Fontan Circulation: Success or Failure?

Mondésert, Blandine; Marcotte, François; Mongeon, François‐Pierre; Dore, Annie; Mercier, Lise‐Andrée; Ibrahim, Réda; Asgar, Anita W.; Miró, Joaquim; Poirier, Nancy; Khairy, Paul

doi:10.1016/j.cjca.2012.12.009

Cited by 73 publications

(71 citation statements)

References 89 publications

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“…This physiologic course can result in many systemic complications, such as hepatic dysfunction, protein-losing enteropathy, plastic bronchitis, and arrhythmias. 26,27 Moreover, the prosthetic material used for the connection between the hepatic vein and the azygos vein can increase the risk for thromboembolic events by promoting thrombus formation. 28 Therefore, our policy is not to perform the HAS shortly after the cavopulmonary connection in the absence of arteriovenous fistulas.…”

Section: Discussionmentioning

confidence: 99%

Off-pump hepatic to azygos connection via thoracotomy for relief of fistulas after a Kawashima procedure: Ten-year results

Arrigoni

Heuvel

Willems

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Off-pump hepatic to azygos connection via thoracotomy for relief of fistulas after a Kawashima procedure: Ten-year results

Arrigoni

Heuvel

Willems

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…However, the treatment of long-term survivors is still often confused by the onset of progressive hemodynamic deterioration and associated complications that eventually lead to late failure (17,53,56,61). Theoretically, maintaining optimal or at least suboptimal hemodynamic conditions would be beneficial to the patients.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the status of hemodynamic abnormalities has a tendency to deteriorate progressively over time after the Fontan operation (56). This highlights the importance of active hemodynamic management in the care of long-term survivors.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Liang

Senzaki

Kurishima

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 307: H1056 -H1072, 2014. First published July 25, 2014 doi:10.1152/ajpheart.00245.2014The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patientspecific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.

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“…Since it was first reported in 1968, the Fontan procedure has transformed the lives of many children born with single-ventricle physiology, offering them the potential for survival and good quality of life well into adulthood 1 2. The original procedure was described by Fontan in patients with tricuspid atresia, and since that time, the surgical technique has significantly evolved 2…”

Section: Introductionmentioning

confidence: 99%

“…Strategies to prevent thrombosis and thromboembolism (TE) after the Fontan procedure vary considerably among institutions, and the literature is fraught with controversy 1 2 10. While few studies discourage the use of any TE prophylaxis, some studies support the use of antiplatelet agents and others recommend the use of therapeutic anticoagulation with vitamin K antagonists 2 7 11 12…”

Section: Introductionmentioning

confidence: 99%