Clinical Outcome of Fenestrated Fontan Patients After Closure

Author:

Goff Donna A.1,Blume Elizabeth D.1,Gauvreau Kimberlee1,Mayer John E.1,Lock James E.1,Jenkins Kathy J.1

Affiliation:

1. From the Departments of Cardiology (D.A.G., E.D.B., K.G., J.E.L., K.J.J.) and Cardiac Surgery (J.E.M.), Children’s Hospital, and the Departments of Pediatrics (D.A.G., E.D.B., K.G., J.E.L., K.J.J.) and Surgery (J.E.M.), Harvard Medical School, Boston, Mass.

Abstract

Background —The late clinical status of Fontan patients after fenestration closure is unknown. Data are now available on all patients who underwent closure from 1989 to 1999. Methods and Results —All patients who underwent catheter closure of a Fontan fenestration were enrolled in either the Clamshell (1989 to 1994) or CardioSEAL (1996 to 1999) regulatory trials. Physiological values obtained at catheterization helped assess the hemodynamic effects of fenestration occlusion. In addition to survival, outcomes assessed included O 2 saturations, medication use, significant clinical findings (eg, heart failure, protein-losing enteropathy, or new arrhythmias), and somatic growth. Of 181 patients who underwent closure, 27 had additional significant leaks. The remaining 154 patients constituted the study group. Median time from closure to latest follow-up was 3.4 years (range 0.4 to 10.3 years). Fenestration closure increased O 2 saturation 9.4% on average ( P <0.001). The numbers of patients receiving digoxin or diuretics decreased at the most recent follow-up compared with baseline ( P <0.001), but use of antiarrhythmic agents increased marginally ( P =0.05). Height and weight percentiles rose (medians of 2 and 4, respectively; P <0.001). Clinical decompensation during follow-up of 154 patients was rare (4.5%), with 2 deaths, 3 Fontan revisions, and 1 patient each with protein-losing enteropathy and ascites. No other patient developed chronic congestive symptoms; 21 patients developed new arrhythmias, and 2 had a stroke or transient ischemic attack. Conclusions —Fenestration closure in Fontan patients was followed by improved oxygenation, reduced need for anticongestive medication, and improved somatic growth at latest follow-up. Death (1.3%) or chronic decompensation (3.2%) was rare.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference30 articles.

1. Surgical repair of tricuspid atresia

2. Clinical and hemodynamic results of the Fontan operation for tricuspid atresia

3. Experience with the Fontan procedure

4. Mair DD Rice MJ Hagler DJ et al. Outcome of the Fontan procedure in patients with tricuspid atresia. Circulation . 1985;72(suppl II):II-88–II-92.

5. Fontan type operation for complex lesions

Cited by 111 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Therapy of Patients with Cardiac Malposition;Children;2023-04-17

2. Narrative review of single ventricle: where are we after 40 years?;Translational Pediatrics;2023-02

3. The pendulum of Fontan fenestration;Translational Pediatrics;2023-01

4. Fontan Patients;Pediatric Cardiology;2023

5. Pediatric Catheter Intervention;Pediatric Cardiology;2023

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3