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[PMID]:28462755
[Au] Autor:Hinkle KA; Wilkes J; McFadden M; Williams RV; Minich LL; Menon SC
[Ad] Endereço:1Division of Pediatric Cardiology,Department of Pediatrics,University of Utah,Salt Lake City,Utah,United States of America.
[Ti] Título:A multi-institutional study of factors affecting resource utilisation following the Fontan operation.
[So] Source:Cardiol Young;27(4):739-746, 2017 May.
[Is] ISSN:1467-1107
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The few studies evaluating data on resource utilisation following the Fontan operation specifically are outdated. We sought to evaluate resource utilisation and factors associated with increased resource use after the Fontan operation in a contemporary, large, multi-institutional cohort. This retrospective cohort study of children who had the Fontan between January, 2004 and June, 2013 used the Pediatric Health Information Systems Database. Generalised linear regression analyses evaluated factors associated with resource use. Of 2187 Fontan patients included in the study, 62% were males. The median age at Fontan was 3.2 years (inter-quartile range (IQR): 2.6-3.8). The median length of stay following the Fontan was 9 days (IQR: 7-14). The median costs and charges in 2012 dollars for the Fontan operation were $93,900 (IQR: $67,800-$136,100) and $156,000 (IQR: $112,080-$225,607), respectively. Postoperative Fontan mortality (30 days) was 1% (n=21). Factors associated with increased resource utilisation included baseline and demographic factors such as region, race, and renal anomaly, factors at the bidirectional Glenn such as seizures, valvuloplasty, and surgical volume, number of admissions between the bidirectional Glenn and the Fontan, and factors at the Fontan such as surgical volume and age at Fontan. The most strongly associated factors for both increased Fontan length of stay and increased Fontan charges were number of bidirectional Glenn to Fontan admissions (p<0.001) and Fontan surgical volume per year (p<0.001). As patient characteristics and healthcare-related delivery variables accounted for most of the factors predicting increased resource utilisation, changes should target healthcare delivery factors to reduce costs in this resource-intensive population.
[Mh] Termos MeSH primário: Técnica de Fontan/economia
Técnica de Fontan/mortalidade
Custos Hospitalares
Síndrome do Coração Esquerdo Hipoplásico/cirurgia
Tempo de Internação
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Feminino
Recursos em Saúde/utilização
Ventrículos do Coração/anormalidades
Ventrículos do Coração/cirurgia
Seres Humanos
Lactente
Modelos Lineares
Masculino
Cuidados Paliativos
Complicações Pós-Operatórias
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1017/S1047951116001244


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[PMID]:28453799
[Au] Autor:Metras A; Fouilloux V; Al-Yamani M; Roques X; Macé L; Thambo JB; Metras D; Kreitmann B; Roubertie F
[Ad] Endereço:Department of Cardiovascular Surgery, Bordeaux Heart University Hospital, University of Bordeaux II, France.
[Ti] Título:Early to mid-term results after total cavopulmonary connection performed in the second decade of life.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):762-767, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Total cavopulmonary connection (TCPC) performed in the second decade of life has rarely been studied. Thus, we investigated (bicentric study) early and late morbidity and mortality following completion of TCPC in these patients. METHODS: From January 1999 to June 2014, 63 patients (14.5 ± 2.9 years) underwent TCPC (extracardiac conduit). Palliation before completion was an isolated bidirectional cavopulmonary shunt (BCPS) in 3 patients or BCPS associated with additional pulmonary blood flow (APBF) that was either antegrade (Group 1) in 38 (63%) or retrograde (Group 2) in 22 (37%). Preoperative and perioperative data were reviewed retrospectively. RESULTS: Mean pulmonary arterial and ventricular end-diastolic pressures were 12.2 and 9.2 mmHg, respectively. Mean Nakata index was 279 ± 123 and 228 ± 87 mm 2 /m 2 in Groups 1 and 2, respectively ( P = 0.01). Aortic cross-clamping was performed in 22 from Group 1 and 8 from Group 2 ( P = 0.04). Mean follow-up was 4.57 years [0.8-15]. Nine patients had prolonged stays in the intensive care unit (>6 days). There were 1 early and 2 late deaths (non-cardiac related). Actuarial survival was 96% at 4 years. At last follow-up, single-ventricle function remained normal or improved in all patients (Group 1) compared to 82% in Group 2 ( P = 0.02). New York Heart Association (NYHA) class had improved in both groups: 47 patients were NYHA class II and 16 class III preoperatively vs 50 class I and 10 class II postoperatively ( P < 0.001). CONCLUSIONS: Single-ventricle palliation with BCPS and APBF allowed completion of TCPC in the second decade of life, with encouraging mid-term results. However, BCPS with retrograde APBF was associated with single-ventricle dysfunction: thus, this technique needs to be used cautiously as long-lasting palliation.
