fontan circulation, n = 6) were evaluated using lung histopathological and immunohistochemical studies and then compared with the normal autopsied controls without congenital heart disease (n = 13). We evaluated the medial thickness of the small pulmonary arteries...
March 1, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29084001/assessing-the-borderline-ventricle-in-a-term-infant-combining-imaging-and-physiology-to-establish-the-right-course
#17
Meryl S Cohen
PURPOSE OF REVIEW: The purpose of this review is to describe the challenges associated with the diagnosis and treatment of children with borderline ventricles. A borderline ventricle is one in which there is concern that it will not be able to support its circulation. If a biventricular repair is attempted and fails, outcome is often poor. Thus, this early decision is important. RECENT FINDINGS: For the borderline right ventricle, options to add an additional source of pulmonary blood flow make the surgical strategy a bit more flexible than for patients with a borderline left ventricle...
January 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29050751/fibrosis-related-gene-expression-in-single-ventricle-heart-disease
#18
Stephanie J Nakano, Austine K Siomos, Anastacia M Garcia, Hieu Nguyen, Megan SooHoo, Csaba Galambos, Karin Nunley, Brian L Stauffer, Carmen C Sucharov, Shelley D Miyamoto
OBJECTIVE: To evaluate fibrosis and fibrosis-related gene expression in the myocardium of pediatric subjects with single ventricle with right ventricular failure. STUDY DESIGN: Real-time quantitative polymerase chain reaction was performed on explanted right ventricular myocardium of pediatric subjects with single ventricle disease and controls with nonfailing heart disease. Subjects were divided into 3 groups: single ventricle failing (right ventricular failure before or after stage I palliation), single ventricle nonfailing (infants listed for primary transplantation with normal right ventricular function), and stage III (Fontan or right ventricular failure after stage III)...
December 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29049683/ventricular-assist-device-in-a-failing-total-cavopulmonary-connection-a-new-step-by-step-approach
#19
Carlo Pace Napoleone, Maria Teresa Cascarano, Luca Deorsola, Andrea Valori
The management of failing Fontan patients with mechanical circulatory support has been reported with unsatisfactory results. A 5-year-old girl, listed for heart transplantation for failing Fontan, underwent rescue extracorporeal membrane oxygenation support. As it was necessary to move the patient to the Berlin Heart Excor, a step-by-step approach was designed to obtain a gradual adaptation to this form of support. A central extracorporeal membrane oxygenation, with a Berlin Heart apical and aortic cannulae, was implanted leaving the previously positioned femoral vein cannula in parallel with the outflow apical one...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29035429/where-is-the-optimal-fontan-hemodynamics
#20
REVIEW
Hideo Ohuchi
Fontan circulation is generally characterized by high central venous pressure, low cardiac output, and slightly low arterial oxygen saturation, and it is quite different from normal biventricular physiology. Therefore, when a patient with congenital heart disease is selected as a candidate for this type of circulation, the ultimate goals of therapy consist of 2 components. One is a smooth adjustment to the new circulation, and the other is long-term circulatory stabilization after adjustment. When either of these goals is not achieved, the patient is categorized as having "failed" Fontan circulation, and the prognosis is dismal...
November 2017: Korean Circulation Journal
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