Factores pronósticos de enteropatía perdedora de proteínas en una cohorte mexicana de pacientes con cardiopatía congénita, corregidas quirúrgicamente con cirugía de Fontan (original) (raw)
Related papers
2015
Background: Protein-losing enteropathy (PLE) is a known postoperative complication affecting about 10% of patients surgically managed with Fontan procedure. The mortality rate associated with this complication increases to 50%. Objective: To determine the risk factors associated to the development of PLE in patients surgically managed with Fontan procedure. Methods: This was a case-cohort study, and the universe of the trial comprised all patients treated with univentricular surgery. We included male and female patients with congenital heart disease that conditioned a single ventricle syndrome. Those patients with previous intestinal disease causing protein loss, were excluded, cow’s milk protein allergy, intestinal resection (previous or after heart surgery), use of cyclic parenteral nutrition or Fontan’s dismantlement. Follow-up began immediately after hospital discharge from Fontan procedure. Outcome variable was the development of PLE; independent variables were some before and ...
Materia Socio Medica, 2014
Background Protein-losing enteropathy (PLE) is a disorder characterized by abnormal and often profound enteric protein loss. It's relatively uncommon complication of Fontan and other complex congenital heart disease (CCHD) procedures. Because of the complexity and rarity of this disease process, the pathogenesis and pathophysiology of protein-losing enteropathy remain poorly understood, and attempts at treatment seldom yield long-term success. Aim of presentation is to describe single centre experience in diagnosis, evaluation, management and treatment of children with protein-losing enteropathy after Fontan and other CCHD procedures in the current era and in centre with limited human and technical resources, follows with a comprehensive review of protein-losing enteropathy publications, and concludes with suggestions for prevention and treatment. Material and methodology Retrospectively we analyzed patients with CCHD and protein-losing enteropathy in our institution, starting from January 2000 to December 2012. The including criteria were age between two and 17 years, to have a complex congenital heart disease and available complete documentation of cardiac surgery under cardiopulmonary bypass. Results Of all patients we evaluated 18 cases with protein-losing enteropathy, aged 6 to 19 years (mean 14± 9); there were three children who had undergone screening procedure for Dtransposition, one Tetralogy of Fallot, and remaining 14 patients had undergone Fontan procedures; (anatomic diagnosis are: six with tricuspid atresia, seven with d-transposition, double outlet right ventricle and pulmonary atresia and two with hypoplastic left heart syndrome). The diagnosis of protein-losing enteropathy was made at median age of 5.6 years, ranging from 13 months to 15 years. Diagnosis was made using alpha 1-antitrypsin as a gold marker in stool. By physical examination in 14 patients edema was found, in three ascites, and six patients had pleural effusion. Laboratory findings at the time of diagnosis are: abnormal enteric protein loss was documented at the time of diagnosis in all 18 patients. At the time of diagnosis all patients receiving some form of anticoagulation, 17 patients receiving other medication: 17-diuretics and ACE inhibitors, 12 digoxin, 9 antiarrhytmics. Cross-sectional echocardiography was performed for all patients and different abnormalities were registered. In 14 patients also magnetic resonance was performed. Therapeutic approach was based on the non-specific medication (diet, diuretics, digoxin, ACE inhibitors, and anticoagulants), heparin and corticosteroids therapy. Long-term response to this type of therapy was registered in three patients. Nine patients underwent treatment with heparin and corticosteroids and no one experienced long term benefit. Despite of needs for catheter therapy or surgical intervention in our study, in the absent of technical and human resources now any one had underwent those procedures. Six patients has been transferred abroad and in five of them surgical intervention was perform. Conclusion Protein-losing enteropathy remains a devastating complication of Fontan procedure and despite in advantages in surgical and medical therapy there is no evidence that protein-losing enteropathy is less common in the current area.
