Late Fontan failure in adult patients is predominantly associated with deteriorating ventricular function
| Autor: | Felix Berger, Stanislav Ovroutski, Hannes Sallmon, Johannes Nordmeyer, Peter Kramer, Sven C. Weber, Anastasia Schleiger, Joachim Photiadis |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Heart Defects Congenital congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Heart Ventricles Diastole Hemodynamics Fontan Procedure Interquartile range Internal medicine medicine Humans Ventricular Function cardiovascular diseases Retrospective Studies Ejection fraction Adult patients business.industry Retrospective cohort study medicine.anatomical_structure cardiovascular system Cardiology Vascular resistance Fontan failure Cardiology and Cardiovascular Medicine business |
| Zdroj: | International Journal of Cardiology. 344:87-94 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2021.09.042 |
| Popis: | Background The Fontan operation is a palliative procedure and a substantial number of patients eventually experiences late Fontan circulation failure. Previous concepts of Fontan failure implicate increasing pulmonary vascular resistance (PVR) as a key contributor to late circulatory failure. However, data to support this assumption are sparse. We sought to characterize longitudinal hemodynamic and echocardiographic findings in adult failing Fontan patients. Methods We performed a retrospective cohort study in adult Fontan patients, identifying patients with Fontan failure. Hemodynamic, echocardiographic and clinical data were recorded. Results Of 173 adult patients (median follow-up after Fontan 20.2 years [IQR 15.7-24.3]), 48 (28%) showed signs of clinical Fontan failure. Thirty-seven patients (77.1%) exhibited ventricular dysfunction (systolic dysfunction defined by ejection fraction ≤45%, n = 22, or diastolic dysfunction defined by systemic ventricular end-diastolic pressure (SVEDP) ≥12 mmHg, n = 15). Elevated indexed PVR (≥2.5 WU*m2) was only observed in 9 (18.8%) patients. Ejection fraction declined from 60% [IQR 55-65] to 47% [IQR 35-55] during follow-up (p Conclusions Systolic and diastolic ventricular dysfunction are frequent features in late Fontan failure in adults, while increases in PVR were rarely observed. The intricate interplay between hemodynamic compromises in Fontan failure deserves further research to optimize treatment strategies and outcome. |
| Databáze: | OpenAIRE |
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