Portosystemic venous shunt in the patients with Fontan circulation

Nagata, Hazumu; Sakamoto, Ichiro; Fukuoka, Shouji; Ishikita, Ayako; Uike, Kiyoshi; Nagatomo, Yusaku; Hirata, Yoshihiro; Yamamura, Kenichiro; Ohga, Shouichi

doi:10.1007/s00380-020-01685-y

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…Systemic arteries dilate in response to hypoxia, although the mechanism is not fully understood [16]. Additionally, liver cirrhosis or a porto-systemic shunt may cause systemic vasodilatation [17,18]. Thus, the patients in category C were in a vasodilating stage.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Kawasaki,

Sasaki,

Kobayashi

2023

Congenital Heart Disease

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Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized that hemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinical features and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients who underwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVR index (SVRI) ≥ 20; B, CI < 3, SVRI ≥ 20; C, CI ≥ 3, SVRI < 20; and D, CI < 3, SVRI < 20. The primary outcome was freedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant, and death. Clinical and hemodynamic variables and freedom from the endpoint were compared between the hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients were included. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. All the patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascular resistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category D had a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category D were outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamic profiling.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Kawasaki,

Sasaki,

Kobayashi

2023

Congenital Heart Disease

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“…1) Portal hypertension is another well-known postoperative condition that often causes esophageal varices, portosystemic shunts, and thrombocytopenia due to hypersplenism. 2,3) Although the management of esophageal varices and portosystemic shunts has been reported, 3,4) literature is scarce about the management of thrombocytopenia in Fontan patients with portal hypertension. Herein we describe a young adult Fontan patient who had thrombocytopenia and a splenic artery aneurysm (SAA) treated with embolization therapy, leading to successful subsequent cardiac surgery.…”

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confidence: 99%

Successful Preoperative Partial Splenic Artery and Aneurysm Embolization for Thrombocytopenia Associated with Failed Fontan Circulation

et al. 2022

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Long-term complications after the Fontan procedure are important concerns for patients with pediatric and adult congenital heart disease. Although thrombocytopenia due to portal hypertension and hypersplenism is a well-known complication of the Fontan circulation, few studies have reported on its management. Herein we describe a young adult Fontan patient with thrombocytopenia and a splenic artery aneurysm caused by conduit stenosis. The patient required conduit replacement due to high venous pressure. We performed partial splenic artery embolization (PSE) and embolization of the aneurysm preoperatively to reduce the risk of bleeding, resulting in successful subsequent cardiac surgery. Preoperative evaluation of the splenic artery aneurysm was informative, and PSE was a safe and effective treatment option for thrombocytopenia to avoid bleeding during open-heart surgery in this patient.

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The Significance of Congenital Portosystemic Shunts in Congenital Heart Disease and the Bizarre Phenomenon of Alternating Portosystemic and Systemic–Portal Shunting

Justino

2024

Interventional Cardiology Clinics

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Portosystemic venous shunt in the patients with Fontan circulation

Cited by 4 publications

References 16 publications

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Successful Preoperative Partial Splenic Artery and Aneurysm Embolization for Thrombocytopenia Associated with Failed Fontan Circulation

The Significance of Congenital Portosystemic Shunts in Congenital Heart Disease and the Bizarre Phenomenon of Alternating Portosystemic and Systemic–Portal Shunting

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