Background: Fontan procedure is the final stage of a three-stage palliation process in patients born with a univentricular heart as part of Hypoplastic Left Heart Syndrome (HLHS) or other types of Univentricular Heart. As essential as this procedure has proven to be for such cases, the Fontan physiology diminishes the cardiac output and expands systemic venous pressure which leads to venous congestion that can be complicated by Protein Losing Enteropathy (PLE). The aim of this retrospective research was to study the predictors of such complications in all patients who underwent completion of Fontan in our center in the past eight years. It involved the examination of medical records of patients who underwent completion of Fontan repair in our center since the inauguration of its cardiac surgery program. Exclusion criteria included the absence of any of the required predictors in a medical report. Included patients were divided into two groups: those who developed PLE and those who d...
Prevalence and Associated Factors of Protein-Losing Enteropathy After Fontan Surgery
2020
Background: Nowadays, the attention is more set on the complications of the Fontan surgery such as protein-losing enteropathy (PLE). Determining the frequency rate and the contributing factors of the Fontan surgery complications like PLE would confer optimized preventive approaches, reduced rates of adverse effects, and improved prognosis and survival. 17 This cross-sectional study aimed to determine the prevalence and associated factors of PLE in a referral heart center. Methods: The present cross-sectional analysis was performed on 73 patients using history taking, careful clinical examinations, laboratory tests (eg, fecal alpha-1-antitrypsin, complete cell blood count, chemistry, and venous blood gas), and echocardiographic and angiographic evaluations. Results: In our study, the prevalence of PLE was 4 (5.47%) cases. The associated factors were edema, diarrhea, abdominal pain, ascites, and hypoalbuminemia. The echocardiographic and angiographic findings revealed that the left ve...
ESC Heart Failure
Protein-losing enteropathy (PLE) due to leakage of lymph into the gut sometimes occurs in young patients after Fontan palliation but is very rarely reported with other aetiologies of chronic heart failure (HF). PLE leads to severe hypoalbuminemia and immunodeficiency and is associated with poor prognosis. The mechanisms and the predispositions to PLE are poorly understood. Here, we report an adult patient with advanced HF due to non-ischaemic non-dilated hypocontractile cardiomyopathy who developed severe PLE, probably owing to increased ventricular stiffness and constraint by atypically placed epicardial electrode encircling both ventricles. Importantly, both PLE and immunodeficiency completely resolved after heart transplantation.
International Journal of Cardiovascular Sciences, 2021
Fontan circulation was described as the final stage of palliation for congenital heart disease with univentricular physiology. 1 In this circulation, blood from the superior and inferior vena cava is bypassed to the pulmonary circulation, so that the dominant ventricle is responsible for systemic circulation. Since its description, this technique has increased the survival and quality of life of patients with univentricular physiology. 2,3 However, this type of circulation may be associated with significant morbidity. 4 That is because the patient is predisposed to a chronic low output, with increased central venous pressure and congestive heart failure. 5 These conditions can lead to pleural and pericardial effusion, gastrointestinal dysfunction, and proteinlosing enteropathy (PLE). 6 PLE is a severe condition derived from chronic venous hypertension leading to inflammation, tumor necrosis factor release, and consequent changes in the enterocyte membrane's composition. Related complications from this condition are hypoalbuminemia, hypocalcemia, hypogammaglobulinemia, and hypercoagulable states. 6 PLE affects up to 10% of patients after Fontan
Congenital Heart Disease, 2012
This case report describes a toddler who developed a protein-losing enteropathy (PLE) 4 years after orthotopic heart transplantation (OHT). He was born with a hypoplastic left heart syndrome for which he underwent a successful Norwood procedure, a Hemi-Fontan palliation, and a Fontan palliation at 18 months of age. Fifteen months following the Fontan operation, he developed a PLE and Fontan failure requiring OHT. Four years after OHT, he developed a severe tricuspid regurgitation and a PLE. His PLE improved after tricuspid valve replacement. It is now 2 years since his tricuspid valve replacement and he remains clinically free of ascites and peripheral edema with a normal serum albumin level. His prosthetic tricuspid valve is functioning normally.
