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Long-Term Effects of Percutaneous Fenestration Following the Fontan Procedure in Adult Patients with Congenital Univentricular Heart.
Smas-Suska, Monika; Róg, Beata; Werynski, Piotr; Plazak, Wojciech; Komar, Monika; Olszowska, Maria; Podolec, Piotr; Tomkiewicz-Pajak, Lidia.
Afiliación
  • Smas-Suska M; Departament of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
  • Róg B; Outpatient Department of Cardiology and Cardiac Surgery, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
  • Werynski P; Department of Pediatric Cardiology, Polish-American Institute of Pediatrics (PAIP), Jagiellonian University, Medical College, Cracow, Poland.
  • Plazak W; Departament of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
  • Komar M; Departament of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
  • Olszowska M; Departament of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
  • Podolec P; Departament of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
  • Tomkiewicz-Pajak L; Departament of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
Med Sci Monit ; 24: 3506-3513, 2018 May 26.
Article en En | MEDLINE | ID: mdl-29802801
BACKGROUND The Fontan procedure, performed for univentricular heart, may also include the technique of percutaneous fenestration to create a small atrial septal defect (ASD) and a right-to-left shunt. The aim of this study was to evaluate the long-term effects of fenestration in adult patients who had a Fontan procedure for univentricular heart. MATERIAL AND METHODS Fontan surgery was performed in 39 patients, including 19 (49%) patients with fenestration (Group I), and 20 (51%) patients without the fenestration procedure (Group II). Laboratory tests in both groups included echocardiography, plethysmography, cardiopulmonary exercise testing, and 24-hour Holter monitoring. RESULTS Compared with patients in Group I, patients in Group II had a significantly increased level of N-terminal pro-brain natriuretic peptide (NT-proBNP) (p=0.04), alkaline phosphatase (ALP) (p=0.01) and a significant increase in frequency of atrial fibrillation (p=0.04). Patients in Group I had a significantly increased systemic ventricular ejection fraction (SVEF) (p=0.05) and increased heart rate (HR) (p=0.006), heart rate reserve (HRR) (p=0.02), ventilatory equivalent (VE) (p=0.01), and VO2 peak (p=0.05) on cardiopulmonary exercise testing (CPET). Renal, hematologic, and ventilatory parameters, and incidence of thromboembolism showed no significant differences between the groups. CONCLUSIONS Long-term follow-up of patients who underwent Fontan procedures with percutaneous fenestration had improved single ventricular function, lower NT-proBNP levels, improved exercise capacity, and reduced ALP levels. These findings indicate that percutaneous fenestration closure should be considered for adult patients who have undergone Fontan procedure for univentricular heart.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimiento de Fontan / Cardiopatías Congénitas Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Med Sci Monit Asunto de la revista: MEDICINA Año: 2018 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimiento de Fontan / Cardiopatías Congénitas Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Med Sci Monit Asunto de la revista: MEDICINA Año: 2018 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Estados Unidos