Renal resistive index reflects Fontan pathophysiology and predicts mortality

Ohuchi, Hideo; Negishi, Jun; Hayama, Yohsuke; Miyazaki, Aya; Shiraishi, Isao; Ichikawa, Hajime

doi:10.1136/heartjnl-2016-310812

Cited by 23 publications

(16 citation statements)

References 27 publications

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“…After completion of the Fontan operation, elevated venous pressure and low cardiac output may contribute further to chronic renal dysfunction [308]. End-stage Fontan failure is characterised by a cardio-hepato-renal interaction, and it is possible that the contribution of the kidneys to this pathological process has been underestimated [309].…”

Section: Postulated Pathophysiologymentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

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Section: Postulated Pathophysiologymentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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show abstract

“…In addition, because serious post-operative complications, such as supraventricular arrhythmias, PLE, PAVF, and thromboembolic problems often coexist, adaptive mechanisms for maintaining both “appropriate” Rs and the redistribution of limited CO might lead to “failing” and unacceptable pathophysiology. Furthermore, the recent concept of failure can include additional non-cardiac end-organ impairments, such as FALD, 13) 14) 15) 27) renal dysfunction, 12) 27) 28) 29) glucose metabolic abnormalities, 30) and even bone and nutritional problems. 31) 32) Hepato-renal pathophysiology, in particular, has a strong impact on morbidity and mortality in these patients.…”

Section: “Failing” Fontan Circulationmentioning

confidence: 99%

“… 31) 32) Hepato-renal pathophysiology, in particular, has a strong impact on morbidity and mortality in these patients. 14) 29) Thus, these emerging pathophysiologic situations make the definition of “failing” more complex.…”

Section: “Failing” Fontan Circulationmentioning

confidence: 99%

Where Is the “Optimal” Fontan Hemodynamics?

Ohuchi

2017

Korean Circ J

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Fontan circulation is generally characterized by high central venous pressure, low cardiac output, and slightly low arterial oxygen saturation, and it is quite different from normal biventricular physiology. Therefore, when a patient with congenital heart disease is selected as a candidate for this type of circulation, the ultimate goals of therapy consist of 2 components. One is a smooth adjustment to the new circulation, and the other is long-term circulatory stabilization after adjustment. When either of these goals is not achieved, the patient is categorized as having “failed” Fontan circulation, and the prognosis is dismal. For the first goal of smooth adjustment, a lot of effort has been made to establish criteria for patient selection and intensive management immediately after the Fontan operation. For the second goal of long-term circulatory stabilization, there is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics in Fontan circulation that could be used as a reference for patient management. Although small clinical trials and case reports are available, the results cannot be generalized to the majority of Fontan survivors. We recently reported the clinical and hemodynamic characteristics of early and late failing Fontan survivors and their association with all-cause mortality. This knowledge could provide insight into the complex Fontan pathophysiology and might help establish a management strategy for long-term hemodynamic stabilization.

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“…Monitoring renal function using US Doppler resistive index is of growing interest as a marker of heart failure and end organ damage in adult congenital heart disease. A recent pediatric Fontan study revealed that a high index >0.81 reflects the severity of heart failure, hepatic and renal function, glucose intolerance and overall mortality [ 69 ].…”

Section: Fontan-associated Liver Diseasementioning

confidence: 99%

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Lange

2020

Pediatr Radiol

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The Fontan operation is performed for various cardiac lesions with single-ventricle physiology. The survival rate of Fontan patients is increasing for adolescents and young adults, with an expected 30-year survival of >80%. Medical health care providers including specialists in organ systems and pediatric radiologists need to improve their knowledge about the Fontan circulation and the various organ complications to monitor care. In this review the author explains the basic anatomical and functional features of Fontan palliation and gives an overview of the multiple long-term organ complications that might present in the pediatric population. These include decreased physical capacity, ventricular dysfunction, atrioventricular valve regurgitation and arrhythmia, as well as protein-losing enteropathy, plastic bronchitis, growth/bone composition disturbances, renal dysfunction, and the recently recognized and important liver fibrosis (Fontan-associated liver disease). Neuropsychological and behavioral deficits occur frequently. This review focuses on the key role of radiology in making the diagnosis of these complications, monitoring therapy and predicting outcomes in the pediatric age group. The author discusses how and when radiology is important in Fontan patients, as well as how new techniques enabling quantitative measures in imaging with US, MRI and CT are adapted for pediatric use, and how they contribute to urgently needed surveillance strategies. Electronic supplementary material The online version of this article (10.1007/s00247-020-04682-5) contains supplementary material, which is available to authorized users.

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Renal resistive index reflects Fontan pathophysiology and predicts mortality

Abstract: The RRI reflected heart failure severity, hepatorenal function and glucose intolerance, and predicted all-cause mortality in Fontan patients. Therefore, the RRI may be a useful marker of Fontan-associated multiorgan pathophysiology.

Cited by 23 publications

References 27 publications

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Where Is the “Optimal” Fontan Hemodynamics?

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

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