[Mh] Termos MeSH primário: Técnica de Fontan/métodos
Cardiopatias Congênitas/cirurgia
Hemodinâmica/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Feminino
Seguimentos
França/epidemiologia
Cardiopatias Congênitas/mortalidade
Cardiopatias Congênitas/fisiopatologia
Seres Humanos
Masculino
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw427


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[PMID]:29194972
[Au] Autor:Evans WN; Acherman RJ; Ciccolo ML; Carrillo SA; Galindo A; Rothman A; Mayman GA; Adams EA; Reardon LC; Winn BJ; Yumiaco NS; Shimuizu L; Inanaga Y; Deleon RJ; Restrepo H
[Ad] Endereço:Department of Pediatric Cardiology, Children's Heart Center Nevada, Las Vegas, Nevada, USA.
[Ti] Título:A composite noninvasive index correlates with liver fibrosis scores in post-Fontan patients: Preliminary findings.
[So] Source:Congenit Heart Dis;13(1):38-45, 2018 Jan.
[Is] ISSN:1747-0803
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We hypothesized that clinic-based, hepatic-ultrasound, elastography measurements, either alone or in combination with other noninvasive variables, might correlate with liver-biopsy fibrosis scores in patients post-Fontan. METHODS: Between March 2012 and February 2017, we identified patients post-Fontan that underwent elective cardiac catheterization and simultaneous transvenous hepatic biopsy. From this group, we selected patients that met inclusion criteria for liver-ultrasound, shear-wave elastography. Utilizing the results of elastography, laboratory testing, and time post-Fontan, we constructed a composite Fontan hepatic index as a sum of elastography measurements in kilopascals, model for end-stage liver disease excluding INR scores, and the square root of the number of years post-Fontan. Further, we analyzed correlations between Fontan hepatic index values and fibrosis scores from hepatic biopsy. RESULTS: We identified a total of 79 post-Fontan patients that underwent cardiac catheterization and liver biopsy. Of the 79 patients, 53 met inclusion criteria, and 32 consented to undergo hepatic-ultrasound elastography. Of the 32 that underwent elastography, data from 30 patients was used for analysis. We found no statistically significant differences in demographics, laboratory values, or cardiac catheterization data between the 30 included patients and the 21 that did not participate. Utilizing data from the 30 included patients, we found a strong, highly statistically significant correlation between the Fontan hepatic index values and total fibrosis scores (R = 0.8, P < .00001). However, the cohort size prevented reliable discriminating cut-off values for the range of total fibrosis scores. CONCLUSIONS: In a small cohort of patients post-Fontan, preliminary findings suggest that the composite Fontan hepatic index might be a clinically useful, noninvasive method of serially monitoring for hepatic fibrosis. Further studies, with large patient cohorts, are necessary to validate our findings and develop clinically useful discriminatory cutoff values.
[Mh] Termos MeSH primário: Técnica de Fontan/efeitos adversos
Cirrose Hepática/diagnóstico
Fígado/diagnóstico por imagem
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Adolescente
Adulto
Biópsia
Criança
Técnicas de Imagem por Elasticidade/métodos
Feminino
Seguimentos
Cardiopatias Congênitas/cirurgia
Seres Humanos
Cirrose Hepática/etiologia
Masculino
Meia-Idade
Estudos Retrospectivos
Índice de Gravidade de Doença
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1111/chd.12558


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[PMID]:29181882
[Au] Autor:Pollak U; Mishaly D; Kenet G; Vardi A
[Ad] Endereço:Department of Pediatric Cardiac Intensive Care, The Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Aviv, Israel.
