Single-center experience of hemodialysis in patients after Fontan palliation

Young, Brian; Franklin, Wayne; Lam, Wilson; Ermis, Peter

doi:10.1016/j.ijcha.2018.10.008

Cited by 1 publication

(1 citation statement)

References 7 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intermittent HD is often not tolerated due to HD's requirement for adequate preload and its creation of large intravascular fluid shifts that can result in significant hemodynamic instability. Case reports of HD in Fontan patients demonstrating the success of HD has been limited to those with normal ventricular function and absence of significant extracardiac disease ( 19 ). PD raises intra-abdominal pressure increases inferior vena cava and intrathoracic pressure resulting in CVP elevation ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Case report and review of the literature: Successful transition from acute continuous veno-venous hemodiafiltration therapy to chronic peritoneal dialysis in a chronically ventilated child with hypoplastic left heart syndrome following fontan

et al. 2022

View full text Add to dashboard Cite

Fontan palliation depends on low pulmonary vascular resistance in order to maintain pulmonary blood flow and adequate oxygenation. This physiology results in higher central venous pressures with limited renal perfusion pressure and cardiac output. Positive pressure ventilation with mechanical ventilation increases intrathoracic pressure and raises central venous pressure and can further limit pulmonary and renal perfusion. Fluid removal with intermittent hemodialysis can be challenging in Fontan patients and can cause intolerable hypotension, however the increased abdominal filling pressures during peritoneal dialysis dwells can exacerbate systemic venous hypertension seen in Fontan patients and threaten adequate pulmonary blood flow and cardiac output. Successful transition to peritoneal dialysis in a chronically ventilated patient with hypoplastic left heart syndrome, end-stage renal disease and Fontan physiology has not been described. We present details outlining the successful transition across multiple modalities of renal replacement therapy to assist other teams faced with similar challenges in chronically ventilated Fontan patients with end-stage renal disease.

show abstract

Section: Discussionmentioning

confidence: 99%