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https://www.readbyqxmd.com/read/29035429/where-is-the-optimal-fontan-hemodynamics
#1
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...
September 18, 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/29016830/a-stepwise-approach-to-conduit-puncture-for-electrophysiological-procedures-in-patients-with-fontan-circulation
#2
Jae-Sun Uhm, Nam Kyun Kim, Hee Tae Yu, Pil-Sung Yang, Jung Ok Kim, Tae-Hoon Kim, Mi Kyoung Song, Sang-Yun Lee, Boyoung Joung, Hui-Nam Pak, Jae Young Choi, Jo Won Jung, Moon-Hyoung Lee
Aims: In patients with Fontan circulation, the conduit may be punctured for electrophysiological procedures. We evaluated the feasibility and safety of a stepwise approach to conduit puncture in adults who have undergone Fontan operation. Methods and results: We included 13 consecutive patients with lateral tunnel or extracardiac conduit Fontan circulation [median age (interquartile range), 24.0 (16.0-25.0) years; seven men] who had undergone electrophysiological procedures...
June 14, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28988309/durable-benefit-of-particle-occlusion-of-systemic-to-pulmonary-collaterals-in-select-patients-after-superior-cavopulmonary-connection
#3
Michael L O'Byrne, David N Schidlow
Systemic to pulmonary arterial collaterals (SPC) are commonly found in patients undergoing staged operative palliation for single ventricle heart disease. Occlusion of SPC as part of pre-Fontan catheterization has been shown to improve hemodynamics acutely. Anecdotally, the effect of this intervention appears to be transient, and to our knowledge there is no data supporting its durability in these patients. Between 1/1/2016 and 5/1/2017, 24 children underwent Glenn operations at our institution. Of these, 3 patients had signs and symptoms deteriorating clinical status suggestive of volume overload in the period between their Glenn operation and Fontan completion, prompting heart catheterization...
October 7, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28976338/false-positive-perfusion-ventilation-spect-study-for-pulmonary-embolism-in-a-patient-with-fontan-circulation
#4
Emmanouil Panagiotidis
Fontan circulation is the consequence of an operation that results in the flow of systemic venous blood to the lungs without passing through a ventricle. An 18-year old man with a history of congenital heart disease surgically treated with Fontan circulation, presented with pleuritic chest pain and a raised D-dimer level. Perfusion/ventilation SPECT was performed to exclude the possibility of pulmonary embolism (PE) that showed unilateral reduced perfusion of the left lung with a mismatched right upper lobe defect, suspicious of PE...
October 3, 2017: Molecular Imaging and Radionuclide Therapy
https://www.readbyqxmd.com/read/28932977/hepatic-stiffness-using-shear-wave-elastography-and-the-related-factors-for-a-fontan-circulation
#5
Seong-Ook Kim, Sang-Yun Lee, So-Ick Jang, Soo-Jin Park, Hye-Won Kwon, Seong-Ho Kim, Chang-Ha Lee, Eun-Seok Choi, Seong-Kyu Cho, Sun-Hwa Hong, Yang-Min Kim
Hepatic problems related to a Fontan circulation have been highlighted and elastography using ultrasound is a non-invasive tool that can measure the severity of hepatic stiffness. We investigated the hepatic stiffness using shear wave elastography (SWE) and related factors in patients with a Fontan circulation. This study enrolled 64 patients with a Fontan circulation who underwent cardiac catheterization and abdominal ultrasound from 2011 to 2015. The correlation between the laboratory tests, hemodynamic factors by cardiac catheterization, and SWE was evaluated...
September 21, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28928608/intraocular-pressure-in-children-after-congenital-heart-surgery-a-single-center-study
#6
Sunali Goyal, Paul H Phillips, Lamonda A Corder, Michael J Robertson, Xiomara Garcia, Michael L Schmitz, Punkaj Gupta
BACKGROUND: The impact of varied cardiac physiologies on intraocular pressure (IOP) among children undergoing heart operations is unknown. AIM: The aim of this study was to determine the IOP among children with varying cardiovascular physiologies and varying hemodynamics after their heart operation. SETTING AND DESIGN: This was a prospective, observational study. MATERIALS AND METHODS: Patients ≤18 years undergoing congenital heart surgery were included in this study...
September 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28928606/quantification-of-ventricular-unloading-by-3d-echocardiography-in-single-ventricle-of-left-ventricular-morphology-following-superior-cavo-pulmonary-anastomosis-and-fontan-completion-a-feasibility-study
#7
Deepa Sasikumar, Bijulal Sasidharan, Baiju S Dharan, Arun Gopalakrishnan, Kavasseri M Krishnamoorthy, Sivasubramanian Sivasankaran
BACKGROUND: Three-dimensional echocardiography. (3DE) is comparable to cardiac magnetic resonance imaging for estimating ventricular volume in congenital heart diseases. However, there are limited data on estimation of ventricular volumes by 3DE in univentricular heart and change in ventricular volumes after surgical creation of cavopulmonary connection. We sought to quantify the unloading of the single ventricle of left ventricular. (LV) morphology by 3DE after superior cavopulmonary anastomosis...
