scholarly journals Managing adult Fontan patients: where do we stand?

2016 ◽  
Vol 25 (142) ◽  
pp. 438-450 ◽  
Author(s):  
Paul Clift ◽  
David Celermajer
Keyword(s):  
Quality Of Life ◽  
Life Expectancy ◽  
Fontan Operation ◽  
Adult Survivors ◽  
Late Complications ◽  
Therapeutic Interventions ◽  
Palliative Procedure ◽  
Fontan Patients

The Fontan operation is performed as a palliative procedure to improve survival in infants born with a functionally univentricular circulation. The success of the operation is demonstrated by a growing adult Fontan population that exists with this unique physiology. Late follow-up has demonstrated expected and unexpected sequelae, and has shown multisystem effects of this circulation. This review discusses the challenges of managing the late complications in terms of understanding this unique physiology and the innovative therapeutic interventions that are being investigated. The challenge remains to maintain quality of life for adult survivors, as well as extending life expectancy.

scholarly journals Tricuspid Atresia in Adulthood

2021 ◽  
Author(s):  
Fabrizio Ricci ◽  
Mohammed Yunus Khanji ◽  
Sabina Gallina
Keyword(s):  
Quality Of Life ◽  
Life Expectancy ◽  
Fontan Operation ◽  
Adult Survivors ◽  
Tricuspid Atresia ◽  
Failing Fontan

Abstract Patients with tricuspid atresia can reach their adulthood after Fontan operation. The major challenge is to maintain quality of life for the failing Fontan adult survivors, as well as extending their life expectancy.

Adult CHD patients under clinical follow-up have a similar quality of life to the general population in Malta

2016 ◽  
Vol 27 (6) ◽  
pp. 1051-1059
Author(s):  
Maryanne Caruana ◽  
Victor Grech
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
General Population ◽  
Negative Impact ◽  
Adult Survivors ◽  
Cardiac Medication ◽  
Self Reporting Questionnaire ◽  
The Impact

AbstractBackgroundThe improved survival of patients born with CHD has led to increasing interest in research on quality of life of adult survivors. We report the findings of the first study in Malta carried out to investigate quality of life in adults with CHD under follow-up.MethodsA self-reporting questionnaire modelled on the basis of the European Health Interview Survey 2008, including questions on mental health and vitality, was administered to consecutive adult CHD outpatients, aged 16 years and over, between May, 2013 and May, 2014. Foreigners and patients with learning difficulties or cognitive impairment were excluded. Quality-of-life data were compared with that from 371 age- and sex-matched 2008 survey responders – general population cohort. The impact of congenital lesion complexity, hospitalisation in the preceding 12 months, arrhythmias, co-morbidities, and cardiac medication use on quality of life of the CHD cohort was also investigated.ResultsThere were a total of 120 patient responders (63 males; mean age 30.53, SD 12.77 years). Overall, there were no significant differences in mental health and vitality between patient and general population cohorts, although older patients had better mental health scores compared with age-matched controls. Within the adult CHD cohort, hospitalisation in the preceding 12 months was the only factor associated with a poorer quality of life.ConclusionsOverall, CHD has no negative impact on mental health and vitality in Maltese adult patients under follow-up. Patients needing frequent hospitalisations might warrant closer attention by clinical psychologists.

Health-Related Quality of Life in Adult Survivors After the Fontan Operation

2015 ◽  
Vol 27 (3) ◽  
pp. 299-306 ◽  
Author(s):  
Manisha Kukreja ◽  
Ayesha S. Bryant ◽  
David C. Cleveland ◽  
Robert Dabal ◽  
Neha Hingorani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Fontan Operation ◽  
Adult Survivors ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Health-Related Quality of Life in Adult Survivors after the Fontan Operation

2015 ◽  
Vol 27 (3) ◽  
pp. 307-308
Author(s):  
James K. Kirklin ◽  
Charles B. Huddleston ◽  
Pirooz Eghtesady ◽  
Emile A. Bacha
Keyword(s):  
Quality Of Life ◽  
Fontan Operation ◽  
Adult Survivors ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Sternal Reconstruction with the Omental Flap—Acute and Late Complications, Predictors of Mortality, and Quality of Life

2018 ◽  
Vol 34 (05) ◽  
pp. 376-382
Author(s):  
C. Hörner ◽  
A. Sogorski ◽  
O. Goertz ◽  
A. Ring ◽  
K. Harati ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Late Complications ◽  
Omental Flap ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Predictors Of Mortality ◽  
Sternal Reconstruction ◽  
American Society