[Ti] Título:Heparin-induced thrombocytopenia complicating children after the Fontan procedure: Single-center experience and review of the literature.
[So] Source:Congenit Heart Dis;13(1):16-25, 2018 Jan.
[Is] ISSN:1747-0803
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin therapy. The risk for HIT correlates with the cumulative dosage of heparin exposure. In Fontan patients, recurrent systemic anticoagulation, traditionally with heparin, is used to alleviate the thrombotic complications that may occur postoperatively when the venous pressure rises and the systemic venous flow into the pulmonary arteries becomes sluggish, putting them at increased risk. As a pressure gradient-dependent circulation, elevation in systemic venous pressure, most often by venous thrombosis, contributes to circuit failure. Therefore, when HIT complicates patients after the Fontan procedure, it is associated with a high thrombotic morbidity and mortality; thus, a high index of suspicion is mandatory, based on the clinical signs of HIT. It is crucial to intervene early with alternative anticoagulants when HIT is suspected as this step may improve outcome in these patients.
[Mh] Termos MeSH primário: Técnica de Fontan
Heparina/efeitos adversos
Complicações Pós-Operatórias
Trombocitopenia/induzido quimicamente
Trombose/prevenção & controle
[Mh] Termos MeSH secundário: Anticoagulantes/efeitos adversos
Anticoagulantes/uso terapêutico
Criança
Cardiopatias Congênitas/cirurgia
Heparina/uso terapêutico
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants); 9005-49-6 (Heparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1111/chd.12557


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[PMID]:29187113
[Au] Autor:Kumar SR
[Ad] Endereço:1 Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
[Ti] Título:Immune System in Single Ventricle Patients-A Complex Nexus.
[So] Source:World J Pediatr Congenit Heart Surg;8(6):683-684, 2017 11.
[Is] ISSN:2150-136X
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Técnica de Fontan
Ventrículos do Coração/cirurgia
[Mh] Termos MeSH secundário: Anormalidades Cardiovasculares
Cardiopatias Congênitas
Seres Humanos
Sistema Imunitário
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1177/2150135117739830


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[PMID]:29187105
[Au] Autor:Kovacikova L; Krasnanova V; Skrak P; Zahorec M; Kantorova A; Semberova J; Bacharova L
[Ad] Endereço:1 Pediatric Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases, Limbova 1, Bratislava, Slovakia.
[Ti] Título:Immune Abnormalities in Patients With Single Ventricle Circulation Precede the Fontan Procedure.
[So] Source:World J Pediatr Congenit Heart Surg;8(6):672-682, 2017 11.
[Is] ISSN:2150-136X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Immune abnormalities are common in Fontan patients with protein-losing enteropathy. Limited data exist on immune function of other patients with single ventricle circulation. METHODS: This prospective cohort study evaluated immunologic characteristics of children with single ventricle circulation from neonatal age up to early post-Fontan period. RESULTS: Low leukocyte counts were observed in half of the patients prior to bidirectional Glenn and Fontan surgery. Total lymphocyte counts were below normal range in 36% to 63% of patients across all groups except patients following Fontan procedure who had normal counts. Typical lymphocyte subpopulation patterns were (1) high counts of total and helper T lymphocytes (CD3 and CD4 cells), low B lymphocytes (CD19 cells), and increased CD4/CD8 ratio in neonates and (2) low T lymphocytes (CD3 , CD4 , CD8 cells) with high natural killer cells (CD16 ) and B lymphocytes (CD19 cells) in other groups. Low preoperative total lymphocyte counts were associated with longer intensive care unit stay in patients after bidirectional Glenn and Fontan procedure ( P = .03 and P = .01, respectively) and low leukocyte counts with higher incidence of pleural effusions and chylothorax after Fontan procedure ( P = .005 and P = .002, respectively). CONCLUSIONS: Single ventricle patients display several immunological abnormalities. Beyond the neonatal age, an immune pattern includes CD3 , CD4 , CD8 lymphopenia, and CD16 and CD19 lymphocytosis. B-cell lymphocytosis compensates T-cell lymphopenia, producing normal total lymphocyte counts in patients early after Fontan surgery. Low preoperative total lymphocyte counts may be associated with longer postoperative intensive care unit stay in patients with bidirectional Glenn and Fontan procedure and leukopenia with pleural effusions in Fontan patients.
