Systemic Artery Vasoconstrictor Therapy in Fontan Patients with High Cardiac Output-Heart Failure: A Single-Center Experience

Miike, Hikari; Ohuchi, Hideo; Hayama, Yosuke; Isawa, T; Sakaguchi, Heima; Kurosaki, Kenichi; Nakai, Michikazu

doi:10.1007/s00246-020-02532-7

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…Hebson et al [6] reported that SVRI in adult symptomatic post-Fontan patients was lower compared with asymptomatic pediatric post-Fontan patients (1,680 ± 368 vs. 1,960 ± 550 dyn s/cm 5 /m 2 , p = 0.02). Systemic artery vasoconstrictor therapy may prevent the rapid deterioration of the hemodynamics in patients with Fontan failure characterized by a high cardiac output [14].…”

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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“…Fontan-associated liver disease often causes cirrhosis and hepatocellular carcinoma, which are associated with a worse clinical prognosis [ 54 ]. The terminal stage of Fontan-associated liver disease can even develop hepatic encephalopathy [ 55 ]. Thus, regular liver imaging and liver function tests are recommended after the Fontan procedure [ 56 ].…”

Section: The Interactions Between Hf and Liver Dysfunctionmentioning

confidence: 99%

“…Liver stiffness measured with shear wave elastography has been used to evaluate liver fibrosis non-invasively [ 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 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. A shear wave is generated by inducing a push pulse of an ultrasound wave, which deforms a part of the tissue.…”

Section: Clinical Applicationsmentioning

confidence: 99%

Association between Cardiovascular Disease and Liver Disease, from a Clinically Pragmatic Perspective as a Cardiologist

et al. 2023

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Cardiovascular diseases and liver diseases are closely related. Non-alcoholic fatty liver disease has the same risk factors as those for atherosclerotic cardiovascular disease and may also be a risk factor for atherosclerotic cardiovascular disease on its own. Heart failure causes liver fibrosis, and liver fibrosis results in worsened cardiac preload and congestion. Although some previous reports regard the association between cardiovascular diseases and liver disease, the management strategy for liver disease in patients with cardiovascular diseases is not still established. This review summarized the association between cardiovascular diseases and liver disease. In patients with non-alcoholic fatty liver disease, the degree of liver fibrosis progresses with worsening cardiovascular prognosis. In patients with heart failure, liver fibrosis could be a prognostic marker. Liver stiffness assessed with shear wave elastography, the fibrosis-4 index, and non-alcoholic fatty liver disease fibrosis score is associated with both liver fibrosis in patients with liver diseases and worse prognosis in patients with heart failure. With the current population ageing, the importance of management for cardiovascular diseases and liver disease has been increasing. However, whether management and interventions for liver disease improve the prognosis of cardiovascular diseases has not been fully understood. Future investigations are needed.

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“…These maneuvers adjust oxygen delivery and perfusion pressure to the organs. 980 This type of circulatory failure has a bleak prognosis. Palliative care might be the way to go.…”

Section: Ii) High Cardiac Output With High Cvp Typementioning

confidence: 99%

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Ohuchi

Kawata²,

Uemura

et al. 2022

Circ J

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9JCS 2022 Guideline on Management/Re-Intervention in ACHD comorbidity, 172 and cardiac catheterization is fundamental for its evaluation. 173 ▋ 3.4.4 Left Heart Catheterization and Coronary Angiography Echocardiography, CT, and MRI are often substituted for left ventriculography, aortography, or coronary angiography. CT precisely illustrates abnormal origins and courses of the coronary arteries in many cases, which is why coronary angiography is not recommended as a routine examination (Class III). In some patients, nonetheless, coronary angiography is quite informative beyond CT resolution; for example, anastomotic stenosis at the coronary arterial origin would be better demonstrated by catheter angiography after the arterial switch procedure. 174 ▋ 3.4.5 Endomyocardial Biopsy Endomyocardial biopsy is rarely required in patients with postoperative CHD. ▋ 3.4.6 Catheter InterventionTranscatheter closure of atrial septal defect or patent ductus arteriosus is carried out routinely in the cardiac catheterization room, as is percutaneous pulmonary angioplasty. Interventional closure of ventricular septal defect needs more evidence before becoming established in Japan.Transcatheter pulmonary valve replacement will be introduced in the near future.Electrophysiological study and catheter ablation are common practices for arrhythmias in the CHD field. Recent advances in technology and devices, such as 3D mapping systems, have contributed to notable results in anti-arrythmic treatments in patients with repaired CHD. 175

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Systemic Artery Vasoconstrictor Therapy in Fontan Patients with High Cardiac Output-Heart Failure: A Single-Center Experience

Cited by 8 publications

References 20 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

Association between Cardiovascular Disease and Liver Disease, from a Clinically Pragmatic Perspective as a Cardiologist

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

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