The Fontan and the Sea: First-in-Man Data on Swimming and Diving Physiology in Fontan Patients

: In patients having undergone the Fontan operation, besides the well discussed changes in the cardiac, pulmonary and gastrointestinal system, alterations of further organ systems including the hematologic, immunologic, endocrinological and metabolic are reported. As a medical adjunct to Fontan surgery, the systematic study of the central role of the liver as a metabolizing and synthesizing organ should allow for a better understanding of the pathomechanism underlying the typical problems in Fontan patients, and in this context, the profiling of endocrinological and metabolic patterns might offer a tool for the optimization of Fontan follow-up, targeted monitoring and specific adjunct treatment.

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Induction and Increased Risk of Infections in Pediatric Fontan Patients after Heart Transplantation

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.380 ◽

2021 ◽

Vol 40 (4) ◽

pp. S120

Author(s):

H. Ahmed ◽

J. Lee ◽

D. Bernstein ◽

K. Weinberg ◽

D.N. Rosenthal ◽

...

Keyword(s):

Heart Transplantation ◽

Increased Risk ◽

Fontan Patients

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Myocardial Deformation in Fontan Patients Assessed by Cardiac Magnetic Resonance Feature Tracking: Correlation with Function, Clinical Course, and Biomarkers

Pediatric Cardiology ◽

10.1007/s00246-021-02650-w ◽

2021 ◽

Author(s):

Alessia Callegari ◽

Simona Marcora ◽

Barbara Burkhardt ◽

Michael Voutat ◽

Christian Johannes Kellenberger ◽

...

Keyword(s):

Ventricular Function ◽

Feature Tracking ◽

Heart Diseases ◽

Fontan Operation ◽

Myocardial Deformation ◽

Time Interval ◽

Ventricular Volumes ◽

Atrioventricular Valve Regurgitation ◽

Cine Mr ◽

Fontan Patients

AbstractCardiac MR (CMR) is a standard modality for assessing ventricular function of single ventricles. CMR feature-tracking (CMR-FT) is a novel application enabling strain measurement on cine MR images and is used in patients with congenital heart diseases. We sought to assess the feasibility of CMR-FT in Fontan patients and analyze the correlation between CMR-FT strain values and conventional CMR volumetric parameters, clinical findings, and biomarkers. Global circumferential (GCS) and longitudinal (GLS) strain were retrospectively measured by CMR-FT on Steady-State Free Precession cine images. Data regarding post-operative course at Fontan operation, and medication, exercise capacity, invasive hemodynamics, and blood biomarkers at a time interval ± 6 months from CMR were collected. Forty-seven patients underwent CMR 11 ± 6 years after the Fontan operation; age at CMR was 15 ± 7 years. End-diastolic volume (EDV) of the SV was 93 ± 37 ml/m2, end-systolic volume (ESV) was 46 ± 23 ml/m2, and ejection fraction (EF) was 51 ± 11%. Twenty (42%) patients had a single right ventricle (SRV). In single left ventricle (SLV), GCS was higher (p < 0.001), but GLS was lower (p = 0.04) than in SRV. GCS correlated positively with EDV (p = 0.005), ESV (p < 0.001), and EF (p ≤ 0.0001). GLS correlated positively with EF (p = 0.002), but not with ventricular volumes. Impaired GCS correlated with decreased ventricular function (p = 0.03) and atrioventricular valve regurgitation (p = 0.04) at echocardiography, direct atriopulmonary connection (p = 0.02), post-operative complications (p = 0.05), and presence of a rudimentary ventricle (p = 0.01). A reduced GCS was associated with increased NT-pro-BNP (p = 0.05). Myocardial deformation can be measured by CMR-FT in Fontan patients. SLVs have higher GCS, but lower GLS than SRVs. GCS correlates with ventricular volumes and EF, whereas GLS correlates with EF only. Myocardial deformation shows a relationship with several clinical parameters and NT-pro-BNP.

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