Background The omental flap is a reliable flap for the coverage of sternal defects. However, little is known about the predictors of mortality and the long-term outcome in such patients. Methods We, therefore, performed a retrospective study from 2002 to 2013, including all patients who underwent sternal reconstruction with the omental flap. Results A total of 50 patients were identified and mean follow-up was 3.8 years. Patient data was collected from the charts and 14 patients were available for telephone interviews. The majority of patients suffered from deep sternal wound infections. There was no complete flap loss and an overall success rate was 96%. In-hospital mortality was 14% and overall survival over follow-up was 50%. Significant predictors of mortality were age > 65, American Society of Anesthesiologists' status, defect size, prolonged ventilation, and the need for tracheotomy. Postoperative quality of life was reduced compared with other cohorts, especially with regard to bodily function. Pain was also a major problem for most patients along with herniation. Conclusion The omental flap is a safe option even in patients with severe comorbidities. However, based on the data in this study, we would recommend the omental flap as a reserve option rather than first-line treatment for sternal defects.

scholarly journals Modified Mainz Pouch II (sigma rectum pouch) urinary diversion: 12 years experience

2007 ◽  
Vol 54 (4) ◽  
pp. 73-77 ◽  
Author(s):  
I. Ignjatovic ◽  
D. Basic
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Urinary Diversion ◽  
Life Quality ◽  
Late Complications ◽  
Anastomotic Site ◽  
Mainz Pouch Ii ◽  
The Mean

Objective: To analyze the outcome of Mainz Pouch II urinary diversion related to complications and life quality. Patients and Methods: From 1995 to 2006, a total of 67 patients (60 male and 7 female, mean age 58.4 years, range 48 to 70) who underwent modified ureterosigmoidostomy (Mainz Pouch II) procedure have been retrospectively analyzed. The mean follow-up was 18 (1 - 72) months and it was available for 56 patients (84%). Early and late postoperative complications as well as quality of life after surgery were analyzed. An clinical questionairre has been used for examination specific urinary diversion items. Results: Early postoperative complications (<30 days) we-re detected in 9 patients (13%) and late complications (>30 days) in 19 patients (28%). Early complications consisted of urine leakage of moderate degree in 5 (7%) and ileus requiring surgical revision in 4 (6%) patients. The late complications included acute pyelonephritis in 12 patients (18%) and uretero-sigmoidal anastomotic site stenosis in 7 (11%). Ureterosigmoidal anastomotic site stenosis was detected in 7 patients with 7 renoureteric units (RU). In 4 RU, metal Strecker stent was successfully applied. In 3 RU, permanent nephrostomy catheter was applied. Oral alkalizing agents were applied in 22 patients (33%) due to metabolic acidosis. Two patients died due to severe acidosis. Continent rate was 96%. The mean voiding frequency during the day and night was 5.2+1.8 and 2.7+ 0.5, respectively. Global life quality was bad for 3 (8%), acceptable for 15 (38%) and good for 22 (54%) patients. Conclusion: The Mainz Pouch II urinary diversion is simple and safe procedure regarding complications rate, continence and quality of life. It is good alternative to other forms of continent urinary diversion. Patient selection and compliance following by meticulous follow-up are of utmost importance for successful operative outcome.

scholarly journals Prediction of quality of life at long-term follow-up after Fontan operation by scoring risk factors.

1994 ◽  
Vol 58 (8) ◽  
pp. 646-652 ◽  
Author(s):  
PARK INSAM ◽  
MAKOTO NAKAZAWA ◽  
YASUHARU IMAI ◽  
KAZUO SAWATARI ◽  
KAZUO MOMMA
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Fontan Operation ◽  
Long Term Follow Up

OUTCOME OF POSTERIOR SAGITTAL ANORECTOPLASTY IN ANORECTAL MALFORMATIONS WITH AND WITHOUT FISTULA IN TERTIARY CARE CENTRES OF NORTH INDIA

2021 ◽  
pp. 126-130
Author(s):  
Ankur dutt tripathi ◽  
D. Kumar ◽  
Akansha Dubey ◽  
Akhilesh Maurya ◽  
Shashank tripathi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Developing Countries ◽  
Urine Analysis ◽  
Tertiary Care ◽  
Anorectal Malformations ◽  
Late Complications ◽  
North India ◽  
P Value

Introduction: Anorectal malformations (ARM) have been a source of concern for centuries. The reported incidence of ARM is 1 in every 2500 to 5000 live births but maybe even more frequent in certain 1,2 developing countries . Although ARM comprise approximately 0.2-0.3% births. They have been reported to comprise up to 3,4,6-24 1.2% of reported birth defects. Approximately 36.4% are isolated lesions and 63.6% are associated with other anomalies . ⁵ Studies demonstrated several mutations of HLXB9 associated with ARM . 33 patients with intermediate 25 Method and Material: ARM were included A thorough perineal examination, complete haemogram, urine analysis, colposcopy and . radiological studies were conducted. Patients underwent PSARP, the comparison of late complications and functional outcome at the end of 1 year follow- up in ARM patients with and without stula was done. Fischer Exact Test was done for getting Two tailed P- value. Observation and Results: Out of 33 patients 16 males were without stula and 17 males were with rectourethral stula. 33 patients underwent PSARP, 8 cases (24.24%) had early complications. Late complications in 12 cases (36.36%). No postoperative complications were recorded in 13 (39.39%) children. At end of follow-up, 31 remaining patients (including patients with supercial wound infection) had normal looking perineal body and anus with good contraction. No recurrence of stula, stenosis of anus or anterior displacement of rectum. PSARP is a useful procedure for the correction Conclusion: of ARM in children in developing countries and quality of life depends on clinical status of patient and age at the time of presentation. No signicant statistical differences in quality of life was seen in patients with stula vs patients without stula post PSARP

scholarly journals Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG)