Protein-Losing Enteropathy after Fontan Operation
Congenital Heart Disease, 2007
Objective. We sought to define what clinical parameters were related to the ultimate outcome in Fontan patients who had developed protein-losing enteropathy (PLE). Background. PLE is a serious complication of the Fontan operation. Several preoperative and perioperative findings are associated with later PLE. However, there is limited information regarding postoperative abnormalities contributing to or influencing outcome in PLE. Methods. We evaluated 44 consecutive Fontan patients with PLE. A matched control group of Fontan patients without PLE was used for comparison (matched-pair analyses). Kaplan-Meier and Cox proportional hazard methods were used for survival analyses. Results. Median age was 18 years (range 4-48 years). Short-axis and apical fractional area change (DFA) were less in PLE patients than in controls (50 vs. 57% [P < .0001] and 49 vs. 54% [P = .01]). Five and 10-year actuarial survival rates for the PLE group were 49 Ϯ 9% and 30 Ϯ 11%. Deceleration time <120 milliseconds (hazard ratio [HR] = 9.2, P = .04), New York Heart Association classification III or IV (HR = 4.0, P = .01), and lower serum albumin (HR = 0.30, P = .04) were independent predictors of mortality in those with PLE. Conclusion. Mild reduction in DFA was the only late echocardiographic finding associated with development of PLE. However, short deceleration time, poor New York Heart Association (NYHA) class, and low serum albumin identify a group of patients at the greatest risk for death. Presence of these findings in a PLE patient should lead to aggressive management strategies and may warrant early consideration of transplantation.
Revista Portuguesa de Cardiologia, 2021
Protein-losing enteropathy is one of the most feared complications of the Fontan circulation. The diagnosis of protein-losing enteropathy in this setting should prompt a thorough investigation for the presence of a treatable hemodynamic impairment. In this report, we describe a complete reversal of protein-losing enteropathy following percutaneous enlargement of a restrictive atrial septal defect in a patient with a fenestrated lateral tunnel Fontan and severe mitral stenosis.
PubMed, 2023
Background: The Fontan procedure is the final stage of a three-stage palliation process in patients born with a univentricular heart as part of hypoplastic left heart syndrome (HLHS) or other pathologies with a univentricular heart. As essential as this procedure has proven to be for such cases, the Fontan physiology diminishes cardiac output and expands systemic venous pressure, which then leads to venous congestion that can be complicated by protein-losing enteropathy (PLE). This retrospective study aimed to identify the predictors of such complications in all patients who underwent completion of the Fontan procedure at our center (Sheikh Khalifa Medical City/SKMC) in the past eight years. Methods: This study examined the medical records of patients who underwent completion of Fontan repair at our center since the inauguration of the cardiac surgery program of SKMC in the United Arab Emirates (UAE) - 01 Jan 2012 to 31 Dec 2020. Exclusion criteria included the absence of any of the undermentioned data in patient files. Patients were divided into two groups: those who developed PLE and those who did not. For each group, the following data were collected: demographics data (current age and age at completion of Fontan), clinical and laboratory data (oxygen saturation, serum albumin), echocardiographic data (classification of original cardiac diagnosis, degree of atrio-ventricular valve regurgitation, ventricular functions), hemodynamic data (mean pressures of superior vena cava and pulmonary arteries before Fontan completion), operative data (type of initial palliation, type of Fontan, presence of fenestrations and its size) and the need for any cardiac intervention prior to Fontan completion, such as atrio-ventricular valve repair, peripheral pulmonary stenting and arch balloon dilatation. Results: Of the 48 included patients,13 (25%) developed PLE. Multivariate regression analysis proved that the best predictors of PLE were superior vena cava mean pressure (P = 0.012) and the degree of atrio-ventricular valve regurgitation (P = 0.013). An oxygen saturation <83% prior to Fontan completion was 92% sensitive in predicting PLE after Fontan completion. Conclusion: This is a single-center study of the predictors of PLE after Fontan procedure and, as expected from similar studies, SVC pressure higher than 11 mmHg and moderate-to-severe atrio-ventricular valve regurgitation were predictors of Fontan failure. The higher prevalence of PLE in our cohort, as well as lower cut-offs of SVC pressure that can predict complications, may be related to the predominance of hypoplastic left heart in the operated patients, which has been the main referral center for cardiac surgeries in UAE in the last decade.