September 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28904256/current-surgical-outcomes-of-congenital-heart-surgery-for-patients-with-down-syndrome-in-japan
#8
Takaya Hoashi, Norimichi Hirahara, Arata Murakami, Yasutaka Hirata, Hajime Ichikawa, Junjiro Kobayashi, Shinichi Takamoto
BACKGROUND: Current surgical outcomes of congenital heart surgery for patients with Down syndrome are unclear.Methods and Results:Of 29,087 operations between 2008 and 2012 registered in the Japan Congenital Cardiovascular Surgery Database (JCCVSD), 2,651 were carried out for patients with Down syndrome (9%). Of those, 5 major biventricular repair procedures [ventricular septal defect repair (n=752), atrioventricular septal defect repair (n=452), patent ductus arteriosus closure (n=184), atrial septal defect repair (n=167), tetralogy of Fallot (TOF) repair (n=108)], as well as 2 major single ventricular palliations [bidirectional Glenn (n=21) and Fontan operation (n=25)] were selected and their outcomes were compared...
September 12, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28898966/employment-characteristics-of-a-complex-adult-congenital-heart-disease-cohort
#9
L Pickup, T Gaffey, P Clift, S Bowater, S Thorne, L Hudsmith
Background: Due to advances in surgical techniques and subsequent management, there have been remarkable improvements in the survival of patients with congenital heart disease. In particular, larger numbers of patients with complex disease are now living into adulthood and are entering the workforce. Aims: To establish the types of employment complex adult congenital heart disease (ACHD) patients are engaged in, based on the largest cohort of patients with a single-ventricle circulation in the UK...
August 1, 2017: Occupational Medicine
https://www.readbyqxmd.com/read/28893257/preoperative-single-ventricle-function-determines-early-outcome-after-second-stage-palliation-of-single-ventricle-heart
#10
Jacek Pająk, Michał Buczyński, Piotr Stanek, Grzegorz Zalewski, Marek Wites, Lesław Szydłowski, Bogusław Mazurek, Lidia Tomkiewicz-Pająk
BACKGROUND: Second-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures. MATERIAL AND METHODS: We analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart...
September 11, 2017: Cardiovascular Ultrasound
https://www.readbyqxmd.com/read/28884283/clinical-outcomes-of-early-scheduled-fontan-completion-following-kawashima-operation
#11
Takashi Kido, Takaya Hoashi, Masatoshi Shimada, Hideo Ohuchi, Kenichi Kurosaki, Hajime Ichikawa
OBJECTIVES: This study reviewed late clinical features after Kawashima operation to confirm the impact of scheduled subsequent early Fontan completion. METHODS: Of the 17 consecutive patients who underwent the Kawashima operation between 1987 and 2010, 11 underwent the procedure as inter-stage palliation (scheduled Fontan group). Ten of these patients underwent subsequent early Fontan completion after a median interval of 0.6 years. The remaining 6 patients underwent the Kawashima operation initially as definitive surgery (non-scheduled group)...
September 7, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28884212/routine-sildenafil-does-not-improve-clinical-outcomes-after-fontan-operation
#12
J Leslie Gaddis Collins, Mark A Law, Santiago Borasino, W Clinton Erwin, David C Cleveland, Jeffrey A Alten
Fontan operation can be complicated by persistent chest tube output (CTO) leading to prolonged hospital length of stay (LOS). Postoperative sildenafil administration has been shown to improve clinical outcomes in selected patients after Fontan. We initiated a practice change utilizing intravenous (IV) sildenafil in early postoperative period in all patients undergoing Fontan operation with aim to decrease LOS and CTO. Nineteen patients (February 2014-May 2016) received 0.35 mg/kg sildenafil IV (three doses) followed by enteral, 1 mg/kg every eight hours until hospital discharge...
September 7, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28874285/international-collaborative-initiative-towards-improving-the-lives-of-patients-after-the-fontan-operation-a-call-for-action
#13
EDITORIAL
Margarita Brida, Michael A Gatzoulis
No abstract text is available yet for this article.
October 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28851719/surgical-and-catheter-based-reinterventions-are-common-in-long-term-survivors-of-the-fontan-operation
#14
Tacy E Downing, Kiona Y Allen, David J Goldberg, Lindsay S Rogers, Chitra Ravishankar, Jack Rychik, Stephanie Fuller, Lisa M Montenegro, James M Steven, Matthew J Gillespie, Jonathan J Rome, Thomas L Spray, Susan C Nicolson, J William Gaynor, Andrew C Glatz
BACKGROUND: There are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the Fontan operation. METHODS AND RESULTS: All 773 patients who underwent Fontan at our institution between 1992 and 2009 were retrospectively reviewed. Current information regarding post-Fontan intervention was available for 70%. By 20 years after Fontan, 65% of patients had experienced either surgical or transcatheter intervention. The median time to first reintervention was 9...
