Risk Factors for an Elevated Ventricular End-Diastolic Pressure Prior to the Fontan Operation

Schwartz, Matthew C.; Brock, Michael; Nykanen, David; DeCampli, William M.

doi:10.1007/s00246-017-1757-8

Cited by 7 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 28 , 29 , 30 The chronic preload insufficiency may result in myocardial remodelling, increased ventricular stiffness, increased filling pressures and eventually a progressive decline in cardiac output. 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ,…”

Section: Terms and Definitionsmentioning

confidence: 99%

“… 37 , 38 At the moment, direct measurement of ventricular end‐diastolic pressure remains the gold standard for the evaluation of diastolic dysfunction. 39 , 40 Various studies have suggested >10 or 12 mmHg as defining an elevated end‐diastolic pressure, with the recent emergence of the potential role for provocative testing (fluid challenge) to help identify patients with occult diastolic dysfunction. 39 , 40 , 41 Data on the haemodynamic definition, however, are sparse, and further research is needed to provide more definitive guidance on specific cut‐offs and best options for provocative testing.…”

Section: Terms and Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

Reaching consensus for unified medical language in Fontan care

Alsaied

Rathod

Aboulhosn³

et al. 2021

ESC Heart Failure

View full text Add to dashboard Cite

AimsThe Fontan operation has resulted in improved survival in patients with single-ventricle congenital heart disease. As a result, there is a growing population of teenagers and adults with a Fontan circulation. Many co-morbidities have been increasingly recognized in this population due to the unique features of the Fontan circulation. Standardization of how Fontan co-morbid conditions are defined will help facilitate understanding, consistency and interpretability of research and clinical experience. Unifying common language usage in Fontan is a critical precursor step for data comparison of research findings and clinical outcomes and ultimately accelerating improvements in management for this growing group of patients. This manuscript aimed to create unified definitions for morbidities seen after the Fontan palliation. Methods In association of many congenital heart disease organizations, this work used Delphi methodology to reach a broad consensus among recognized experts regarding commonly used terms in Fontan care and research. Each definition underwent at least three rounds of revisions to reach a final definition through surveys sent to experts in the field of single-ventricle care. Results The process of reaching a consensus on multiple morbidities associated with the Fontan procedure is summarized in this manuscript. The different versions that preceded reaching the consensus are also presented in the Supporting Information. Table 1 represents the final definitions according to the consensus. Conclusions We propose the use of these definitions for clinical care, future research studies, registry development and clinical trials.

show abstract

Section: Terms and Definitionsmentioning

confidence: 99%

Section: Terms and Definitionsmentioning

confidence: 99%

Reaching consensus for unified medical language in Fontan care

Alsaied

Rathod

Aboulhosn³

et al. 2021

ESC Heart Failure

View full text Add to dashboard Cite

show abstract

“…In prior work, we have shown that patients with systemic right ventricle have a higher single ventricle end-diastolic pressure before the bidirectional Glenn operation and before the Fontan operation compared to those with LV. 13,14 We hypothesise that chronic preload deprivation in the Fontan circulation drives diastolic dysfunction regardless of ventricular morphology.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and age are associated with ventricular end-diastolic pressure in adults with a Fontan circulation