[Mh] Termos MeSH primário: Técnica de Fontan/métodos
Cardiopatias Congênitas/imunologia
Imunidade Inata
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Cardiopatias Congênitas/cirurgia
Seres Humanos
Lactente
Recém-Nascido
Masculino
Período Pós-Operatório
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1177/2150135117732529


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[PMID]:28465331
[Au] Autor:Ohuchi H; Negishi J; Hayama Y; Miyazaki A; Shiraishi I; Ichikawa H
[Ad] Endereço:Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
[Ti] Título:Renal resistive index reflects Fontan pathophysiology and predicts mortality.
[So] Source:Heart;103(20):1631-1637, 2017 10.
[Is] ISSN:1468-201X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The renal resistive index (RRI) reflects non-renal pathophysiology, such as great artery stiffness, haemodynamics and even end-organ damage in patients with hypertension. This study was conducted to clarify the clinical significance of the RRI in Fontan pathophysiology. METHODS: We measured the RRI in 280 consecutive Fontan patients and 36 healthy controls. RESULTS: The patients exhibited a higher RRI than the controls (0.71±0.07 vs 0.60±0.04, p<0.0001). A high central venous pressure, low arterial pressure, greater pulse pressure and low arterial oxygen saturation (SaO ) independently predicted a high RRI (p<0.05-0.0001). The RRI was inversely correlated with the peak oxygen uptake (PVO ) and 24-hour creatine clearance, and was positively correlated with the plasma levels of brain natriuretic peptide (BNP) (p<0.0001 for all). The high RRI was also associated with liver dysfunction and postprandial hyperglycaemia during the oral glucose tolerance test (p<0.001). During the follow-up period, 18 patients died. Age, RRI, SaO , BNP, use of diuretics and antiarrhythmic drugs, and PVO predicted mortality. When PVO was excluded, RRI (HR: 1.13; 95% CI: 1.04 to 1.23; p<0.01) or RRI ≥0.81 (HR: 12.0; 95% CI: 3.4 to 50; p<0.0001) independently predicted mortality. CONCLUSIONS: The RRI reflected heart failure severity, hepatorenal function and glucose intolerance, and predicted all-cause mortality in Fontan patients. Therefore, the RRI may be a useful marker of Fontan-associated multiorgan pathophysiology.
[Mh] Termos MeSH primário: Insuficiência Cardíaca/fisiopatologia
Rim/fisiopatologia
Circulação Renal/fisiologia
Resistência Vascular/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Criança
Pré-Escolar
Feminino
Técnica de Fontan
Insuficiência Cardíaca/diagnóstico por imagem
Insuficiência Cardíaca/cirurgia
Seres Humanos
Rim/irrigação sanguínea
Rim/diagnóstico por imagem
Masculino
Ultrassonografia Doppler em Cores
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1136/heartjnl-2016-310812


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[PMID]:29246897
[Au] Autor:Egbe AC; Connolly HM; Miranda WR; Ammash NM; Hagler DJ; Veldtman GR; Borlaug BA
[Ad] Endereço:From the Department of Cardiovascular Medicine (A.C.E., H.M.C., W.R.M., N.M.A., B.A.B.) and Division of Pediatric Cardiology (D.J.H.), Mayo Clinic, Rochester, MN; and Department of Pediatrics, Cincinnati Children's Hospital, OH (B.A.B.).
[Ti] Título:Hemodynamics of Fontan Failure: The Role of Pulmonary Vascular Disease.
[So] Source:Circ Heart Fail;10(12), 2017 Dec.