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Stefano Cariani ◽  
Laura Agostinelli ◽  
Luca Leuratti ◽  
Eleonora Giorgini ◽  
Pietro Biondi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Morbid Obesity ◽  
Gastric Bypass ◽  
Vertical Banded Gastroplasty ◽  
Late Complications ◽  
Early Complications ◽  
Banded Gastroplasty ◽  
Significant Challenge

Background. Revision of failed bariatric procedures is a significant challenge for bariatric surgeons, because of the increasing number of recurring morbid obesity or complications, especially in patients with a previous Vertical Banded Gastroplasty (VBG).Methods. Since November 1998, 109 patients with failed or complicated VBG were followed in a retrospective study. 49 patients underwent re-VBG and, since 2004, 60 underwent Roux-en-Y Gastric Bypass-on-Vertical Banded Gastroplasty (RYGB-on-VBG).Results. At 3 years follow-up, mean BMI decreased from 37.4 to 31.2  in the first group, and from 35.0 to 28.4  in the second. Early complications were 7 (14.3%) in the first group and 4 (6.5%) in the second; late complications were 33 (59.1%) and 11 (18.3%), respectively.Conclusion. Although both operations seem to be effective as bariatric revision procedures in terms of BMI, the mid-term outcomes of RYGB-on-VBG demonstrate the lowest rate of complications and better quality of life.

scholarly journals LONG-TERM CLINICAL OUTCOMES IN SURVIVORS OF CORONAVIRUS OUTBREAKS AFTER HOSPITALISATION OR ICU ADMISSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF FOLLOW-UP STUDIES

2020 ◽  
Author(s):  
Hassaan Ahmed ◽  
Kajal Patel ◽  
Darren Greenwood ◽  
Stephen Halpin ◽  
Penny Lewthwaite ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Meta Analysis ◽  
Adult Survivors ◽  
Icu Admission ◽  
Follow Up Studies ◽  
Clinical Problems

ABSTRACTObjectiveTo determine the long-term clinical problems in adult survivors of coronavirus (CoV) infection [Coronavirus disease 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)] after hospitalisation or Intensive Care Unit (ICU) admission.DesignSystematic review and meta-analysis of the literature.Data sourcesOvid MEDLINE, EMBASE, CINAHL Plus and PsycINFO were searched using the strategy: (Coronavirus OR Coronavirus Infections OR COVID OR SARS virus OR Severe acute respiratory syndrome OR MERS OR Middle east respiratory syndrome) AND (Follow-up OR Follow-up studies OR Prevalence). Original studies reporting the clinical outcomes of adult survivors of coronavirus outbreaks two months after discharge or three months after admission were included. The quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 Level of Evidence Tool. Meta-analysis was conducted to derive pooled estimates of prevalence and severity for different outcomes at time points up to 6 months follow-up and beyond 6 months follow-up.ResultsThe search yielded 1169 studies of which 28 were included in this review. There were 15 Level 1b, 8 Level 2b, 2 Level 3b and 3 Level 4 studies by OCEBM grading. Pooled analysis of studies revealed that complications commonly observed were impaired diffusing capacity for carbon monoxide (DLCO) [prevalence of 27.26%, 95% CI 14.87 to 44.57] and reduced exercise capacity [(6-minute walking distance (6MWD) mean 461m, 95% CI 449.66 to 472.71] at 6 months with limited improvement beyond 6 months. Coronavirus survivors had considerable prevalence of psychological disorders such as post-traumatic stress disorder (PTSD) [38.80%, CI 30.93 to 47.31], depression [33.20%, CI 19.80 to 50.02] and anxiety [30.04%, CI 10.44 to 61.26) beyond 6 months. These complications were accompanied by low Short Form 36 (SF-36) scores at 6 months and beyond indicating reduced quality of life which is present long-term.ConclusionsThe long term clinical problems in survivors of CoV infections (SARS and MERS) after hospitalisation or Intensive Care Unit (ICU) admission include respiratory dysfunction, reduced exercise capacity, psychological problems such as PTSD, depression and anxiety, and reduced quality of life. Critical care, rehabilitation and mental health services should anticipate a high prevalence of these problems following COVID-19 and ensure their adequate and timely management with the aim of restoring premorbid quality of life.

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