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction: Systemic ventricular end-diastolic pressure is an important haemodynamic variable in adult patients with Fontan circulation. Risk factors associated with elevated end-diastolic pressure have not been clearly identified in this population. Methods: All patients > 18 years with Fontan circulation who underwent cardiac catheterisation at our centre between 1/08 and 3/19 were included. Relevant patient variables were extracted. Univariate and multivariate general linear models were analysed to identify variables associated with end-diastolic pressure. Results: Forty-two patients were included. Median age was 24.0 years (20.9–29.0) with a body mass index of 23.7 kg/m2 (21.5–29.7). 10 (23.8%) patients had a systemic right ventricle. The median (Interquartile range) and mean pulmonary artery pressure were 11.0 mmHg (9.0–12.0) and 16.0 mmHg (13.0–18.0), respectively. On univariate analysis, end-diastolic pressure was positively associated with body mass index (p < 0.01), age > 25 years (p = 0.04), symptoms of heart failure (p < 0.01), systemic ventricular systolic pressure (p = 0.03), pulmonary artery mean pressure (p < 0.01), and taking diuretics (p < 0.01) or sildenafil (p < 0.01). End-diastolic pressure was negatively associated with aortic saturation (p < 0.01). On multivariate analysis, end-diastolic pressure was positively associated with age ≥ 25 years (p < 0.01), and body mass index (p = 0.04). Conclusions: In a cohort of adult patients with Fontan circulation undergoing catheterisation, end-diastolic pressure was positively associated with age ≥ 25 years and body mass index on multivariate analysis. Maintaining a healthy body mass index may offer haemodynamic benefit in adults with Fontan physiology.

show abstract

“…Despite its importance, diastolic function of the palliated single ventricle is poorly understood, and no-invasive risk factors associated with higher end-diastolic ventricular pressure have not yet been clearly identified in pre-Fontan patients. In 2018, Schwartz et al 23 studied possible predictors of an elevated end-diastolic ventricular pressure in pre-Fontan patients, and they found that invasive ventricular systolic pressure and decreased ventricular systolic function were positively associated with end-diastolic ventricular pressure. In our knowledge, this is the first study that investigates non-invasive MRI predictors of pre-Fontan end-diastolic ventricular pressure.…”

Section: Discussionmentioning

confidence: 99%

Role of cardiac MRI in the prediction of pre-Fontan end-diastolic ventricular pressure

et al. 2021

View full text Add to dashboard Cite

Background: Growing evidence has emphasised the importance of ventricular performance in functionally single-ventricle patients, particularly concerning diastolic function. Cardiac MRI has been proposed as non-invasive alternative to pre-Fontan cardiac catheterisation in selected patients. Aim of the study: To identify clinical and cardiac magnetic resonance predictors of high pre-Fontan end-diastolic ventricular pressure. Method: In a retrospective single-centre study, 38 patients with functionally univentricular heart candidate for Fontan intervention, who underwent pre-Fontan cardiac catheterisation, beside a comprehensive cardiac MRI, echocardiographic, and clinical assessment were included. Medical and surgical history, cardiac magnetic resonance, cardiac catheterisation, echocardiographic, and clinical data were recorded. We investigated the association between non-invasive parameters and cardiac catheterisation pre-Fontan risk factors, in particular with end-diastolic ventricular pressure. Moreover, the impact of conventional invasive pre-Fontan risk factor on post-operative outcome as also assessed. Results: Post-operative complications were associated with higher end-diastolic ventricular pressure and Mayo Clinic indexes (p < 0.01 and p = 0.05, respectively). At receiver operating characteristic curve analysis end-diastolic ventricular pressure ≥ 10.5 mmHg predicted post-operative complications with a sensitivity of 75% and specificity of 88% (AUC: 0.795, 95% CI 0.576;1.000, p < 0.05). At multivariate analysis, both systemic right ventricle (OR: 23.312, 95% CI: 2.704–200.979, p < 0.01) and superior caval vein indexed flow (OR: 0.996, 95% CI: 0.993–0.999, p < 0.05) influenced end-diastolic ventricular pressure ≥ 10.5 mmHg. Conclusions: A reduced superior caval vein flow, evaluated at cardiac magnetic resonance, is associated with higher end-diastolic ventricular pressure a predictor of early adverse outcome in post-Fontan patients.

show abstract

Risk Factors for an Elevated Ventricular End-Diastolic Pressure Prior to the Fontan Operation

Cited by 7 publications

References 16 publications

Reaching consensus for unified medical language in Fontan care

Reaching consensus for unified medical language in Fontan care

Body mass index and age are associated with ventricular end-diastolic pressure in adults with a Fontan circulation

Role of cardiac MRI in the prediction of pre-Fontan end-diastolic ventricular pressure

Contact Info

Product

Resources

About