[Is] ISSN:1941-3297
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Nonpulsatile pulmonary blood flow in Fontan circulation results in pulmonary vascular disease, but the potential relationships between pulmonary vascular resistance index (PVRI) and Fontan failure have not been studied. The objective was to determine whether the absence of subpulmonary ventricle in the Fontan circulation would make patients more vulnerable to even low-level elevations in PVRI, and when coupled with low cardiac index, this would identify patients at increased risk of Fontan failure. METHODS AND RESULTS: Two hundred sixty-one adult Fontan patients underwent cardiac catheterization; age 26±3 years, men 146 (56%), atriopulmonary Fontan 144 (55%). Patients were divided into 2 groups: those with high PVRI (>2 WU·m ) and low cardiac index <2.5 L min m (group 1, n=70, 30%), and those with normal PVRI and normal cardiac index (group 2, n=182, 70%). Fontan failure was defined by the composite of all-cause mortality, listing for heart transplantation, or initiation of palliative care. There were 68 (26%) cases of Fontan failure during a mean follow-up of 8.6±2.4 years. When compared with group 2, freedom from Fontan failure was significantly lower in group 1: 66% versus 89% at 5 years. The combination of high PVRI and low cardiac index was an independent risk factor for Fontan failure (hazard ratio, 1.84; 95% confidence interval, 1.09-2.85). CONCLUSIONS: When coupled with low cardiac index, even mild elevations in PVRI identify patients at high risk of Fontan failure. This suggests that pulmonary vascular disease is a key mechanism underlying Fontan failure and supports further studies to understand the pathophysiology and target treatments to pulmonary vascular tone in this population.
[Mh] Termos MeSH primário: Velocidade do Fluxo Sanguíneo/fisiologia
Técnica de Fontan/efeitos adversos
Cardiopatias Congênitas/fisiopatologia
Artéria Pulmonar/fisiopatologia
Doenças Vasculares/complicações
Resistência Vascular/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Feminino
Seguimentos
Cardiopatias Congênitas/complicações
Cardiopatias Congênitas/cirurgia
Hemodinâmica/fisiologia
Seres Humanos
Masculino
Estudos Retrospectivos
Fatores de Tempo
Falha de Tratamento
Doenças Vasculares/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE


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[PMID]:29195575
[Au] Autor:Wilson TG; Shi WY; Iyengar AJ; Winlaw DS; Cordina RL; Wheaton GR; Bullock A; Gentles TL; Weintraub RG; Justo RN; Grigg LE; Radford DJ; d'Udekem Y; Australia and New Zealand Fontan Registry
[Ad] Endereço:Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
[Ti] Título:Twenty-Five Year Outcomes of the Lateral Tunnel Fontan Procedure.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):347-353, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The objective of this study was to characterize late outcomes of the lateral tunnel (LT) Fontan procedure. The outcomes of all patients who underwent an LT Fontan procedure in Australia and in New Zealand were analyzed. Original files were reviewed and outcomes data were obtained through a binational registry. Between 1980 and 2014, a total of 301 patients underwent an LT Fontan procedure across 6 major centers. There were 13 hospital mortalities, 21 late deaths, 8 Fontan conversions and revisions, 8 Fontan takedowns, and 4 heart transplantations. Overall survival at 15 and 25 years was 90% (95% confidence interval [CI]: 86%-93%) and 80% (95% CI: 69%-91%), respectively. Protein-losing enteropathy or plastic bronchitis was observed in 14 patients (5%). Freedom from late failure at 15 and 25 years was 88% (95% CI: 84%-92%) and 82% (95% CI: 76%-87%), respectively. Independent predictors of late Fontan failure were prolonged pleural effusions post Fontan operations (hazard ratio [HR] 3.06, 1.05-8.95, P = 0.041), age >7 years at Fontan (vs 3-5 years, HR 9.7, 2.46-38.21, P = 0.001) and development of supraventricular tachycardia (HR 4.67, 2.07-10.58, P < 0.001). Freedom from tachy- or bradyarrhythmias at 10 and 20 years was 87% (95% CI: 83%-91%) and 72% (95% CI: 66%-79%), respectively. Thromboembolic events occurred in 45 patients (16%, 26 strokes), and freedom from symptomatic thromboembolism at 10 and 20 years was 93% (95% CI: 89%-96%) and 80% (95% CI: 74%-86%), respectively. Over a 25-year period, the LT technique has achieved excellent late survival. As this population ages, it is at an increasing risk of failure and adverse events. We are likely to see an increasing proportion requiring heart transplantation and late reintervention.