September 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28845873/-late-complications-of-fontan-operation
#15
Alessandro Frigiola, Mauro Lo Rito
Complex univentricular heart defects are treated with the Fontan operation that consists in the diversion of the systemic venous return to the pulmonary arteries. Currently, the operation is achieved through a staged approach and with the use of prosthetic extracardiac conduits to connect the inferior vena cava to the pulmonary arteries. The improvement of early and late survival allowed these patients to reach adulthood, although long-term complications remain a relevant problem. Most of the complications are caused by chronic systemic venous hypertension due to the lack of a pumping sub-pulmonary ventricle...
September 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28845580/comparison-of-extracardiac-conduit-and-lateral-tunnel-for-functional-single-ventricle-patients-a-meta-analysis
#16
Zhiyong Lin, Hanwei Ge, Jiyang Xue, Guowei Wu, Jie Du, Xingti Hu, Qifeng Zhao
OBJECTIVE: This study aims to assess and compare the early and long-term effects of extracardiac conduit (EC) and lateral tunnel (LT) in patients with a functional single ventricle through meta-analysis. DESIGN: A systematic search was performed in PubMed, Embase, Cochrane Library, CNKI, VIP, CBM, and WanFang databases for papers that were published until August 1, 2016. Cochrane systematic review method was used for paper screening and information retrieve, and RevMan 5...
August 28, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28831564/post-operative-outcomes-in-children-undergoing-fontan-palliation-in-a-regionalized-surgical-system
#17
Billie-Jean Martin, David B Ross, Mohammed Al Aklabi, Joyce Harder, John D Dyck, Ivan M Rebeyka
Evidence suggests that outcomes in pediatric cardiac surgery are improved by consolidating care into centers of excellence. Our objective was to determine if outcomes are equivalent in patients across a large regional referral base, or if patients from centers without on-site surgery are at a disadvantage. Since 1996, all pediatric cardiac surgery has been offered at one of two centers within the region assessed, with the majority being performed at Stollery Children's Hospital. All patients who underwent a Fontan between 1996 and 2016 were included...
August 22, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28831530/evolution-of-ventricular-energetics-in-the-different-stages-of-palliation-of-hypoplastic-left-heart-syndrome-a-retrospective-clinical-study
#18
A Di Molfetta, R Iacobelli, P Guccione, L Di Chiara, M Rocchi, F Cobianchi Belisari, M Campanale, M G Gagliardi, S Filippelli, G Ferrari, A Amodeo
Hyperplastic left heart syndrome (HLHS) patients are palliated by creating a Fontan-type circulation passing from different surgical stages. The aim of this work is to describe the evolution of ventricular energetics parameters in HLHS patients during the different stages of palliation including the hybrid, the Norwood, the bidirectional Glenn (BDG), and the Fontan procedures. We conducted a retrospective clinical study enrolling all HLHS patients surgically treated with hybrid procedure and/or Norwood and/or BDG and/or Fontan operation from 2011 to 2016 collecting echocardiographic and hemodynamic data...
August 22, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28799708/acute-and-mid-term-outcomes-of-stent-implantation-for-recurrent-coarctation-of-the-aorta-between-the-norwood-operation-and-fontan-completion-a-multi-center-pediatric-interventional-cardiology-early-career-society-investigation
#19
Osamah Aldoss, Bryan H Goldstein, Saar Danon, Sebastian Goreczny, Robert G Gray, Shyam Sathanandam, Wendy Whiteside, Derek A Williams, Jeffrey D Zampi
OBJECTIVES: We sought to evaluate outcomes of stent implantation (SI) for recurrent coarctation of the aorta (RC) following the Norwood operation. BACKGROUND: RC is common following the Norwood operation. Balloon angioplasty (BA) is standard treatment but may result in unsatisfactory relief of RC. SI may improve RC, but outcome data are limited. METHODS: We performed a multi-center retrospective study of patients who underwent SI for RC between the Norwood operation and Fontan completion...
August 11, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28799131/pulmonary-vascular-disease-in-a-failed-fontan-patient-with-down-s-syndrome
#20
Masaya Aoki, Keiichi Hirono, Tomonori Higuma, Yoko Suzuki, Kazuhiko Nakayama, Akio Yamashita, Kazuaki Fukahara, Fukiko Ichida, Noriaki Emoto, Naoki Yoshimura
It is well known that Down's syndrome is a strong risk factor for mortality after Fontan operations. We performed two lung biopsies in a Down's syndrome patient who underwent staged Fontan operations. The pathological findings revealed severe pulmonary arterial hypertrophy and a quantitative real-time polymerase chain reaction revealed the overexpression of endothelin and a decline in the eNOS level at the Fontan operation. Although the preoperative hemodynamic studies revealed that all of the criteria for Fontan had been fulfilled, the patient died of acute cardiac insufficiency, 35 days after the Fontan operation...
August 10, 2017: General Thoracic and Cardiovascular Surgery
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