[Mh] Termos MeSH primário: Técnica de Fontan
Cardiopatias Congênitas/cirurgia
Ventrículos do Coração/cirurgia
[Mh] Termos MeSH secundário: Austrália
Criança
Pré-Escolar
Intervalo Livre de Doença
Feminino
Técnica de Fontan/efeitos adversos
Técnica de Fontan/mortalidade
Cardiopatias Congênitas/mortalidade
Transplante de Coração
Ventrículos do Coração/anormalidades
Mortalidade Hospitalar
Seres Humanos
Masculino
Nova Zelândia
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/mortalidade
Complicações Pós-Operatórias/cirurgia
Sistema de Registros
Reoperação
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Falha de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:29224651
[Au] Autor:Egbe A; Khan AR; Khan SF; Anavekar NS; Said SM; Young PM; Akintoye E; Miranda WR; Al-Otaibi MN; Veldtman GR; Connolly HM
[Ad] Endereço:Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: egbe.alexander@mayo.edu.
[Ti] Título:Role of Doppler echocardiography for cardiac output assessment in Fontan patients.
[So] Source:Am Heart J;195:91-98, 2018 Jan.
[Is] ISSN:1097-6744
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To determine (1) correlation between Doppler stroke volume index (SVI) and cardiac magnetic resonance imaging (CMRI) SVI and (2) association between Doppler SVI and Fontan-associated diseases (FAD) and Fontan failure. METHODS: Review of Fontan patients who underwent same-day CMRI and transthoracic echocardiography (TTE), 2005 to 2015. We defined FAD as cardiac thrombus, protein-losing enteropathy, arrhythmia, and hospitalization for heart failure. Fontan failure was defined as Fontan conversion or revision, heart transplantation or listing, or death. RESULTS: Fifty-three patients with systemic left ventricle (LV) underwent 86 sets of TTE/CMRI. Mean (SD) age 31 (6) years. SVI (45 [16] vs 42 [13] mL/m ), CI (3.0 [1.1] vs 2.8 [0.8] L min m ), and ejection fraction (53 [4]% vs 51 [5]%) were similar for both modalities (P>.05 for all). Doppler SVI correlated with CMRI (r=0.68; P<.001). Sixteen patients had cirrhosis, and these patients had a higher CI (3.9 [0.9] vs 2.8 [1.0] L min m ; P<.01). Among the 37 patients without cirrhosis, Doppler SVI <39 mL/m was associated with FAD (odds ratio [OR], 2.11; 95% confidence limit, 1.26-3.14; P=.02); Fontan failure was more common in patients with CI was <2.5 L min m (3/9 [33%] vs 0/28 [0%], P=.01). Another 11 patients with systemic right ventricle (RV) underwent 17 sets of TTE/CMRI, mean (SD) age 17 (3) years, and CMRI SVI also correlated with Doppler SVI (r=0.75; P<.001). CONCLUSION: Doppler SVI correlated with CMRI SVI in patients with systemic LV and systemic RV. The association between output measures (SVI and CI) and FAD were seen only in single LV patients (single RV patients not assessed for this outcome due to small numbers). An association between low Doppler CI and Fontan failure was suggested in a small number of single LV patients.
[Mh] Termos MeSH primário: Ecocardiografia Doppler/métodos
Técnica de Fontan
Cardiopatias Congênitas/diagnóstico
Ventrículos do Coração/diagnóstico por imagem
Volume Sistólico/fisiologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Cardiopatias Congênitas/fisiopatologia
Ventrículos do Coração/fisiopatologia
Ventrículos do Coração/cirurgia
Seres Humanos
Imagem Cinética por Ressonância Magnética
Masculino
Reprodutibilidade dos Testes
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE



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